Health care

If you think access to and quality of medical care in America leave something to be desired — as I occasionally do — you’d better take a look at this. Particularly interesting is the long, long round of reader comments, which suggests this horrifying story is hardly an isolated incident. Makes things here look a lot better, by comparison.

Now, I will say the fact that Britain’s National Health Service apparently isn’t great, even if you have influence (if not money), doesn’t change the fact that care is not always easy to acquire in this country and certainly isn’t affordable for anyone who doesn’t have a full-time job with a good insurance policy.

Over 35 years ago, my mother died under circumstances not unlike those MP Ann Clwyd describes. She was in Arizona’s first HMO, an arrangement that looked like a bargain to my father, who retired before he and my mother reached Medicare age. At that time it was still too early for people to understand exactly what sacrificing a choice of doctors means.

The HMO was set up to provide a financial incentive for doctors to avoid delivering care that was likely to be expensive. As a result, her doctors simply refused to acknowledge anything was wrong with her as she was dying of cancer, a condition obvious to anyone who knew and observed her. We couldn’t get her to another doctor, because my parents were trapped in the HMO, and so as she lay on her deathbed we were told she was a mental case.

After we finally persuaded her quacks to perform exploratory surgery and she was found to be full of inoperable cancer, she was left to rot in a nursing home near Sun City, in the most hideous conditions imaginable. Just to get them to clean her up as she lay in her own stinking fluids, I had to threaten to call a lawyer — literally, only when I told the doctor’s front office staff that my next call would be to my lawyer did he show up and order the listless nurses to change her sheets and clean up the mess.

After that I managed to get her admitted to a better nursing home in Phoenix, but it meant my father had to make a 40-minute drive every day to be with her. He insisted on doing so, because he realized that the only way to see to it that even marginally adequate care was delivered was for him to sit there in her room from dawn until after dark.

The HMO, which was run by Blue Cross/Blue Shield, fought the nursing care every inch of the way. We managed to force them to cover most of the cost because she needed skilled nursing care — heavy-duty, addictive painkillers had to be administered by injection, plus they’d stuck in a tube to drain her abdomen and a tube to drain her urine — and that was the only reason we could get her into a nursing home.

My father was unable to care for her; he was an elderly man who couldn’t lift her, he was in no condition to administer injections, and she would get up in the middle of the night and stagger around, dazed, in the dark, crashing into furniture and injuring herself. They tried to claim she really didn’t need this care, and to prove it one of the HMO doctors ordered the nurses to mash up morphine pills and stuff the slurry down her throat. This wasn’t very successful, because by then she was on the verge of coma. On the day that she died, they were going evict her from the nursing home, because, they said, she really didn’t need any care.

The upshot of all this, for me, was that I was unable to be with my mother in her dying days, because I literally spent all of my time fighting with the medico-insurance bureaucracy. I lost track of how often I uttered the words “would you like talk to my lawyer.” I would go by the nursing home once a day, but there was no way I could sit at her bedside all day, with so much battle to be done.

In my observation, things have not changed much for the better. The guy who sold SDXB his house here in the neighborhood did so because he was dying of a cancer that went undiagnosed by HMO doctors who kept telling him the swelling in his neck was an infection; he knew his wife couldn’t handle the place, and he needed the money to cover the medical bills. Same thing happened to a colleague’s wife: for over three months, her HMO doctors treated her fulminating breast cancer with antibiotics.

Even for those who have managed to avoid HMOs, access to medical care can be iffy, at best. Quality is too often questionable.

Several days ago, I called the Mayo to ask for an appointment with an orthopedist, since the back pain and plantar fascitis haven’t cleared up. The woman I spoke with said she’d ask my internist for a referral and shunted me off the phone. I’ve never heard another word.

I have the name of an orthopedist from Young Dr. Kildare; however, if you let your name slip off the rolls of the Mayo for a year, you get “fired” as a patient. They don’t want to do business with Medicare, and so if you’re on Medicare, you can’t get in at the Mayo. If you were already a patient at the time you went on Medicare, you get grandfathered in (at least, for the time being…that may change), and since the Mayo is best game in town (they saved my life after St. Joseph’s ER ignored me when I showed up with advanced acute appendicitis), it’s in your interest to show up over there once a year. This looked like a good opportunity for the annual visit.

Meanwhile, I needed the name of an ophthalmologist — an MD, not an optometrist — having experienced stabbing pain in an eye. Called YDK’s office: they didn’t have a clue. They referred me to a guy I stopped seeing years ago, after he told  me, incorrectly, that he believed I had a melanoma in one eye. That was after the time he told me he thought I had MS.

I may have MS, indeed. But I do not have eye cancer, something that was elucidated only after two fear-filled weeks of waiting to get in to see an oncologist.

The other day I fell, hit my head on a wooden chair, and walloped my knee. The bruising is healing up, but a sharp pain remains in the knee. So now I have even more reason to see an orthopedist.

