Two Sides

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The woman daubed at her red nose and sniffled. She did look miserable.

“Well, after three weeks of green snot it is clear you have a sinus infection. Let me get you an antibiotic.”

She nodded her head in agreement, relieved.

I pulled out my prescription pad and started scribbling. The woman craned her neck to see what I was writing.

“Uh. Doc? I don’t want that antibiotic. It never works. I want something else.” She went on to name the newest, most expensive antibiotic on the market.

My hand froze.

I looked up at her, one eyebrow raised. That was silly. She didn’t need a cannon. She needed a BB gun.

“That is going to cost more than you want to spend. Let’s pick something else.”

She scowled.

“No. The copay for my meds is all the same. I want the best.”

After ten minutes of discussion I had convinced her that what she really wanted was what I wanted and that was a generic antibiotic.

She also wanted me to do a CT of her sinuses. After only one sinus infection per year. After almost yelling at me, she finally agreed to wait and only do it if she didn’t start feeling better in the next two weeks.

She got better without it.

That was ten years ago.

Nowadays the conversation goes something like this:

“Doc, how much is that medication going to cost me?”

“Um. I really don’t know about your specific pharmacy coverage, unfortunately. It is impossible to keep track of the dozens of insurance companies and the hundreds of permutations of coverage in each. But I do try to start with the cheapest medications first. This is generic so you should not have to mortgage the house.”

“Fine. But if it costs more than $10, I’m not getting it.”

“Fair enough. If it is too expensive please call me so we can change things if needed. Meanwhile, I will get the scheduling coordinator to schedule that MRI for your intractable headaches with L sided weakness…”

“Wait, wait, wait, Doc. That is going to be pretty expensive isn’t it?”

“Maybe. I’m sorry. We really need to get it done. I think you might have brain cancer.”

“Tell you what. If I am not better in a month, we can schedule it….”

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72 thoughts on “Two Sides

  1. I wish there was another alternative to liking a post. I like the post, hate the situation with “I can’t afford it if it is over $10” and “let’s play Russian roulette with the diagnostics.” (And if it is cancer and you don’t have adequate coverage, well, hurry up and die, s’ready.)

    I’ll put you in charge of fixing insurance, ok? You should have that implemented in a week or so?

    Liked by 2 people

    • Yep. It is nice not to have to argue with patients about over treatment. They are better stewards when they are paying more. But there is an awful lot that needs to get done that is not at this point now that cost is translated more to the patient. And I completely understand it. They are not stupid people. They are making economic choices.

      Like

      • Well, if we’re talking about prescription medications, it does still depend on whether the patient has private health insurance with drug coverage. If they do, they take any prescription you give them. If they don’t, there might be a small discussion about cost…
        If we’re talking about diagnostic tests, patients will only refuse your request if they don’t want the test, not because of the cost (there is no cost!) Instead, we might have a more in depth discussion about how long it would take to get the test done… But I’d still take that over issues of cost πŸ™‚

        Liked by 2 people

  2. Greetings again Miss,
    Since yours is the only blog I’m currently following, it tends to show up in my reader the most:) I hope you won’t mind another comment from me. I do suppose people think you really do wish to see what they blew out of their noses don’t they? From the sound of your hectic schedule, I can’t help but wonder if you’ve ever had to decide whether eating or going to the bathroom was more important because you didn’t have time to do both? The real reason I wrote to you was to ask if you’ve ever read the wonderful book, ‘William Osler: A Life in Medicine’ – by Michael Bliss? It was a marvelous read… almost like a novel. Kindest thoughts to you and your family.

    Liked by 1 person

  3. Lord have mercy! Thank goodness you have your two children to keep you SANE. I would not have patience with either scenario, because I know how advertising crazy people are, number one, and they make peeps just gotta have the latest the best, and then the MRI …. really? You must not have had to fight for you health if you take that health so lightly. Mankind has NO idea what a Blessing it is to have health until it is lost. Doc, my hat is off to you. I don’t know how you work at the job you do.

    Liked by 1 person

    • If you have to decide between the MRI and feeding your kids… I guess what makes it easier is knowing that generally speaking people are not stupid or selfish or evil. They make choices for reasons that make total sense to them even if it does not make sense to me at the time! πŸ™‚

      Like

  4. β€œTell you what. If I am not better in a month, we can schedule it….”

    Substitute three months, ignore advice if it’s a really serious condition like cancer, trust time to do its work, and that’s probably the best recommendation for 95% of all medical conditions. Just my half penny’s worth.

    Liked by 1 person

  5. This makes me chuckle, but it also makes me want to beat my chest and roar like some kind of horror movie villain.

    Re: the current setup …

    One of my most popular posts, accidentally deleted (of course), was how I attribute my mom’s death in part to the crazy systems of this country. She avoided and avoided treatment, thinking the problem would “just clear up.” The alternative was care she couldn’t afford; she was desperately afraid of losing her house, for which she’d fought long and hard. By the time my sister was able to finally persuade her to seek treatment through county health problems, it was far too late.

    The thought that my mom is not alone in this, that many people choose wishing and praying when there’s technology potentially equipped to save them … it infuriates me. Just infuriates me. I can’t imagine what it must be like to witness this as a doctor, though a couple of nurse friends have shared their experiences with me.

    Arrrrgh.

    Liked by 1 person

  6. I’m sure you have SO many people who come in to your office and have no idea what they are talking about, but think they know what they want. And It must be so frustrating for you. But the other side of the coin is that as a patient, I know me better than a doctor does, and I do know which antibiotics I’m allergic to, which ones give me problems, etc., and the ONE (literally!) I can take (Keflex) I guarantee I’ll need for 14 days to clear a sinus infection because I’ve always been a slow healer. Yet, each and every time, the doctor tries to give me a Z-pack (BAD reaction when I’ve taken that) and when I finally talk him into Keflex, he says I can come back if I need more after 7 days… And I ALWAYS do. So I feel frustrated that he gets paid for another office visit when I knew what was wrong in the first place. That said, again, I DO completely understand your side of things, and feel bad for what you must go through! Not to mention the potential legalities involved if you just blindly did what the patient requested. It’s too bad there isn’t a happy medium.

    Liked by 1 person

  7. The sad thing is that its so “not” funny that we’re starting to laugh at it just to hide the pain. It has got to be very tough on you professionals who just want to help when everything you recommend threatens your patient with financial insolvency (is that even a word?).

    Liked by 1 person

  8. It’s simple. We just have to plan ahead. When I turn 60 next year, I’ll be due for my second “routine” colonoscopy. I think that means I have to pay a $1000 deductible which I think is good for the year. But, wait. Is it the calendar year, or does it start over July 1? I better find out. If any other deductible type stuff is going to come up, it better happen in that window, so by the time I’m 61, I can retire into being an artist and writer with who knows what kind of insurance. Or maybe I’ll take a leap of faith with whatever insurance I can afford and the belief I’ll be happier and healthier as a writer/artist.

    Liked by 1 person

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