Health care
05/08/13 04:35
Here is one of the things that is wrong with our health care system here in the United States and how I am a part of the problem. In June, I turned 60. I had a “routine” colonoscopy when I turned 50 and most doctors recommend the test at 10-year intervals after age 50.
Don’t worry, I’m not going to go into detail or describe the preparation for the procedure. People who are a lot cleverer and a whole lot more funny than I have already done that. Frankly, so far in the process, I haven’t found anything to write home about. What interests me is how I got myself to this place and how the decisions I make have an impact on health care for myself and others. And I am not convinced that I have made the best decisions, though I do understand how I got to this point.
First of all, it is important to note that I am not opposed to routine cancer screenings. I think they are a good idea. Many cancers, when detected early are quite treatable. Early detection saves millions of dollars to the health care system each year and saves countless lives that might otherwise be lost if the cancer were to go undetected for a long period of time. Additionally, I don’t believe that we amateurs should be spending all of our time and energy second-guessing health care professionals. Doctors have access to education and research that laypersons do not read. If you find yourself in a position where you don’t trust your doctor’s investment in your well being and care, I suggest that you look for a different doctor. There are plenty of physicians who are well educated and who care deeply about patient care. I have an excellent personal physician and I trust the advice and judgments of that doctor. Furthermore I am engaged in my own health care decisions and value the consultations that I get from my physician.
Have you ever wondered why so-called “routine” colonoscopies are recommended only once every 10 years when no symptoms are present? The polyps that develop into cancer in the colon grow slowly. There are different cancers that can develop in the digestive system, but the ones detected by routine colonoscopy screenings are the ones that grow very slowly. The aggressive cancers that are very dangerous and far more fatal usually present symptoms long before the colonoscopy is ordered. They are detected by lab tests and usually involve acute symptoms including bleeding.
Here is the thing. Most of the polyps that are detected in colonoscopy procedures could also be detected by a much less invasive and saver procedure called a sigmoidoscopy. The sigmoidoscopy involves examination of just the last part of the colon rather than the whole bowel. Flexible sigmoidoscopy is an office procedure that can be conduced by any trained physician and does not require sedation or costly apparatus. The number of cancers that could be detected by a colonoscopy but not by a sigmoidoscopy is very low, probably lower than the number of colonoscopies that involve serious complications. In other words, the risks of harm caused by a colonoscopy is probably higher than the risk of undetected cancer if the patient had a sigmoidoscopy instead.
The risks of colonoscopies are not insignificant. The most dangerous complication from the procedure is an accidental perforation of the bowel. This can result in infection, require surgery to repair and result in significant danger to the patient. If allowed to go untreated it is life threatening. Different endoscopy centers have different rates of bowel perforation, but in general rates are only about one in one thousand. Still, if you consider how many of the procedures are done each year in the several endoscopy centers in our city you will understand why most of us know someone who has experienced that particular problem.
Much higher risk comes from the use of total anesthesia when the procedure is performed. There are always risks associated with anesthesia and these must be weighed against the benefits. This is of particular interest in colonoscopy procedures because the use of total anesthesia is mostly a matter of convenience for the doctor. The procedure can be successfully completed with conscious sedation in most cases, yet conscious sedation is usually not used for colonoscopies unless the patient refuses anesthesia.
Here is the situation. Routine colonoscopies with anesthesia are expensive. People who don’t have insurance generally don’t get the test performed. People with insurance are going to pay the out of pocket expenses and the insurance company is going to pay the rest. And insurance companies don’t often balk at colonoscopies. They save the company money in claims. They detect problems. So the insurance company pays for the procedure. My insurance has pre-approved the entire procedure with anesthesia. The cost of the procedure is the same to me whether or not I have anesthesia. It probably is very close to the same out of pocket cost for me as a sigmoidoscopy, had my doctor performed the less expansive procedure.
So I am spending the money of the insurance pool on a procedure that probably is not necessary and certainly could be performed for hundreds of dollars less than it will cost.
And, quite frankly, I’m not quite sure why. It is the path of least resistance. My doctor ordered the procedure. My insurance company approved it. The endoscopy center is so practiced at the procedure that it is almost like a factory, processing patients quickly and routinely. The surgeons perform many procedures each day. They are set up to do this. The risks are statistically very small. I have little reason to suspect that there will be any problems. I am in good health. I’m a cooperative patient. I have been studious in reading all of the literature provided as well as doing a bit of extra research on my own. I complied very carefully with every detail of the preparation instructions.
But it does bother me that our city has more centers and more of these expensive machines than we really need for our population. It does bother me to spend money out of the insurance pool that might be better invested in treatment of someone with an acute disease. I am perfectly healthy and symptom-free. Although I’d like to remain that way, I’m not convinced that consuming health care dollars is the best way to do so.
And no one, from my doctor to the folks at the endoscopy center to the insurance company, seems to be interested in discussing what we might do the best we can to assure continued good health without spending so much money. Unlike other areas of our life, we don’t seem to see the connection between the things we buy and the cost of the insurance premium. When it comes to health care, it seems that we often take a “the sky is the limit,” “or no matter what the coast” approach.
