Do As I Say, Not As I Do
The Fourth of July 2007

Medical Indignities

category_bug_journal2.gif Thank you for your concern yesterday about my colonoscopy and most of all for the compelling conversation on the topic. The procedure itself was a lot easier than the preparation, as Millie Garfield of My Mom’s Blog noted in comments yesterday. It took a mighty effort not to vomit that disgusting stuff and I’m relieved that the doctor says I won’t need to do this again for five years.

Judy left a comment I could have written word-for-word:

“When I made the appointment for the test the clerk told me it was required that someone accompany me to the clinic and be available to drive me home. I protested that I had no one to do that (that was true as I have no family in the area at all and I would not ask a friend to take off work). My plan had been to take a taxi to the clinic and back home. The lady said they could not allow that as the taxi driver might "take advantage" of me and the clinic would be liable. I thought that was ridiculous!”

In my case, the clinic clerk had informed me that a taxi is not allowed because my “safety is their primary concern.” Of course, both reasons are nonsense. The clinic has no liability for taxi drivers’ behavior nor can they guarantee (in practice or in law) that a friend will necessarily ensure one’s safety.

We had quite a go-round about my return home until I capitulated by asking my young, downstairs neighbor to act as my driver. He’s a nice kid, a young, up-and-coming musician, and we have become friends. But I didn’t relish the inevitable question of “I hope it’s nothing serious” and having to explain.

It turned out all right, but the issue that bothers me is the insistence by the clinic that the driver be a friend or relative.

Let’s be clear: there is no liability to the clinic if anyone – taxi driver or otherwise - crashes the car or if the patient falls while entering his or her home. And in my case, a clinic employee insisted on walking me to my friend’s car so if I fell on their property, she was there to help. Therefore, the refusal to perform a colonoscopy without my signed assurance of a friend driver places an unwarranted obstacle in the path of one’s healthcare.

It took 15 years for a doctor to talk me into a colonoscopy and I had been willing to forgo it over the driver issue until it occurred to me to ask my neighbor who happened to be free yesterday morning. Fortunately, the clinic is only 15 minutes from our condominium. Had it been twice that long or more, I doubt I would have asked.

There is also the indignity of it. Because I am independent to a fault, I am undoubtedly making too much of this, but I felt infantilized. I’ve been taking care of myself since I was 17 years old. I may be stupid about healthcare in general (see Monday’s post), but I’m not an idiot; I know when to ask for help. Yesterday, it was not needed.

Like Millie, I was also told to take it easy for the rest of the day, not to drive and to avoid stairs even though I was previously advised that there is no hangover from the anesthesia after 20 minutes. Also like Millie, I was fine. Directly from the clinic, I took my neighbor out for a spicy, Indian lunch. (I was a mite hungry after 28 hours without food.) Later, I trudged up and down the 14 stairs to my apartment three times taking garbage out for the trash collectors and later drove to the store.

Now I'm wondering if the propensity of doctors and clinicians to treat patients as children, particularly when common sense contradicts their directives, is a cause of my reluctance to spend much time with them. I respect their superior knowledge of medicine itself and rely on it when it is needed, but I'd like a little respect for my intelligence. It would be better to be treated more like a grownup.

Otherwise, all went well. The doctor, nurses and helpers were kind, efficient and answered all my nitpicky questions - although the clinic, which specializes in gastroenterology, did feel like an assembly line of naked bums.

[At The Elder Storytelling Place today, Virginia DeBolt returns with a funny story titled Laughing in Loving that also reminds us of the golden pleasures of old friends.]


Comments

Congratulations! I know you are glad that you have five years before going through the prep again. I agree. That is the worst part of the entire thing. I'm glad you did it though. It is a very important screening. I have done that one. Fell down on the "easy one" - mammograms - and am paying the price!

I'm so glad you followed through, and had the test done. Now you can put the episode out of your mind. My husband will be going in for his third colonoscopy, and feels the same about the preparation as you do. I've had one, too. While I dislike everything about it, it seems like a small price to pay to head off colon cancer. Since my mother has had colon cancer, I had my first procedure at 55.

I'm sure there will come a day when I may want to use the issue of needing a driver to get out of taking the test, but I'm glad you perservered. Your readers will be happy to know that you're in good health!

I'm glad the test was fine, too. My first (maybe last?) one was this Spring. The doc told me I won't need another one for 10 years - fine by me.
My biggest problem with the western medical system is that most, if not all, have studied disease exclusively and really know very little about health.
I went because my (new) health insurance was providing a 'wellness checkup'. By the time everything was done I was out-of-pocket for over $1000 and the insurance premium just went up. Makes me crazy! and I will be canceling the policy.
Back to working on being healthy, not treating disease.

