THE TGB ELDER GEEK: You and Your Files – Part 1
REFLECTIONS: Edward M. Kennedy

How Much Do You Use the Health Care System?

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?


Comments

I use the system as little as possible, but then I know it's there and will take care of me, should something awful strike. It was the case five years ago when I had breast cancer. I did run into some expense at one point because I wanted to have surgery as soon as possible and that was in the middle of sacro-sanct (in France) summer vacation. Still, the health system was there for me, even as imperfect as it is, and knowing that it is there is reassuring

Pap test and mammogram once a year. Nothing wrong with me, no medication, don't enjoy listening to people talk about their aches and pains, because I think it could jinx me. I go to the dentist 2x a year, no problems there either. Guess I have mom's good genes.

Ronni,
I can't get over how much your story and mind are alike. (as well of many,many others) I didn't go to doctors until I was on Medicare,by then was disabled by RA and OA.People would fuss at me to go, but with no money did not do it. (New hubby wanted me to go, but I would not let him spend that huge sum of money) In our area more and more doctors are not seeing NEW Medicare patients.

I go only when necessary, mostly now for cortisone shots.

I am one with you also Ronni. Mammogram once a year, colonoscopy every 5 years; yadayada.

That said, I am thrilled I have health insurance to pay for doctor visits and medications that keep me healthy.

And, with the success of our health reform blog led by you last week, we should all keep this in the forefront of our blogs. Especially with the loss of Senator Kennedy. I fear Senator Baucus who is leading the charge to defeat the public option of health care coverage, and who took almost $3 million from health insurance companies, will overtake and defeat public health insurance.

Then, I could not get medicines or see a doctor, even once a year.

I think there must be many people our age, Ronni, who don't run to the doctor with every ache and pain and insist on tests and meds. In fact, I refuse medication unless it is absolutely necessary. If we take reasonable care of ourselves (good nutrition and exercise) we can usually avoid a lot of doctor visits. We have somehow become a nation that believes that every "twinge" requires attention. I think we would be astonished at the amount of OTC pain meds that are consumed in this country, as well as the amount of prescribed pain meds.
Ah, well, there are a lot of things about our system that are broken, and one hardly knows where to focus our attention - we really need major change, but I think we're not going to get it.

I love you for writing this Ronni - it pretty much sums up my and my parents' attitude to medical care. If it ain't broke, don't fix it! I look at my brother & how he & his wife take their kids to the doctor for every conceivable reason (or non-reason!) and I just despair. They are going to grow up thinking of themselves as ill, rather than in the belief that, as you say, their bodies should keep on ticking over until they wear out and die.

I have always hated doctors (despite my dad being a radiologist!!) and luckily for me my parents never took us to the doctor unless we were on the verge of needing hospitalisation. I also understand that I am lucky in that I am very healthy (great genes) and I try to take the best care of myself that I can.

Here in the UK where we already have a public health system in place, rather than overprescribing, doctors have gone too far the other way. When my husband (who similarly avoids the doctor like the plague) went to the doctor to ask for antibiotics for a low-level respiratory infection that had bugged him for weeks and would nto go away, the doctor spent less than 5 minutes examining him or reading up on his file (which is available on-screen in our practice), refused him antibiotics and told him to gargle salt water. Unsurprisingly, the infection did not get better and 2 weeks later he woke up with the side of neck so swollen he could not turn it. One trip to the hospital, one throat swab, one needle biopsy, one scope up his nose and one MR scan later (to rule out a tumour), they confirmed that the throat infection had gone untreated for so long that his lymph node was now infected (lymphadenitis) and he immediately needed... antibiotics. Oh, and because he was so run down by then, he also developed shingles.

Why is it so hard for doctors to just sit down and LISTEN to patients??

Yes, very similar story with me, Ronni. Bits hacked off over 20 years which were basal cell carcinomas. High BP diagnosis 2 years ago and only for fear of a stroke did I agree to medication. Nothing other than that and reluctant to have other investigatory procedures for anything. Much prefer complementary therapies like acupuncture or homeopathy for niggly arthritic pains. Fresh fruit, veg, fish and nuts plus gardening exercise seem to work.

