A nation of placebo addicts

My internet woes continue, but at least I have some access now.  It’s always great when you call up an internet provider whose not providing you with internet and they can’t even pretend to care.  I’m such a troublemaker, demanding the services I pay for.

I once made the mistake of getting really sick.  I can’t recommend it.  Personally, I’m not going to do it again.  I had a really nasty flare of my Crohn’s disease that lasted for a couple months.  I lost 25 pounds, 10 of which were probably useful organs.

Then one week a friend passed on some run of the mill virus, but my weakened system broke down.  I was eating and watching T.V., when I felt so incredibly awful I had to lie down.  But lying down didn’t help.  I was cold and clammy and I was having trouble staying conscious.  My mom, who used to be a medical transcriptionist and before that a nurse, discovered I had an irregular heart beat, a blood sugar of 51 and a temperature of 95.  She rushed me to the hospital.  I had to lay down to stay conscious in the car and needed a wheelchair to get inside.

When they took me in, I was kicking myself.  How could I make such a terrible mistake?  I saw the bills piling up in my head.  They had to give me ondansetron so I would stop throwing up.  40 dollars a pill.  Yes, pill.  No, regular sized pill.  Imagine the care with which you take a tiny, breakable 40 dollar pill out of a package.  It took four bags of fluids before I could stand again.  It turned out that it was a good medical decision.  I had so little blood and nutrients that the doctor said I was probably only hours away from my heart giving out.

My mindset and that of millions of Americans in similar situations is a good indication of how bad things have gotten.  The fear of dying versus the fear of the hospital bill is a tug of war match.  Right now all over America there are people in ERs having even worse experiences where they know that they are going to be paying the rest of their life for the worst day of their lives, which more likely than not was of no fault of their own.

So, what’s wrong with our medical system?  The horrible answer is just about everything.  Doctors, patients, insurance companies, medical manufacturers, pharmaceutical companies, malpractice lawyers, transcription companies, health service bureaucrats, and many more entities are sabotaging the process.  We are in a quagmire of incompetence, ignorance and corruption.  Insurance companies want you dead.  That’s not even an exaggeration.  The only way their business model works is if you die quickly.  They are the ones who you pay to keep you alive.  It’s like hiring bodyguards, putting them in your will and expecting to survive the night.

The problem starts with the patients themselves.  The average American seems to have no clue about how their bodies work.  One of the things I like about my job is having a good understanding of how medical care works.  When I should go to the hospital or sleep it off, how much is too much medication, the difference between an annoying mole and a suspicious lesion, etc.  We now have a lot of services such as WebMD that can help the average person figure out when it’s time to get an expert opinion.  Still, a lot of the people go to the ER for frivolous crap.  People come in for the common cold.  Not just will you live, but there’s nothing your doctor can do for you.

By far, however, it is the knowledge of how the system itself works that I find most useful in life.  Knowing when to get care is the first step in a long war.  Perhaps more important is knowing when you’re getting bad care.  All doctors make mistakes.  Like it or not they’re human beings.  We need them to be perfect and yet they never will be.  You could get in a car accident and need the best care of your life, but the doctor on call has been on duty too long.  He’s not thinking clearly and now you’re a goner.  It’s his fault, but is it really?  If you just worked 35 hours of a 36 hour shift, how alert would you be?

Of course, many doctors are just bad at their job 24/7.  The doctor who put me on the Paxil was a well-meaning first year resident.  She didn’t like examining people (an aversion to the human body used to rule out a medical career).  She wrote a bunch of fake physical exams on my record that never happened.  Quite the superpower being able to palpate my liver through my shirt with her eyes.  All my early medical records say I’m only 5 feet tall.  She scheduled a cardiac workup for me while I had temporary insurance and messed it all up.  A ruined echo and Holter monitor later we knew nothing more than at the start.  She was my mom’s doctor too and almost got her killed.  She was treating her for kidney stones when she had glomerulonephritis.  They have opposite treatments.  My mom suffered kidney damage from it.  She was a nice person, great bedside manner, and I wouldn’t trust her with a hamster.

It was a big learning experience for me.  I should have known better then, but I trusted my doctor.  Never ever trust your doctor.  So, we need to make ourselves better patients.  Do your own research.  Make your own decisions.  Know yourself.

