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Wednesday, August 15, 2007

Want Socialized Medicine? Great. I'd Be Dead

I am exaggerating a little. It's very unlikely I would have died. Bankruptcy and permanent physical incapacitation to some degree was much more likely. And all over thirteen dollars.

You see, we do not yet have real socialized medicine. I live in Massachusetts, and am being fined and hounded by the government because I cannot afford paying for all my medical care in advance, plus a huge cushion, which is what non-catastrophic insurance really entails; but I am still allowed to purchase medical care from whoever will sell it to me. It's unlikely that would be the case if it was socialized. Sooner or later, it's always rationing and a diminution of rights and choice to the point of denial of care on a capricious basis. More or less, with all the meddling in the medical market already, we're halfway there.

I have Lyme disease. It's no big deal, really. That is, if you treat it in a timely manner. The effects of it can be very severe and last you your whole life long, if it goes untreated for any length of time. What length of time constitutes "any length of time," you ask? Don't ask that question at Tobey Hospital in Wareham, Mass. You'll suffer until they're good and ready to treat you. They'll insult your intelligence in the interim, repeatedly. And then repeatedly after you find someone elsewhere -- someone competent-- to help you.

I went to the emergency room. I know that people treat the emergency room like their own private nursemaid now, but that's not me. I had a very high fever, intermittently, for over a month, and when it returned again I knew that I was very sick, and if I didn't act immediately, I was in a lot of trouble.

I do not have x-ray vision and a crystal ball. I did not go to the hospital and tell them I had Lyme disease. I looked up all the symptoms I had, and what they might mean, so I could speak with some sort of intelligence about my situation. They were not interested.

The doctor was interested in all sorts of diseases I manifestly did not have. He told me, at 6:00 pm, that he was going to give me a broad spectrum antibiotic in any case, and so I put up with an enormous amount of discomfort and wasteful foolishness because I knew that no matter what version of a bug borne illness I had, the treatment for it all was the same. Immediate treatment with an inexpensive antibiotic.

Six hours later, he wouldn't give it to me. He never did give me any believable reason why he would not. I had an infected bite on my ankle, and he was testing me for Lyme, along with all sorts of other tick borne illnesses. Ipso facto he suspects it. But those tests take a lot of time. He told me to visit an outpatient facility the next day. I assumed he meant that was where I would be given the medicine and could get ongoing outpatient care. I had a very high fever and was exhausted. I surrendered.

I went to where he sent me. Two doctors there said that if the doctor that sent me would not give me any treatment, they would certainly not. One doctor lied right to my face and said antibiotic treatment for Lyme disease without a positive test is always withheld.

If there should be suspicion of disease, then a course of Doxycycline should be immediately given for ten days without waiting serology tests which only yield positive results after an interval of one to two months.
Another doctor from Tobey hospital called me the next day and refused to give me the prescription, and also lied or was incorrect, what difference does it make, and said treatment for suspicion of Lyme disease always waited for the test to come back. Then she wanted to schedule me for a CAT scan of all things. She couldn't tell me for what reason that was necessary.

I called around to anyone I could think to help me. Our neighbor is related to the local Department of Health official, who informed us that over 2500 people in our area were suffering from Lyme disease right now. There are only 4500 people in the town I live in. 2500 people in Southcoast Massachusetts is a lot. The hospital must know this, or be incompetent.

I called everyone that was necessary to conclude my affairs in business, declare bankruptcy, and sell my house and move away, with a phone propped on my pillow. I had to be prepared for it all. I have never been as sick as I was that week. I could no longer stand unaided; could not read properly; my hands shook too much to even hunt and peck type; and I had a roaring sound in my ears. I had only aspirin and water to treat it. The fevers were titanic.

And then a kind man, a real doctor, gave me the only advice that was any good from anyone. He told me I must find a doctor that knew me somehow, anyone, my wife's gynecologist, my son's pediatrician, anybody that would be inclined to listen to me and have pity on me.

My father's doctor. I take my father to a doctor every three months. He called me back at 8 pm that very night from his home, and agreed to see me first thing next day. It was 2 hours in the car, and my wife had to walk me into the building on her arm. The doctor said:

Do not trouble yourself over those other doctors. It can only make you upset, and serves no purpose. I do not know why they would not do for you such a simple thing. I will give you this right now.

I took the first pill, trembling and sweating in the lobby of the Walgreens, the pharmacist wondering silently why that beautiful woman was holding the hand of that wretched looking wraith of a man.

Four hours later the fever was gone for good. I went back to work, feeble and enervated, but no longer sick, the next week. The prescription cost $13.

The hospital called the following week. You have Lyme disease. You really need a prescription for Doxycycline. Terrible things could happen to you if you don't get it. Do you still want your CAT scan?

