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How Much Do You Use the Health Care System?

Posted Aug 26 2009 10:46pm

EDITORIAL NOTE:The monthly Gay and Gray column, which is written by Jan Adams, who also blogs at Happening Here, is on hiatus this month. It will return toward the end of September.

category_bug_journal2.gif One of President Obama's health care reform goals is to reduce waste and unnecessary spending.

Due to the high number of medical-related lawsuits in the U.S. and the consequent high price of malpractice insurance, physicians often order many more tests than are needed. That increases everyone's insurance premiums. If you've ever spent time in a hospital, you have probably seen such charges as a $10 aspirin. Private insurers' administration costs are sky high and although that's not true for Medicare, fraud sucks billions of dollars a year from that system.

Those are just a few of ways unnecessary costs pile up. But patients can be at fault too.

Before I go any further with this, you should know that I am biased in living as close to a physician-free life as I can get away with. I suspect I just don't want to ever be told that I have a frightful disease and if I don't see a doctor, that can't happen. I know, not too bright, but there you are.

I also believe, deeply so, that my body ought to toot along with minimal disruption until it wears out and I die. I sometimes get stupidly extreme about this belief.

Ten or 15 years ago, roundish rough spots began appearing here and there on my body. Some were the color of my skin and some were dark brown. If there had been one on the end of my nose, I suppose I would have consulted a doctor, but none were and I just thought of them as barnacles.

When I became eligible for Medicare three-and-a-half years ago, it was required that I name a primary care physician. Not being entirely an idiot about medical care, I thought it was also a good idea at my age to have a doctor who had a bit of experience with me and whatever ails me, so I engaged one soon after I moved to Portland, Maine.

During my initial examination, he noticed those brown and skin-colored eruptions and asked if I wanted them removed. Although I can't remember what he called them (I prefer barnacle), they are not dangerous, he told me, they are never cancer. But that red spot on the back of one leg was probably cancer, he said. A biopsy proved him correct, a basal cell carcinoma. It was removed and there have been no recurrences.

A friend or two who know that everyone in my family has died of one kind of cancer or another, suggest that I am being monumentally stupid not to see a doctor more frequently and they undoubtedly have a point. But I still don't see how going to the doctor more than what is minimally required is going to do anything except make me nervous about about what I might be told.

Certainly that medical mindset affects my attitude, but it seems to me too many people spend way too much time in doctors' offices adding unnecessarily to the nation's astronomical health care costs - double per person what other countries spend. I've known a few hypochondriacs over the years, and I was married to one. They can drive you nuts. Not one I've known who went rushing off the to a doctor for every pimple was ever diagnosed with anything.

It is estimated that 30 percent of babies in the U.S. are delivered by Caesarian section. That cannot possibly be medically necessary. Doctors have been prescribing antibiotics for decades for viral infections, for which they are useless, often because patients demand them. MRIs are routinely ordered for back pain when most back pain disappears on its own within about six weeks.

I'm not saying there are not people who need a lot of medical attention to control chronic conditions and diseases. That is reasonable use. But between overuse by doctors themselves and demands of some patients, billions of dollars are being wasted every year.

Dr. Kay Schwebke, medical director of the Hennepin County Medical Center Coinfection Clinic in Minneapolis, believes that because doctors are forced to see more patients than they reasonably can, health care suffers for it. She had this to say recently at MPR News:

“Although I have no data to prove it, personal experience has convinced me that when we spend less time with patients we are more likely to order tests and medications.

“During medical training we are taught that 90 percent of the diagnosis comes from a good history, asking the patient questions before diving into action. When we fail to obtain a comprehensive history, we resort to something we can do quickly - prescribing a medication or ordering a test.

“Meanwhile, we have created a cultural expectation that more is better. And if something is new and expensive, it must be great.”

Now I wouldn't argue against the fact that I am extreme case of medical underuse which may be to my detriment in the future. When a doctor wants tests, I ask for the rationale and when I don't feel they are necessary I refuse.

In the past, my reason for avoiding doctor's offices was my personal dislike of all medical procedures, even simple ones. But having read so much now during our summer of health care reform debate, I've come to believe that if health care is to be made affordable for all, we must each do our part to use that care responsibly. That doesn't mean curtailing necessary medical attention and treatment, but we should ask ourselves if all of what we use is really necessary.

How much of the health care system do you use?

At The Elder Storytelling Place today, Johna Ferguson: Apocalypse?

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