I am blessed with decent health. I used to see a doc every 3 mos - but recently "graduated" to every 4 mos., for blood work associated with some BP meds I take, as well as statins. They have to keep track of certain levels. I have not seen a specialist since my last colonoscopy (6 yrs.). I get a mammogram every year and a Pap smear too. I have a lot of those brown spots (keratoses) and I'd love them removed, but a dermatologist said if you remove one, two come to the funeral.

Timely...I have an appointment with the doctor today. Until I retired, I didn't have a family physician and it had worked well that way for about 30 years. Back in the 70's I had seen collusion between doctors and hospitals to drive up costs and I wasn't thrilled with doctors in general so I avoided them and that worked. Until I began to wear out. It's what happens to us all. Now I have had three surgeries in the past two years...each quite necessary. I certainly don't enjoy wearing out as it's quite painful and takes a lot of enjoyment out of life. But...I do have Medicare and that has saved us from financial ruin. That's serious stuff we're talking about! And that's why we need serious discussion about health care and not a one way dialog by right wing ranters. OK, I got off subject a little.

My attitude and that of my parents matches yours. I go in very seldom but do try to stay aware of my body's differences. I do the yearly mammogram and a physical every couple of years but I find it mostly a waste of time as physicals really are best at blood work but otherwise people have had them to die a week later. I hadn't seen a doctor for several years when I had to have some stitches where I cut myself badly and then I asked do I need to come back in to have them removed and when he said no, I took care of them at home.

I agree with your sentiments entirely. Mom and I call it 'medical minimalism.' Mom has to see her doctors routinely because she does have long standing conditions that require monitoring and long term medication. She has a sinus condition that doctors have urged her to medicate but she learned a long time ago that the medicines they want to prescribe don't work for her and has refused them. I will never forget the look on one doctor's face when he tried to give me a sample decongestant and I refused it. I was at the tail-end of an infection that would have been gone in a couple of days anyway with out the medication. However, I would like to be able to see a doctor when I need to and not have to wonder if I will be able to pay the rent or utilities if I do. Since I don't have health insurance and have to pay out of pocket that becomes a serious question. I have had only one job that offered health insurance but I was part time and could not afford my part of the premiums. Every other job I had did not even offer it. A public option is the only solution that will provide me with the health care so many of those self-righteous right wing ranters (as Steven calls them) take for granted.

I live in Canada and I recently spent some time visiting (socially) with a couple of doctors; they had a couple of things to say that they thought would reduce some of the problems we have here with healthcare (our system is great but not perfect, like anything else). One was that a small fee, or deductible, on a doctor's office visit would go a long way to reducing frivolous visits. I tend to avoid the doctor's if I can help it, but apparently they get an amazing number of appointments with people who really don't need it. They also said it's hard to resist the pressure to order unnecessary tests, and a bit of a judgment call as to what is unnecessary and what is not.

My approach too, Ronni. I think doctors' waiting rooms are good places to pick up something so I avoid them as much as possible.
I eat well, exercise (ok Not as much as I could) and do the things I enjoy.
Did hear good advice from a doctor on the radio; go out the door, walk for ten minutes, return home. No need for gym or equipment.

Ronni, my husband and I avoid doctors, too.

Part of this is a consequence of moving around a lot, plus no primary care doctors in our area take Medicare patients...so this philosophy may be a necessity rather than a virtue. I "have insurance" but as every intelligent person knows, none of us will have it long if we have the effrontery to actually get sick under the current "system."

Overall, I am much more afraid of being tortured to death by the medical system than I am of keeling over with a heart attack.

It's a shame, in a way, because I think there's a lot doctors could do (if they would) to improve seniors' lives. But it doesn't pay them to do it, or it's not their specialty, or whatever insurance we have is never the right kind, or something.

There is so much wrong with the scale of the current "system" that I despair of ever getting real help when I get into bad trouble, even the simple kind.

