A Longing for Yesterday’s Medicine

 

Did you ever long for the old days when the family doctor or general practitioner could diagnose the cause of your headache; your stomach ache; your side ache or your chest pain?

Those were the days before the medical specialists so populated the landscape-the days before the coming of the hematologists; the radiologists; the cardiologists; the rheumatologists; the gastroenterologists; the urologists or the endocrinologists.  They were here but in very limited quantities.  That was the time before greed ushered in specialized medicine.  It may also have been the time before the cost of higher education “went through the roof”.  After the cost of education went off the charts the medical profession wanted to be able to pay off the loans made to obtain that expensive education; wanted to drive that fancy sports car to their place of practice and also wanted to afford the high cost of education for their children.  There is nothing at all wrong with this desire except the requirements to bilk and deny the patients the quality of care that was once “SOP”.  When the specialist came in, time restraints came in with them because they began to see the benefits of cramming as many appointments into their day as possible and cutting the time spent on each in order to fulfill their patient quota for a given day.  By the time the specialist arrived in numbers, the landscape had become savvy enough to project an annual income based on the volume of patients seen and the procedures administered.  That way they could reasonably predict an amount of income available to buy those fancy toys and props.  There is no doubt that the educational institutions aided in igniting this greed psychology because they became a part of it.  After the cost of education went “off the charts”, the medical profession also wanted a larger slice of the economic pie.  Education became a for-profit business and medicine became a business that began to put money before healing human frailties-seeking even larger returns for their efforts.  The Hippocratic Oath became nothing much more than vain babblings.  The medical profession has virtually reached a point whereby if you can’t afford the cost of the treatment you can virtually be sent away to die.  Yesterday’s family doctor (general practitioner) was replaced with today’s specialists and the family doctors of today are using nurse practitioners to do their work.  These who are usually RNs do the things the doctor once did.  The cost is the same or more than what you would have paid to see the doctor but often you only see his nursing assistant.  The few family doctors who are still general practitioners may still be such because they could not afford the cost of the specialized medicine education or may not have been academically up to the task of acquiring the advanced education.  Never-the-less they can still get a slice of the pie because referring patients to a specialist gets them a small slice.  It seems that everyone is on the receiving line.  Pharmacist pay doctors for writing prescriptions for their drugs and specialist pay doctors for sending them patients.  “One hand seems to wash the other”.  So it’s not a total loss to be less than a specialist.  The role of education was pivotal in reshaping the notion of greed.  In the culture of yesterday institutions of higher learning that were responsible for educating doctors and others were content in collecting just enough tuition to offset the cost of educating the student-giving due consideration to instruction as well as plant and maintenance.  In today’s society institutions of higher learning are focused on creating endowment funds in the hundreds of millions-and beyond-and spinning the behavior as set asides for educating future generations.  The future education for children is now.  None except God knows what the needs of the future will be or what the future may look like for the world (in general) or America (in particular).  It seems that the way some nations are headed, there may not be a future (the likes of what we expect).  Denying a child an education (including one as a medical specialist) in an institution of higher learning because of the high cost of education  is akin to robbing America of needed skills and training.  This is also embodied in the culture of greed.

In the days prior to the modern forms of communication and transportation-and prior to specialized medicine, when a citizen fell ill someone got on a horse and rode with all deliberate speed to summon the nearest general practitioner.  That little country doctor (as he was often known to be) responded with like deliberate speed to come to the bedside of the individual who had fallen ill.  This was done without regard for (in most cases) weather conditions; social status or any other prior obligation-the patient truly came first.  In today’s society you can have an emergency medical situation, pick up a phone and be connected (in seconds) to the doctor’s phone, which is usually an answering device.  The doctors seem no longer willing to hire secretaries and the nurse assistant is playing the role of the doctor.  When the doctor’s phone picks up you usually get a series of prompts (that can range in number from 3-9) before you get an opportunity to leave a message-forget about getting a live voice on the other end-that’s a thing of the past.  The first instruction of the prompt tells you to hang up and “dial 911 if this is a medical emergency”.  After that and after listening to the series of other phone prompts, you may be allowed to leave a message for a nursing assistant to call you back when it is convenient.  In other words go to a hospital emergency room-the doctor isn’t available.  Sometimes it become hours in the time going forward before you get the call back.

