A Long Day

Because I have been ill, my blogging has been curtailed.  To give you a sense of what has been going on - I'll describe yesterday.

Phone rang once at 5:20 AM. No one there.
As instructed, I appeared ( accompanied by my spouse) at the University Medical Center at 7:20 AM. Confusion prevailed since the department's computer had me scheduled to show up at 9:30, though someone from the department had called the night before with instructions to show up before 8:00 AM.  Sat and waited.

Called into the pre-op room, changed into hospital garb, climbed into the preop "bed,"  answered a lot of questions the answers to which were pretty much in the electronic medical record, though not entirely accurately in the electronic medical record. Nurse was very thorough and competent. Started on IV.  Waited.  Waited. A Fellow appeared and we discussed the proposed procedure, discussed my history, went through a limited physical exam, and negotiated some issues which were important to me relating to lab tests and operative procedure related events. Faculty member came and we had a sensible and appropriate (more mature) discussion of his plans and recommendations, the proposed procedure and the likelihood that my procedure would be significantly delayed because he had to treat a child and we agreed the child should come first (which was the faculty member's plan anyway). More waiting.  More waiting. Reminded nurse that I needed a simple blood test done and it was done. Told that the procedure was going to start soon.  It didn't, but eventually it did. Brought by a pleasantly chatty nurse to a high technology room containing 5 people and placed on a hard narrow table. IV running (fluids, pain relief and sedation). O2 running. Monitors running. Local anesthesia for a biopsy provided. Biopsy done with little pain or discomfort and lots of instruction for the Fellow who was there learning. Off the table to the wheeled transport. To another room for  recovery and two hours of fitful dozing. Then to another room for final awakening and sitting up. Then to a wheelchair to my car. Then home where I arrived after an almost 11 hour day.  Now the wait for pathology and lab results.

Do You Receive Adequate Quality Health Care?

If you are a young man or woman, and see your doctor infrequently because you know you are in good health, the insurers want you. The young healthy nonuser of health care is what keeps insurers and HMOs not just solvent, but profitable. So there you are, making money for your health care insurer or HMO, going to see your doctor every few years - probably for a bad cold. When you see your doctor, what is the quality of the care you get? Do you know how to assess quality, other than by the time you have to wait to see the doctor and the age of the magazines in the waiting room?

Does anyone check your skin for melanoma? Does anyone check your neck for a thyroid nodule? Does the doctor (or other health care professional) check a young man's testicles for a mass? Does the doctor check the woman's breasts or instruct her on self examination? How about checking lymph nodes? Does the doctor listen to your heart and lungs through three or four layers of fabric because there isn't enough time (or professional interest) to have you take off your garments. Is the doctor (or other health care professional) sufficiently skilled in physical examination to be able to recognize an abnormality or is his or her professional continuing education dictated by the programs which insurers and pharmaceutical companies offer? Or does the doctor or other health care professional ignore the role of history and physical examination and believe that the only way to find disease is by lots of lab tests?

If no one looks, no one finds treatable pathology. If no one finds treatable pathology, the patient will probably change jobs, move to another insurer, and the first insurer or HMO will not be burdened with the costs of diagnosis and treatment. As the insured, you have fulfilled your duty of providing profit for the insurer or HMO and allowed the health care provider to see his or her allotted number of patients.

You may know a lot about football or baseball. In both sports there are rules and umpires. What are the rules governing the care you should be receiving and who is enforcing the rules? If you don't know the rules, you may be the loser.