Well, I think a lot of it is just that if the doctor orders a test, people feel there must be a need so they do it.

I'm the one who gets in trouble because I very rarely do the mammograms (no history of breast cancer, no lumps, so I go only every few years) and the bone density tests (I work out with weights and have plenty of estrogen with THESE hips), etc.... I only get what I think I need done, but...

I do recommend people get those colonoscopies, since I've had a run-in with HPV and colon cancer. Kills way more people than breast cancer. Not fun, but it can save your life.

And always good to get a long-term personal relationship with your doctor, so they KNOW you. That really helps.

That doesn't mean skipping the basics. Every year go in once. Have your mammogram, pap every 2 years, BP checked, Blood sugar.......and once now have a bone density done.

Why: I did it your way and had a stroke.

I am a believer in checking my own blood pressure and have an at home tool that helps me be sure that it's normal. I do that partly because whenever I go into the doctor I used to get what they call white coat syndrome. It made it look bad but by testing regularly at home I know it's okay. I also switched to aspirin from ibuprofen which lowered my bp about 10 points. I thought maybe it was something else, tried ibuprofen again and up it went. By using aspirin, it stays nicely normal and actually wasn't as high when I went in from the stitches as it used to be.

In my opinion
deliberately staying away from medical care is foolish, especially as we age. I have always enjoyed excellent health except for several bouts of pneumonia and a tendency to severe bronchitis at times for which I got medicines and treatment.

After age 70 I have had more medical problems, none of which fall into the frivolous category.

Temporal arteritis at age 70, (I would have gone blind without diagnosis and treatment) parathyroid surgery ( without which the leaching calcium from my bones would have resulted in fractures,)knee meniscus arthroscopy for torn meniscus) I would not have had this procedure as it did not help)

Earlier in my 60's I had Glaucoma surgery without which I would have lost my eyesight. The eye pressure was controlled with prescription drops for many years until they no longer worked.

My husband has Macular degeneration which the eye doctor retina specialist) diagnosed and saved his eyesight with a brand new injectable drug called Lucentis. A godsend.
He also has had many basal and some aquamous skin cancers removed. One near his eye that required plastic surgery. He must see a cancer specialist dermatologist on a regular basis.

Yes, when we are in our 50's and 60's we can many times avoid the medical profession but at times they are lifesavers.

The first 45 years of my life I hardly saw a doctor and except for a hysterectomy and 3 babies I was never in a hospital. To this day I have only been to an emergency room once due to a fall.

Without drugs for high blood pressure I might have already have had the type of stroke that killed my father at age 65.

Preventive medicine, like preventive dentistry, and good self care in the long run is well worth the time and expense.

I will be a healthy 80 years old in December. I am thankful for these extra years of reasonably good health during which I have watched my grandchildren ranging from 9 to 21 grow and flourish.

My husband of almost 58 years is in good shape and he works out at least 3 days a week. We both try to eat right and stay healthy but we are not foolish enough to ignore symptoms that seem serious to us.

I seem to be in the minority here, but, since my early 30s, I've gotten a complete physical every year as well as periodic mammographies and dexa scans. I have been fortunate to have health insurance through my various jobs and primary care physicians who make a point of getting to know and treat me as a whole person, not just occasional symptoms. Last January, when I moved to where I live now, the first thing I did was find a primary care doctor who also treats the whole person and takes the time to listen. I like knowing that there's a long-term record of my health issues so that if anything major pops up, there is data to put it all into context before prescribing treatment.

Medicine is often as much an art as a science. When it comes to treatment, I would rather the "science" part have as much information about the condition of my health over the years as possible.

If I get symptoms that don't go away in a week, I get myself checked out. I don't believe in feeling ill if I have the option not to.

I have always figured that if my doctor can catch any developing illness or problem early on, I can take care of it before it gets worse and more expensive to treat.

My father, who died of pancreatic cancer at age 73, had various symptoms for along while (perhaps years) but didn't go to see a doctor until it was too late.