Save the CAT scan for the people who need it, doctor. Examine the heads of people who want to lose their autonomy, their freedom, maybe their very skins, because they are willing to turn over our lives to arbitrary and foolish people and institutions to avoid a lousy ten dollar co-pay.

How much is a thirteen dollar prescription worth, if it's free but you can't have it?

24 comments:

Joe said...

We "don't" have socialized medicine, yet? Your entry reads like a transcript from a report on any number of countries WITH socialized medicine: Canada, Great Britain, France. God help us.

KarenW said...

If you think that experience was bad try showing up with Lyme Disease and Morgellons symptoms!!! You are LUCKY if you're not immediately placed in a straight jacket pending institutionalization while your children are taken from you and handed over to the state. No kidding, 97% of Morgellons sufferers also have Lyme Disease. In most States you can be sued if you sell your house without disclosing your Morgellons to your buyer and in most states, if not all you can lose your children in a custody battle or to the State just for having Morgellons. I guess they figure you either are dilusional or contagious!

Anonymous said...

Do you have insurance? If so why did you first go to the emergency room for a fever?

SippicanCottage said...

anon- Thanks for reading and commenting. It's a fair question, but...What difference would it make if I have insurance? If someone else pays, I'll go, but if I pay, I won't? That's madness.

I went to the emergency room because I was afraid I might die, or become permanently incapacitated if I waited. It was at night in a small town. I was prepared, as always, to pay for whatever services were rendered. I've been paying for medical care on the nail at that hospital for a dozen years.

The point I'm trying to make is illustrated by your question. The first thing out of everybody's mouth is "do you have insurance?" Insurance never cured anybody. I want to be able to buy competent medical care with my money. I want to buy catastrophic health insurance for my family to back me up if an enormous outlay was needed, but it is illegal in Massachusetts. Mitt Romney signed a mandatory health insurance bill with the proviso that the legislature would allow catastrophic insurance to be sold in the state. He left and two weeks later the legislature reneged.

Who do you think would pay for the insurance, anyway? I would, every penny. And then I'd pay for the doctor bills anyways until the deductibles were met.

I needed 13 dollars worth of medicine. 13 dollars. What does insurance have to do with 13 dollars?

DaveO said...

My two cents: My boy and I had just begun a quiet bike ride when he lost his balance and fell, not violently, and nothing he hadn't done before, but when he got up, he couldn't move his arm. He said it hurt. A lot. It looked dislocated to me, so we loaded him up in the car and took him to the local emergency room, ten miles away.

An x-ray of his arm revealed an ugly, jagged break just above his elbow. They wanted to operate immediately, but two victims of an atrocious road accident had just been brought in so the operating theaters were being used, and besides the surgeons wouldn't be able to operate after they were done. They put my boy in traction for the night and operated on him first thing in the morning.

Two weeks later I brought him back to have the pins pulled out and another cast put on. Two weeks after that they cut the second cast off and he was nearly good as new. He had to work the arm a bit to get it to stretch all the way out again, but otherwise, no problems.

This all took place in Great Britain. No doubt others there have had terrible experiences with the emergency room, but my son was treated quickly and professionally, without any question of how it was going to be paid for, which is why I get my hackles up when GB is trotted out as an example of how socialized medicine is evil.

The medical system is screwed up now. I want it fixed as much as anybody else. If basic emergency room care can be made free to all, so much the better, but I wish to god people would stop pointing out how bad it is in Britain, because I can tell you it's not.

Sorry to hear about your experience, SCC. I sure do hope you're feeling much better now.

Chris Byrne said...

The problem here is twofold. Yes, the doctors know there is a Lyme disease problem; but the AMA politically doesnt want to do anything about it.

See, the onbly way to deal with Lyme disease is by making sure there are less than 8 dear per swuare mile.

Rural Massachusetts, Connecticut, Rhode Island, New York, and New Jersey are all dealing with deer populations two to three times that right now (and as much as 5 times that in some areas), because of excessive restrictions on hunting and firearms ownership.

THe seocnd issue of course is a combination of arrogance and fear on the part of Doctors. Because of course they can, and will, be sued over absolutely everything, and absolutely nothing, they are mostly paranoid. They are also mostly arrogant. The combination often has unpleasant consequences.

Now, there is good news however. Though neither of these problems is easily solved, the tactical problem: the lack of antibiotics; is.

If you ever find yourself in a situation where you know you need antibiotics because of a bacterial infection of some kind (the only reason you actually need anti-biotics. Viral and fungal infections aren't helped by anti-biotics) there is always an easy source at hand.

Go to any fish or pet store, or well stocked pet department, and buy tetracycline. It's safe for human consumption, shelf stable, and inexpensive.