The next stage of the horror show is the doctors themselves.  The biggest problem with doctors is the shortage of them we’re facing in the country and the side effects to the solutions.

Numerous Band-Aids have been placed on the doctor shortage.  We are constantly seeking foreign doctors to augment the domestic population.  This has led to there being more foreign than native doctors in America.  While I have suspicions about the quality of many foreign medical schools, for the most part I imagine they aren’t far different from ours, partially because of low standards right here.

The main problem is a Tower of Babel scenario.  It’s not just that foreign doctors can’t communicate properly with their English speaking co-workers and patients, but they can’t communicate with each other.  The Russian speaking doctors don’t understand the Spanish speaking doctors who can’t understand the Cantonese speaking doctors and so on.  Pilots are required to pass an English proficiency course because you wouldn’t want the guy flying your plane to get confused with the air traffic controller.

http://www.engrish.com/2010/08/not-what-i-wanna-hear-before-i-board/

We don’t hold the guy poking your insides with knives to the same standard.  Just yesterday I did a report for a regular doctor of mine who I wouldn’t even say speaks English.  I don’t know what he’s saying.  None of my colleagues know what he’s saying.  He has conversations with nurses and other doctors and they don’t understand what he’s saying.  He prescribes medications like sertralazine.  There’s a cetirizine and a sertraline, but there is no sertralazine.  So which one was it?  Another doctor says “cloppa-doggle” instead of clopidogrel.  I’m trained and paid and skilled at figuring this stuff out.  What about the ordinary patient though?  What about the aforementioned doctor or nurse on the 35th hour of their day?

http://www.engrish.com//wp-content/uploads/2009/11/chinese-hospital-sign.jpg

Without communication there is no society.  Yet often the suggestion that doctors in America should speak English fluently is followed by accusations of intolerance for other cultures.  For the record, any doctor that goes overseas to another country better speak the language well.  If you’re an American doctor in a foreign country and don’t speak the language, you’re a danger to everyone.  My pilot, my doctor and my lawyer should all speak my language.  It’s a matter of safety, not courtesy.

Thanks to lowering edumacation standards and the general stupidification of America, our domestic doctors are idiots too.  A lot of my English as first and only language doctors don’t speak it so good at all and stuff, however.  Many who communicate fine can’t handle the doctoring bit.  I used to have a doctor who worked in the ER that if the patient needed anything more than a bandage or a wound washing, he had to refer them to another ER physician.  I’ve never seen anyone else refer a patient to another ER doctor.  Another doctor couldn’t read an x-ray to save his life.  He saw cancer in every patient, only to have the radiologist tell him it was bones.  In their normal positions.  “Mr. Smith, you’re either riddled with cancer or this is your rib cage.  We’ll know when the real doctor comes in.”  At one of the hospitals in the city we used to live in the head of cardiology for the hospital was busted for not having a medical license.  He never got one and was using his position to sell people heart surgeries and medical products they didn’t really need.  It was the best hospital in the city.

Basically, the shortage has forced us to take anyone who is even willing to practice medicine.  No one wants to become a doctor.  Massive student loans are required.  By the time you’re done, you’re an indentured servant to the university and the hospital.  Then you work crazy hours and pay huge malpractice insurance.  If you’re working in an ER, you risk your life with errant needle sticks, waiting room fights, human bites, blood getting in any exposed orifice, people coughing God knows what in your face, and people raging on PCP or meth who have the strength of a gorilla and can’t feel pain.  So a lot of the time when we do get new doctors fresh out of the education system they’ll go with a high paying profession like plastic surgery or, at least, a safer one like dermatology.  On an aside, Dr. House perfectly summed up the profession of dermatology with “If it’s wet, keep it dry.  If it’s dry, keep it wet.”

Beyond incompetence is the corrupting effect of money on the industry that trickles down that long ladder to every medical professional from top to bottom.  Doctors are salesman.  Some don’t want to be and most don’t seem to know they are, but it’s an inescapable reality for them one and all.  When you ask the prices of the procedures, they don’t know.  There’s no chart on the wall where you can see how much a new knee or a kidney transplant is running.  They tell you that’s not their department.  Talk to billing (who never seem to know either).  They are salesmen who have no clue what their services cost.  Imagine going to your mechanic, they tell you what the problem is and when you ask what it’ll cost, they can’t tell you.  They just want you to sign a waiver saying you agree to pay whatever it might be.