Don’t worry, I’ll be a compliant patient and I won’t be arguing with the doctors today. If they get their way, and they probably will, I’ll sleep through the whole thing anyway.
Don’t worry, I’m not going to go into detail or describe the preparation for the procedure. People who are a lot cleverer and a whole lot more funny than I have already done that. Frankly, so far in the process, I haven’t found anything to write home about. What interests me is how I got myself to this place and how the decisions I make have an impact on health care for myself and others. And I am not convinced that I have made the best decisions, though I do understand how I got to this point.
First of all, it is important to note that I am not opposed to routine cancer screenings. I think they are a good idea. Many cancers, when detected early are quite treatable. Early detection saves millions of dollars to the health care system each year and saves countless lives that might otherwise be lost if the cancer were to go undetected for a long period of time. Additionally, I don’t believe that we amateurs should be spending all of our time and energy second-guessing health care professionals. Doctors have access to education and research that laypersons do not read. If you find yourself in a position where you don’t trust your doctor’s investment in your well being and care, I suggest that you look for a different doctor. There are plenty of physicians who are well educated and who care deeply about patient care. I have an excellent personal physician and I trust the advice and judgments of that doctor. Furthermore I am engaged in my own health care decisions and value the consultations that I get from my physician.
Have you ever wondered why so-called “routine” colonoscopies are recommended only once every 10 years when no symptoms are present? The polyps that develop into cancer in the colon grow slowly. There are different cancers that can develop in the digestive system, but the ones detected by routine colonoscopy screenings are the ones that grow very slowly. The aggressive cancers that are very dangerous and far more fatal usually present symptoms long before the colonoscopy is ordered. They are detected by lab tests and usually involve acute symptoms including bleeding.
Here is the thing. Most of the polyps that are detected in colonoscopy procedures could also be detected by a much less invasive and saver procedure called a sigmoidoscopy. The sigmoidoscopy involves examination of just the last part of the colon rather than the whole bowel. Flexible sigmoidoscopy is an office procedure that can be conduced by any trained physician and does not require sedation or costly apparatus. The number of cancers that could be detected by a colonoscopy but not by a sigmoidoscopy is very low, probably lower than the number of colonoscopies that involve serious complications. In other words, the risks of harm caused by a colonoscopy is probably higher than the risk of undetected cancer if the patient had a sigmoidoscopy instead.
The risks of colonoscopies are not insignificant. The most dangerous complication from the procedure is an accidental perforation of the bowel. This can result in infection, require surgery to repair and result in significant danger to the patient. If allowed to go untreated it is life threatening. Different endoscopy centers have different rates of bowel perforation, but in general rates are only about one in one thousand. Still, if you consider how many of the procedures are done each year in the several endoscopy centers in our city you will understand why most of us know someone who has experienced that particular problem.
Much higher risk comes from the use of total anesthesia when the procedure is performed. There are always risks associated with anesthesia and these must be weighed against the benefits. This is of particular interest in colonoscopy procedures because the use of total anesthesia is mostly a matter of convenience for the doctor. The procedure can be successfully completed with conscious sedation in most cases, yet conscious sedation is usually not used for colonoscopies unless the patient refuses anesthesia.
Here is the situation. Routine colonoscopies with anesthesia are expensive. People who don’t have insurance generally don’t get the test performed. People with insurance are going to pay the out of pocket expenses and the insurance company is going to pay the rest. And insurance companies don’t often balk at colonoscopies. They save the company money in claims. They detect problems. So the insurance company pays for the procedure. My insurance has pre-approved the entire procedure with anesthesia. The cost of the procedure is the same to me whether or not I have anesthesia. It probably is very close to the same out of pocket cost for me as a sigmoidoscopy, had my doctor performed the less expansive procedure.
So I am spending the money of the insurance pool on a procedure that probably is not necessary and certainly could be performed for hundreds of dollars less than it will cost.
And, quite frankly, I’m not quite sure why. It is the path of least resistance. My doctor ordered the procedure. My insurance company approved it. The endoscopy center is so practiced at the procedure that it is almost like a factory, processing patients quickly and routinely. The surgeons perform many procedures each day. They are set up to do this. The risks are statistically very small. I have little reason to suspect that there will be any problems. I am in good health. I’m a cooperative patient. I have been studious in reading all of the literature provided as well as doing a bit of extra research on my own. I complied very carefully with every detail of the preparation instructions.
But it does bother me that our city has more centers and more of these expensive machines than we really need for our population. It does bother me to spend money out of the insurance pool that might be better invested in treatment of someone with an acute disease. I am perfectly healthy and symptom-free. Although I’d like to remain that way, I’m not convinced that consuming health care dollars is the best way to do so.
And no one, from my doctor to the folks at the endoscopy center to the insurance company, seems to be interested in discussing what we might do the best we can to assure continued good health without spending so much money. Unlike other areas of our life, we don’t seem to see the connection between the things we buy and the cost of the insurance premium. When it comes to health care, it seems that we often take a “the sky is the limit,” “or no matter what the coast” approach.
Don’t worry, I’ll be a compliant patient and I won’t be arguing with the doctors today. If they get their way, and they probably will, I’ll sleep through the whole thing anyway.