Anonymous said...

I haven't had much better luck with PPO insurance and apparently competent doctors.

I'm not sure exactly why, but doctors don't listen, seem driven to dismiss and diminish whatever you tell them, and don't seem to want to deal with anything that isn't obvious. So if you have high blood pressure or you're bleeding out on the waiting room floor, they'll deal with it. Otherwise they don't seem to want to know.

I don't know if it has anything to do with how they get paid. I doubt it unless the whole behavior is somehow a response to pressures from insurance companies. But I think the problem lies somewhere else.

SippicanCottage said...

Interesting and thoughtful comments.
Thanks Dave, for wishing me well and sharing your story. My point with socialized medicine is not that it magically makes doctors bad. But if you do get bad care, as I manifestly did, there is no alternative. The doctor is only beholden to the government. And in most such schemes, eventually if not immediately, it literally becomes illegal to go to another doctor and try and pay them for your care. It is a colossal robbery of individual autonomy.

By the way everybody, Dave posts pictures of his environs in Madison, WI that can't be beat. Visit it and see at

SippicanCottage said...

Chris- I had no idea about the tetracycline in the pet store. I can't believe pets can get it but I was refused it by four people. It was funny, but I've been deluged by messages from friends and strangers alike, 100% reporting that they were given these prescriptions without hesitation by their physicians. Many never even had any symptoms yet, just the evidence of a tick bite was enough for their doctor to pull the trigger. I feel as though I fell through some sort of looking glass, with the entire population of my bizarro untreated condition consisting entirely of me.

As far as the deer, you're entirely right about that, too. It's borderline comical how many are around. Our yard is entirely overrun with them. They have eaten all the shrubs and flowers. There are more deer in my yard than squirrels. Got Nature?

SippicanCottage said...

Oops. Dave's blog is here:Okonski

SippicanCottage said...

Anon said this:

"I don't know if it has anything to do with how they get paid. I doubt it unless the whole behavior is somehow a response to pressures from insurance companies. But I think the problem lies somewhere else."

That is very interesting. There was quite a bit of press this week about a shortage of regular doctors in Mass. I can testify to that. Good doctors get tired of being pushed and pulled around and they move on, and I suspect some people who would make good doctors never give it a go in the first place now.

Anonymous said...

"I suspect some people who would make good doctors never give it a go in the first place now."

Possibly siphoned off into specialties or research. I did have a better experience with a neurologist, who paid closer attention to my symptoms and asked more and better questions.

Bruce G Charlton said...

Yikes - I step out of the blog for a coupla months and you nearly die!

Anyway, nice to be back. Lots of good stuff on show, as usual.

Anonymous said...

1. Not as a knock on socialized medicine, but daveo's situation was one wehere there is no other treatment than immediate ORIF. Most Western nations do well overall in trauma care. Had the person tweaked a knee they would very likely be sent home with crutches and an immobilizer with follow up with an orthopod. The difference in the systems would be the legth of time waiting for susequent care-not necessarily the quality of that care. It would be a) a PR nightmare to send a kid away with an obviously displaced fracture b) cheaper to fix it right away than have come back to rebreak and realign.

2) I wasn't clear why the broad spectrum antibiotic was such a bad idea. Your description is someone sicker than the typical Lyme patient. Putting wound infection, abcess, sepsis, or even lymphoma on your differential wouldn't be unreasonable (my guess on why they wanted a CT. So without any lab data starting someone looking fairly toxic on a bigger gun antibiotic sounds like a smashing idea to me.

3)tetracycline: be wary-you can be allergic, it is the one that can cause dental abnormalities in the young(deposits in bone). Absolute No-no for pregnant women.

SippicanCottage said...

Hallo Bruce G editor T-
Nice to see you. I have a confession. I read all your medical papers that are linked on line. Then I read your blogposts about cricket.

The medical stuff was very straightforward. I could not understand one word of the cricket discussion. It was like a London Sunday Times Crossword puzzle translated into sanskrit. Impenetrable.

Anon- Good point in #1.

You're doing a good job touching on everything that came up with the rest of your comment. It would be tedious for me to go over the details of all that, but it was all covered. Big blood draws to check sepsis, ruled out before I left, no lymphoma, no abcesses. Since I am more or less complaining about what happened to me, some will infer that I was an uncooperative patient. I am immensely docile and cooperative when I submit to care from a doctor. I believe you have an obligation to submit, within limits, to the directions of those to whom you entrust your care, and I do so. But I was just putting up with most of it because I knew I needed the antibiotic and had to wait to get it.