In April my wife had what was considered a medical emergency.  We are now well into June and since April she has not seen or been able to see that specialist.  During the emergency her regular attending specialist for that condition referred her and scheduled an appointment for her to see his co-specialist.  She ended up not even seeing him because he was in the operating room.  We saw his nursing assistant that told us the doctor would come shortly-he never came.  We got up and walked out.  He was also too busy-he was a specialist.  Mind you; it wasn’t about money or health insurance coverage.  We have some of the best insurance coverage available.  In the meantime the original doctor’s office billed my wife’s insurance company $480.00 an hour to speak for less than 15-minutes to his nursing assistant.  Is that importance or what?  The insurance carrier paid the doctor’s office $120.00 for the less than 15-minute conversation.  That’s specialized medicine-that’s greed.  Don’t you long for yesterday’s medicine?

New Kids on the Block

We may not be able to deal with the “new kids on the block”-knee replacements; hip replacements; kidney replacements; liver transplants; heart transplants and bone marrow transplants.  I don’t know any adult personally (and there may be others I don’t know) who have benefitted from any of the above procedures.  I have seen close friends; acquaintances and others die-even after having undergone some of the above procedures.  We can think about the possibility that using any of the above procedures may not add anything to better medical intervention-only add to more fees for the specialist.  Among the new kids on the block are the new basics of medical care-blood pressure check and blood work.  As soon as you enter a specialist’s office for a routine visit relating to matters that usually have no connection to your pressure, you are given a blood pressure check.  The blood pressure reading may not impact your other condition for the good or the bad.  What’s more the specialist would probably not be able to address an “off” blood pressure reading anyway due to his specialization in another unrelated area.  However, the “BP” check can add as much as $250.00 to the specialist’s bill and the insurance will pay it.  One time my wife went to emergency for nose bleed which she gets from time to time.  After they found she had good insurance coverage and along with my concern that she be adjudged stable before sending her away, they performed all types of unnecessary procedures; kept her for two days and billed her insurance for almost $30,000.  Everyone got a piece of the action-hospital, doctors and specialists.

If you end up in emergency, another routine is the blood work.  Another time my wife went to an emergency for nose bleed and was bleeding profusely.  The nurse routinely emerged with about seven vials to draw blood.  Draw blood; my wife was losing blood at a rapid rate and they wanted to compound the issue because of a profit incentive?  The nurse became irritated because I told her my wife didn’t need blood work.  The basis of her condition had already been established by a recognized hematologist.  This blood work procedure is in addition to the “BP” check.  The blood drawn and a routine analysis of the blood drawn can add as much as $750.00 to the insurance bill.  Not even in one instance did they find any change in my wife’s blood factor.  What I’m relating in these lines concerning treatment is from personal knowledge and experience.  It’s all related to greed and the high cost of medicine.  Many of the recent and not-so-recent medical procedures do little more than grant a few of us a few more days on this side of life.  I fully recognize one’s desire to live-it’s personal and honorable.  However, in many instances specialists just don’t have the key to keep that door open-only God does.  In many instances of our medical conditions if God doesn’t wring a miracle it won’t happen.  Specialist can only make money-they can’t make life.  One of my family members was dying and in his last two days of hospital treatment his wife said the insurance was billed over $68,000.00.  Another spouse of a church sister was given no more than 6-months to live.  He died in less than two weeks.  However, they administered another costly medical procedure to get him at least to that 6-month mark and maybe beyond.  Did they know before the procedure he wouldn’t reach that point?  I recently ran into a brother in the supermarket who was riding about in a motorized scooter.  He still couldn’t walk normally after having been given two hip replacements.  Another sister died recently from kidney failure.  I was told she had received a kidney from her son.  How much closer to a suitable match can you get that that?  I don’t know for certain but I believe the specialist told her it would work.  Was it misjudgment or was it about money?  Replacing a kidney is expensive medicine; so are heart transplants; knee replacements; hip replacements and radical mastectomies.  How well do they work and how many lives do they save?  Could it be more about money than effective medicine?  All of the above procedures have a home in specialized medicine-that’s where the money is.  I’ll always admire the courage of my mother and cherish her memory.  She died of breast cancer in 1970 and said if she had to die she wanted to die with all of her limbs.  My gut feeling tells me breast removal wouldn’t have saved her life.  If I encounter a similar life-threatening condition, I would like to make a similar choice as my mother did.  Specialized medicine may not cure a condition but it will certainly enrich a specialist.  Do you long for yesterday’s medicine when (although you may not have been cured) you got more bang for your buck and you got honest assessment and advice-it wasn’t about the money.

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