Nice thing about falling on the tiles, though: it seems to have jolted something loose in the back, so the back pain is better. Doesn’t look very hopeful, though, that I’ll be able to hike anytime in the near future: probably not in time to get in shape for the day-long hike up Oak Creek scheduled for next April. Certainly not if the kneecap is fractured. Wouldn’t it be useful to know, though?

 

Welp, I dodged out of the physical therapy gig after a week and a day–that would be four sessions. I’ve never been the gymmy type. In fact, it would be fair to say I dislike even visiting a gym, much less messing around in one. My idea of exercise is a mile-long hike up a mountain, a hour of biking, or a spate of yoga. But my foot and back hurt so much, hiking was out of the question. So, I begged a referral from Young Dr. Kildare (who is, it must be said, coming in handy now and again) and went to a sport and physical therapy outfit near my house.

Launching this endeavor just as 89 tons of work were falling on my head did not help the attitude, I’m afraid.

The athletic young(ish) therapist, who seemed to very knowledgeable and was kind and patient, showed me a few stretches that seem to help the plantar fascitis a bit. They were the same things I’d learned off the Internet. Then she taught exercises for the back pain: except for this one, most were basic yoga poses.

I took yoga classes from a certified trainer for 18 months or two years, so I do know how to do those exercises and don’t need to traipse in to a gymnasium for the infirm three times a week to be guided through them. And yes, they do help: many people find a lot of back pain relief from doing a regular yoga routine.

The issue, though, was not that the instruction was so basic. The issue was the usual one that afflicts American medicine: access to care. As a practical matter, it surely is helpful to have the moral support of someone who knows whereof she speaks or even of a group of people who are working toward the same goal: freedom from pain. But that was obviated by the young woman’s workload: at any given time, all day every day, she was trying to deal with three or four people at a time. Even though she had an assistant (a startlingly dumb assistant), about all she could do was tell you what set of exercises to do; then go off and attend to others while you did that routine; then come back and tell you to do another set of exercises.

But you understand: one set of thirty-second hamstring stretches should take you 180 seconds: that’s three minutes. Add another minute or two for resting in between, and you’ve got maybe five minutes to get through those exercises.

Of course, each person she had to coach required more than three minutes. She would be doing well to finish with one person in eight or ten minutes, and some people who were in really bad shape deserved a great deal more time than that.

All told, she had me doing about 10, maybe at the outside 15 minutes of exercises, plus 10 minutes on a very poky, very easy stationary bike. That’s 20 or 25 minutes of work.

On Monday I was there from 9:30 to 11:15: an hour and forty-five minutes to do 20 minutes of exercises! Exercises that I already know how to do. For me it was an incredible waste of time, when I had no time to waste. And I felt that I was absorbing time of hers that would be better used working with other people. The old guy who’d had knee replacements in both legs and was suffering serious pain obviously needed her attention in ways that I did not.

Back here at the Funny Farm, one set of basic yoga exercises, which includes more stretches than she had time to demonstrate, takes about 40 minutes; add the plantar fasciitis stretches, and you’re at 43 minutes. I quickly found that a round of mild yoga (and getting rid of the bone-crushing office chair…) left the back feeling a lot better.

The foot still hurts a lot, though it’s better than it was. If it’s ever going to get better, presumably it will require tincture of time in large doses.

But in the time department, my gawd! Adding two hours for that to the already wacky schedule just about drove me over the edge. Monday it was out the door at quarter to seven, teach a class for an hour and a half, cope with some bureaucracy; race back to town, change clothes, race to the therapist’s; race home, change clothes again, fly to Scottsdale; schmooze for an hour and a half at a Chamber meeting; traipse all the way back into town again; stop by the grocer on the way home; throw off the “professional” rags, plop down in front of the computer, work till 10 or 11 p.m. trying to catch up with all the work I’m missing while I’m batting around the city all day.

Two established clients resurfaced this week with new projects. As fast as I clear the work off the desk, new work materializes—a good eight or ten hours a day of it, all told. Monday I spent seven or eight hours in meetings, class, therapy, and interminable driving. Add it up, and you get a sixteen-hour work day.

So. Any (16-hour) day, I’d rather do 40  minutes of yoga and hamstring exercises on the living-room floor than spend an hour and 45 minutes sitting around a physical therapy gym.

 

Have you seen this amazing story in the Times? In short, it reports on the custom of drugging kids who have no attention deficits or psychological disorders in order to make them sit still in class. Says one doctor who advocates this practice: “I don’t have a whole lot of choice. . . . We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

We already know that rich kids dope themselves with stimulants to enhance already perfectly fine grade averages, so as to up their chances of getting into elite universities. Now, though, as if that weren’t stupid enough, we’re talking about drugging all the rest of the kiddies…why? So they can get into the local community college? Or more to the point, so they’ll sit down and shut up while their teachers try fruitlessly to wrangle “classes” of thirty or more grade-school children?

As a culture, we now drug our citizens from nativity to senility.

What do you take at this point in your life? Dollars to donuts, you’re on something. It’s not surprising: 90 percent of Americans take drugs for one or more ailments, most of them described as “chronic.”