"Assembly line of naked bums".

Oh what a mental image that is! Thanks for a hearty morning chuckle.

So glad all is well and you are back to your same ol' feisty self.

Doesn't make me more encouraged to make my own appt which is still waiting...ugh.

It's nice that your doctor recommended another one in five years. Did you know that Medicare will only pay for it every ten years?

Well done, Ronni. All the info about medical insurance etc makes me grateful for our National Health Service here in Scotland. By the way, the helper for going home is the same here and applies to all ages wherever an anasthesia or sedative is required.

Yes, I too put it off for almost twenty years. I'd had all the other tests and tried to stay on top of this as my mother and her brother had colon cancer. I had a dramatically bad reaction to the stuff they clean you out with when having a lower GI, and I didn't want to repeat this horror story ever. Finally the GI Doc said I could drink clear liquids for three days and use enemas instead, and I had one this year. Yes, I was dopey after the meds. Yes, I couldn't have driven. But yes too, I could have taken a bus or a taxi to get home.

Ronni
I also am glad that the procedure went well and the results were uneventful.

Don't you think so much of medicine's overemphasis on excessive carefulness derives from their PYA attitude in today's litigious society?

It's good to know that suffered no ill effects and were able to eat afterwards.

I'm glad things went well for you, Ronni. A few months ago I drove my husband to get his second colonoscopy. He almost refused this one because the 'prep' for the first one (ten years ago) had been so nauseatingly disgusting. His doctor prescribed some pills that really cleaned him out. The doctor said no one should have to drink that vile stuff. lol

Hubby needed a driver to get home. He was in no condition to drive. I think different people react differently to the sedation.

The local cancer society provides volunteer drivers to help cancer patients get to and from various treatments. They may draw the line between treatments and screenings. It would be nice if an organization could provide assistance here.

Mine was last week, and I'd been putting it off for years too. My insurance only pays half since my (high!)out-of-pocket limit hasn't been reached. Another future bill to worry about.
But, they recommended over-the-counter laxatives so it was relatively easy, although I had to mix a whole bottle of powder with a half gallon of Gatorade and drink it every 15 minutes, along with pills. The Gatorade, at least, quelled the hunger pretty well. And it worked fast.
I was told, besides the ride home, not to sign any legal papers that day!
I felt fine afterwords, but admittedly fell asleep a few times during the day, so maybe just as well.

I agree with Chancy; I think the reason they insist on the patient needing a driver to take you home is to protect themselves from a lawsuit. Technically, they may not be liable for you after you leave the clinic, but if you fell because of being weak and drowsy you can bet some lawyer would find them liable for not making sure you were safe until the effects wore off.
This requirement is not restricted to a colonoscopy,by the way. My daughter is flying in from California to provide that service when I have surgery for a droopy eye lid on the 16th of this month.
Probably not necessary either, but I am using that excuse to get her to visit. (sneaky, huh?)

I agree with you on the driver issue. I have some friends, but I hate asking them to take time off from work, and I would just as soon have taken a taxi home. The three times I've had to have friends take me home (once for a colonoscopy and twice for minor breast surgery), I could have done perfectly well on my own with a taxi. I have no idea what they do with people who don't have family or friends in the area.

Glad to hear your colonoscopy went well. I put mine off 'till I was 60, but once I did it, I realized that it wasn't as bad as I feared.

The driver issue made no sense for me either as I didn't even go fully under when having my test. I would have easily been able to drive right afterward. It's amazing they make this so difficult on those who don't have family living close by

Interesting to read the different reactions of everyone to preventative health care and the colonoscopy, specifically. My feeling is that if I can scrape up the money to pay the out of pocket cost, I'm just glad I can do so, even if I might have to forego some other personal pleasures for a period of time. For any who might have to give up the basic needs of life, that's a different matter.

Based on my experience, I think the Doctors just prepare a patient handout that covers all situations for care after the procedure. My husband had differing reactions dependent on the anesthetic he was given. One procedure he was completely unconscious, awakened afterward and seemed quite normal. A short time after I drove him home, he reported realizing he had experienced memory loss for the short period of time between leaving the hospital and returning home in the car with me driving. Would not have been good for him to be driving.

More recent years his medical condition was such he could not have the anesthetic, so differing amounts of other sedative was used for subsequent procedures. Doctors had to be very careful about how much was administered, which can well account for his differing reactions to each successive procedure being less comfortable than his first one and what I had experienced. Such variances may account for the differences in other's experiences.