The doctor who finally treated me properly immediately suspected Lyme disease, realized that all the other things it could be instead were treated the same way anyway, gave doxycycline immediately, and outlined a coherent, appropriate, and results specific course of action if the pills didn't answer. It included hospitalization and IV bombs if the bugs had gone into my brain or heart. Tobey hospital told me to go home and drink tap water and take Advil.

The CAT scan was explained to me that if I had a primary care physician, she would not have ordered it. They said it was because they could not see the center of my chest on the x-rays clearly, and wanted to "get a better look."

They had to take the x-rays twice while I was at the hospital, because the first time "they missed the top of my lungs." I put zero credence in what they needed to see.

Anonymous said...

Thanks for the reply. Sorry for the poor spelling- I was at work, typing at between patients. I'm a bad man.

I didn't mean to imply you're a noncompliant patient, just trying to stick up for my fellow MD's. A good internist should be a divergent thinker, they are trained to come up all the possible diagnoses in their "differential". The problem ,from where I sat, is they were too unwilling to rule something out as flat out stupid or unreasonable until they had concrete evidence. Hence a bunch of tests-which often lead to MORE tests (your CXR ends up a CT) when there is a glitch or unexpected result. I made a poor internist because my differential was only 4 diagnoses long because there was no freakin way it was 5-12 and I wasn't going to dink around ordering tests to rule out the possiblity of African sleeping sickness and hold of treating the obvious. 'Ats why I'm a surgeon. (We bang though an algorithm with a concrete action at the end. Execute the action and move on to the next problem.) Occasionally you'll run into a reasonable doc who will pause to ask 'will this result of the test change my management?' but, sadly, we are in a CYA era in a vain attempt to avoid litigation. So much of medicine is not diagnosing disease but discerning which test to order or specialist to refer to. It can get out of hand quickly.

All that said I am more than a touch surprised that in a Lyme endemic area any hint of a tick bite isn't treat first ask questions later. I'm on your side, you got the run-around.

Ross

Ruth Anne Adams said...

Here's a surefire way to get MDs to listen to you. Add JD after your name.

I think they even put it on my kids' charts.

And, if you're in a pinch, I can be your sister-the-lawyer.

SippicanCottage said...

Ross-Thanks for reading and commenting. This part of your last comment made me smile:

"The problem ,from where I sat, is they were too unwilling to rule something out as flat out stupid or unreasonable until they had concrete evidence."

You wouldn't believe the stupid questions I got asked over and over.

"Are you sure you're not gay?"

I look at my wife in the chair next to me.

Yes, I'm pretty sure I'd remember that sort of thing, Doctor.

Ruth Anne- I'm always in a pinch, it seems.

Pastor_Jeff said...

"Are you sure you're not gay?"

Yes, I'm pretty sure I'd remember that sort of thing, Doctor.



I know going through all this was infuriating, but that last exchange has had me chuckling for several minutes now.

amba said...

Total bullshit. I was treated immediately with no test, just a tick bite and a suggestive symptom (a sudden stiff neck). The doctor told me that too many tests came out false negative and it wasn't worth bothering. That was in the '80s, I don't know if they've improved the tests since then.

Of course, it may have helped that the doctor was 1) our friend, having formed a personal relationship with us when Jacques was under her care for osteomyelitis in 1975, and 2) one of the foremost infectious disease specialists in the country, one of the first people to work on AIDS in New York before it had a name. I believe she invented the heparin lock on J, a way of keeping a vein open without a constant saline drip for people who need long-term IV antibiotics.

That was always our dodge around the medical system: make friends with the docs. It was all about J's personality. And we got very lucky with a few doctors who were glorious people. Enough.

Bruce G Charlton said...

SippicanCottage said...Then I read your blogposts about cricket... I could not understand one word of the cricket discussion.

Cricket is almost, but not quite, as esoteric as baseball. At any rate, a billion Indians seem to understand cricket without much effort - whereas I spent at least a year of reading hard-to-find books and browsing the internet before I could get baseball.

I've since tried to describe what was going-on in an at-bat to English people while watching a ball game on TV... unfortunately the human attention span is too short to enable processing of such a heavy cognitive load.

PatCA said...

Sippican,
I'm so glad you are better. I'll tell you my brother's story. He lived in Illinois, land of the purported Obama Health Care bill. He got very sick, had to quit his job as the ER told him he was just stressed out, and was finally diagnosed as Type II diabetes (I guess the blood test was too expensive), and spent another 2-3 years searching for the IL health care program for the uninsured. He finally gave up and now gets treatment from the pay-what you-can clinic run by the local hospital.

He gets great care in a plan designed by locals. No response yet from the state about their health plan.

SippicanCottage said...

Hi Patca-

Thanks. Always nice to see your name in the Intertunnel.

PatCA said...

Nice to see you, Sipp! I'll be sure to stop by again soon.