If you’re not swallowing pills every day, you’re an odd duck. I speak from experience. Because of a familial tendency to stay away from doctors unless I’m sick or hurt, I’m not on any medication. And every time I go into a new doctor or dentist’s office or talk to a new insurance agent, where they make me fill out a two-page checklist confessing to any of scores of diagnoses and then list the prescription drugs and OTC nostrums I’m supposedly gulping down, the staff invariably expresses astonishment.

“You’re not taking anything?”

“Uh…no.”

“That’s amazing!”

I’m sure.

Yesterday an insurance agent called to try to talk me into changing my Medicare supplemental carrier. She said I would have to undergo low-level underwriting, since, after your first enrollment period, Medicare supplement insurers do not have to accept Medicare recipients willy-nilly. She explained, as if to a child, that I would be asked to answer several questions about my health problems. What were they, by the way?

“None.”

“None? You don’t take any medications for anything?”

“No.”

“You don’t have diabetes?” (Flabbergasted tone.)

“Well, no.”

Jayzus.

This kind of thing started when I was about 40. At first, no one could believe I wasn’t on hormone replacement therapy. Being a skeptic, I willfully refused, despite my gynecologist’s assurance that if I would just take these nifty little estrogen pills I would be protected against cardiac disease for the rest of my life, I would be able to screw anything that wore pants until I toppled over into the grave, and my face would never get wrinkles.

No joke. He bought the HRT salesman’s pitch, hook, line, and proverbial sinker.

Soon no one could believe I wasn’t on beta blockers, Drano in a pill (that would be the stuff they foist on you to prevent osteoporosis, which of course you’re going to get because you’re a postmenopausal woman), antidepressants, cholesterol meds, blood pressure meds, megavitamin supplements, estrogen, calcium supplements, vitamin D supplements, or any of the myriad woo-woo herbal snake oil concoctions that grace every grocery store and drugstore’s shelves.

Do you realize that Benadryl is routinely used to sedate and “calm” elderly residents of care and nursing homes? I take it myself, on evenings I think I’d like to sleep past 3:00 a.m., when the internal alarm clock goes off. It knocks you out quickly and effectively. But the stuff isn’t used in care homes to help people sleep; it’s used to keep the inmates under control, because when you’re not sleeping after you’ve dropped one of those nifty little pink tablets, you’re in a haze. And it has a particularly dire side effect for the elderly: it can cause cognitive dysfunction (we of an earlier generation call that “senile dementia”) or aggravate it if the person already suffers underlying dysfunction.

It’s used on old people who don’t need it for the same reason Adderall and the like are used on kids who don’t need it: to make them compliant within an institutional setting.

And why is any of that stuff used routinely? To enrich pharmaceutical companies, by and large.

Particularly telling, I think, is the cost of prescription meds in this, the most overmedicated country of a medicated world: U.S. residents pay six times what Canadians pay for the same drugs, and many times more than that for the same drugs sold in in other countries. Big Pharma has a vested interest in seeing to it that every one of us gulps down as many pills as possible. All the time. And Big Pharma has deep enough pockets to make that happen.

I suspect that about 90 percent of the drugs we’re all expected to take—to get on at a certain age and stay on for the rest of our lives—yes, about 90 percent of it is unnecessary. Some of these chemicals no doubt are not even very good for us—witness the late, great miracle of HRT. We have got to be the most overmedicated population in the history of humanity!

Do they keep us alive longer?

I’ll bet not. Not unless you have a truly life-threatening disease such as diabetes or cancer, one that can be treated successfully with long-term pharmaceutical therapy.

My great-aunt and great-grandmother were Christian Scientists, a little wacky in the head about what God would and would not elect to do. Their peculiar religious beliefs led them to abjure doctors and medications—not such a strange idea for a couple of women who grew up in the late 19th century, when the practice of medicine was akin to the practice of voodoo. Neither of them ever took a medication in her life. And they each lived to their mid-90s. Great-Granma hosted a dinner party for a dozen people, scrubbed the kitchen floor at midnight, and then went to bed and died in her sleep. Great-Auntie died a few days after returning from a trip to Hawai’i.

My father, who smoked and drank and had what people in our time would regard as a pretty hard life, lived to 85, as did both of his brothers. They did not take pills. My father’s idea of medication was a dram of Scotch. His brother Ed did not smoke, did not drink, and had a quiet enough life with a quiet enough wife in a quiet enough Dallas suburb. His brother Charles smoked and drank and had what people in our time would regard as a damn hard life. They all lived to exactly the same ripe old age, kicking vigorously right up to the end.

If you needed to take drugs to stay well and alive, then my father, my uncles, my aunt, and my great-grandmother should have croaked over at about 50, no?

It’s a brave new world, my friends, a brave and dystopic one where all of us think we need to gulp down pills to make it through our days to the end of our God-given lives.

If there is a God, may She help us all.

Image: Ritalin. Sponge. GNU Free Documentation License.