Glad you could be so active so quickly afterward, Ronni. I, too, felt as though I could have been. However, since I had polpys removed, I concluded for myself the better part of wisdom was to take it easy, lest their be any internal bleeding, even ate soup. Common sense probably tells each of us what instructions are likely applicable for ourselves.

Initially, with my first test, not wanting to cause my husband to be off work, I, too, wanted to take a cab; was furious and argumentative when I was told "no" for many of the reasons having to do with being independent that you describe. Frankly, given the differences in cabbies and other liability issues for doctors and hospitals, knowing what I do now about the reactions some can have to the procedure, I find that medical recommendation not necessarily unreasonable. In this sue-happy society, many suits deserved, our health care costs just go up and up with attorneys taking the bulk of the winnings.

Now that I am alone, when my next test is due in a few years, I will be faced with that transportation issue. Since my friends have all left the area one way or another, and I was so preoccupied with personal responsibilities at home with my husband and my work, I neglected my local social network for too many years. Am rebuilding that now. Perhaps there will be someone on whom I can call by then. Also, though I haven't been active in the local senior centers, I'll contact them and see what they might suggest. Additionally, I can ask the volunteers office at my local hospital for suggestions. Those active in churches, other social organizations should not be shy about making a need such as this known. There must surely be many of us across this country in the same independent and alone boat.

Sorry, I left out synagogues and mosques, any other religious gathering places as sources of contact for a driver.

Thanks for addressing the driver problem - a big one for me, too - and I'd never seen it mentioned before, anywhere. I'd love to see a follow-up on this one.

Yes, as you say, Ronni,"It would be better to be treated more like a grownup." But any time we go into a hospital we run the risk of having our 'grown-up' identities taken from us at the door. It is all part of the ritual. Triage staff are a bit like butlers taking people's overcoats. And it is downhill from there.
I worked for some while in a large, public hospital and one of the things that struck me very forcibly, as a psychologist, was the fact that the patient is ritually infantilized. It goes with the territory, and ten times more so if you are an inpatient.
Think about it. In what other setting except early childhood do you sit in bed in your nightie while other people tower over you wearing their street clothes? In what other setting except early childhood do other people poke and prod your body, stick a thermometer in your mouth and suppositories up your bum, look at your private parts without showing you theirs, ask you about your bowels, hand you medicine to take, tell you what you can and cannot eat and turn out the light before you feel ready to go to sleep? It is a situation that is almost guaranteed to make you feel little, no matter how old you are and no matter how hard you (or the medical staff) try to interact in a normal, adult-to-adult way. And let's face it, a lot of medical staff don't even bother to try.
So a lot of patients, even the ones who in normal life are very strong and assertive people, find themselves falling automatically into the 'small and helpless' role and becoming either uncharacteristically passive or unusually rebellious. And a lot of doctors and nurses, especially the under-confident ones, easily slide into the 'big and powerful' role, which is also hard to resist, especially for certain types of people. It is a very hard ritual to resist.
(But at least you get to go home. All the same things are true of nursing homes, as we all know, and there the pattern is even stronger and deadlier.)
Anyway, you are OK, and that is good news.
As regards the driver thing: are you certain that liability is not involved? When I was in private practice as a therapist I had to have professional liability insurance because I was told that people can sue you for giving them 'wrong advice'. I suspect that allowing someone to leave the premises unescorted after sedation might actually fall into that sort of category. Not sure though. You'd need to check with an insurance expert.
So glad your results were NAD.
Blessings, Marian.

I've had the same experience. It was no fun, but like you, I discovered that finding someone to accompany me was the biggest problem. Fortunately, an old friend had the morning off from her job, and I'd taken her home from her similar appointment a while back. Probably the worst aspect was having my procedure delayed until the anestehtic wore off--while I listened to another patient moaning and yelling in pain. My mother swore after her second coloscopy that she'd never have another, and as far as I know, she didn't. I probably will, but I won't enjoy it!

Anyone can bring a lawsuit against anyone, liability or not!

RE: My TWO colonoscopies...I am young and healthy, but I react strongly to all meds/procedures. I could NOT have driven myself home either time and I too had memory lapses, fell alseep sitting up hours afterwards....for those of you, RONNI too, whom the procedure was no big deal, congratulations!

Ronni,
It is my guess that you usually don't agree with Rich Karlgaard of Forbes but on this you do agree. See this post:
http://blogs.forbes.com/digitalrules/2007/06/more_mayo_clini.html
Marion

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