Doctors will argue that health care is so important the price tag doesn’t matter.  How can you put your wallet before your health?  Medicine is a higher calling.  They maintain the illusion that medicine is some holy practice.  Tons of hospitals even have religious affiliations.  Hospitals that are Catholic or Presbyterian or any number of other Christian denominations.  What an odd association.  I guess they left out the part of the New Testament where everyone Jesus healed got a hundred thousand dollar bill in the mail.

Doctors’ offices have gone Nascar over the years.  Advertisements for medications and companies all over the walls, the paper, the pens, the clocks, the chairs and more.  One day your doctor will be wearing a Nascar jacket covered from top to bottom in corporate logos.  Unless the doctor chooses to do their own research (many do and many don’t), they have to trust what the drug and medical equipment companies tell them, then hear later on the news if they were wrong.

Some studies have placed the success of the placebo effect as high as 51%.  In other words, the majority of the time if you pretend to do something you’ll be as well off or better than if you had actually been treated.  Last year it was discovered that fake knee arthroscopies had a higher success rate than real ones.  They cut your knee a little, don’t do a thing and say you got the surgery.  This won’t effect your outcome.  Most SSRIs have a questionable efficacy and many are outperformed by the placebo.  There’s little evidence to support that statin drugs do anything but lower your cholesterol.  It even says in some commercials that they don’t lower your risk of coronary or embolic problems.  Why take the risk of side effects just to get a lower cholesterol when the number apparently means about as much as the DOW?  Because your doctor thinks 10 points off your cholesterol is good for you.  Maybe it is.  No one knows.

I always feel bad when I meet a good doctor.  Watching them struggle up the stream of money and ignorance and bureaucracy and corruption coming their way.  There’s still plenty of them out there, but they’re outgunned and outnumbered.

One of my favorite doctors I work for is a urologist.  He’s a colonel and veteran of 4 wars, the founder of two clinics, and a great guy.  He’s in his 70’s and he just went overseas to Iraq to work as a surgeon at a FOB.  He always give his patients the truth.  He jokes around with them and doesn’t sell them on things they don’t need.  He’s the rare kind of surgeon that recommends you don’t get surgery unless you have to.  Plus, he hates robotically assisted prostate surgery, which I’ve found to be less than effective.  At some point in every procedure, the robot gets a little too snippy.  I picture the doctor and staff having to physically wrestle a 1950’s Sci-Fi style robot with saw blades for arms away from the unconscious patient.  The guy does everything he can to help, but more importantly he’s honest that sometimes there’s simply nothing you can do that won’t make the situation worse.

I think the lesson to take from all this is that the human body is resilient.  We survive our trips to the hospital, not necessarily because of the people treating us, but in spite of that.  The fact that anyone comes out of a hospital alive these days is a monument to human survival.  So, next time you get sick and get better, if you had a good doctor thank them, and if you don’t, thank your own body for being strong enough to endure the treatment.

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About fanaticalhypocrite

I'm your average agnostic Irish Catholic Welsh Jew born in rural West Virginia as the mildly autistic son of a motorcycle riding nurse and an unemployed, ex-military, atheist theology major (likes there's any other kind.) Just another tragically disconnected member of the bitter American proletariat living in the twilight of U.S. world dominance. I'm a medical transcriptionist by day ("They're going to fire me tomorrow" has been my motto for 11 years), a security guard/campground host/lost & found department/problem solver/bouncer/bookkeeper understudy 24/7/365, and a nerdy wannabe writer by night. And also day. My life is basically a non-linear blender full of random activities. And now I run a blog because... why not? It's not like I was using my precious time to cure disease or end world hunger. Might as well tell a bunch of strangers about why [insert anything here] really pisses me off.
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3 Responses to A nation of placebo addicts

  1. Sabura says:

    Wow, fascinating, the placebo knee surgery study. I’d never heard about that before. I think the results are well worth knowing, but I’m still trying to wrap my mind around the ethics of subjecting patients to the risks of general anesthesia and doing superficial incisions on them without performing real surgery. http://www.dailymotion.com/video/xex9wu_the-placebo-effect-knee-surgery_tech#.UY8un6LKKqw http://abcnews.go.com/Health/story?id=116879&page=2#.UY8vxaLKKqw

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