I'm with Elaine. Living in a very small town, I've had the same doctor for 30 years and it's a godsend. Baseline mammogram showed microcalcifications but the mastectomy has kept me safe since '85. Hubby has severe disc problems as well as sinus conditions, despite an athletic lifetime when he was younger. I'm now treated for a chronic mental challenge as well, and bless the doctors and their sensitive referrals. Get those checkups and follow sensible advice--that's my advice!

I e-mail my Group Health doctors as often as I have any question about my health. That way I keep on top of everything that is going on.

I question anything that I don't understand or think is not in my best interests.

I reckon at 62 I know my body better than any doctor, even one who has treated me for years. I go and see her when the need arises but don't at this stage feel the need for regular checkups.

So far that has worked fine - I had some blood tests a month or so ago, because of general tiredness and lack of energy and my cholesterol levels are 'disgustingly low'. We agreed was tired because basically sometimes you have more energy than others - it doesn't mean there is a problem.

Oh - and just to make sure the point is made, I'm in the UK and over 60 so none of this cost me a penny in co-payments or any other sort of charge.

I think everyone needs to accept the responsibility of fully educating themselves on health issues through all stages of life to death. We also need to pay attention to and "listen" to our bodies -- know ourselves well so we can recognize when something is out of kilter, then monitor ourselves (without being a hypochondriac about it which is possible.)

I strongly believe in preventative care that we can initiate ourselves if we make an effort to find out what we don't know. Certainly, it's best to catch a medical problem in the early stages not only from a personal health standpoint, but also because treatment can be much less costly to the health care system. Doing this does not dictate a lot of unnecessary and expensive tests if people would only exercise a rational and common sense approach.

I think the reasoning that not pursing some periodic medical followups once certain types of problems have occurred is a disservice to self, others and may be contradictory to the belief this is somehow saving health care system monies.

Finally, we each have to make our own judgments based on our personal medical histories as to what is necessary treatment and care and what is superfluous. We should have no reservation about declining tests, questioning our medical caregivers and acting accordingly.

That said, I have sometimes been less than perfect in practicing what I preach. I have sometimes failed to follow known health care preventative measures. I've always avoided medications as much as possible and have refused various tests including the much too frequent dental x-rays my dentist likes to administer.

Medical tests followup time lines vary based on each individual's problem. What may be appropriate for one person may not be for another with a similar diagnosis. That's one reason why a health plan must allow for some flexibility which is possible to do and still be cost effective.

A truly critical issue is educating people on end of life issues since the bulk of costs occur in the final few (two?) years of life. This is the psychologically touchy area when people wait until the last minute to adopt ideological views and attitudes toward death. I see it all the time in my work, often privately wondering why some individuals and their families experience such pain and turmoil for weeks and much longer fighting the obvious inevitable.

I will go in early, but not often. That is, if something new happens and I'm worried about it, I will see the doctor. If they explain it to me and I know why it's not a big issue, that's the end of it - and when it happens again I will know.

My mother disliked doctors and didn't want to go even when she clearly needed to (although she never failed to take me when I needed to go). Her health suffered for it on more than one occasion over the years. I will not emulate her.

At the same time, I will happily call the advice nurse if I think it can be handled over the phone, and again, if I get a good answer, I don't need to be treated. I am just as glad to learn that I don't need to treat whatever-it-is, to be frank!

My son was born this past January. He was 11 pounds, 9 ounces. They didn't know he was that large (the test that might have told them that - there's a fair margin of error - was scheduled for three days after he chose to arrive), so he was delivered normally (albeit not without pain medication), not via C-section. Had they known how large he was, they would have scheduled a C-section instead.

In that case, it might not have been a bad thing. I'm grateful not to have had one, but at the same time, his birth required about the same amount of follow-up care as a C-section, and his arm was injured during the delivery (due to his size relative to mine). I'd rather have had the C-section than have him injured (but he's recovering nicely). At the same time, there was no reason to believe one was needed until he had arrived, and I am very grateful to have a doctor who considers C-sections something to be done only when reasonably necessary.

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