Patients Avoiding Hospitals and Doctors

I remember the first time I saw a young patient with older person’s diseases.  I was in a public clinic, not far from the industrial waterfront in California.  She was 24 years old, weighed 380 pounds, had already had what she claimed was a “slight” heart attack.  She had type 2 diabetes which I thought was virtually impossible to get at such a tender age.  She was able to do little other than to shrug her shoulders.  She said something about health problems having been in her family.  Me, the only thing I could think of was that I was only through 3 years of so of a seven year medical school at her age.  I was quite overweight, but if I had been struck with her degree of obesity or her medical problems, I don’t think I would have had the stamina to get by.  Sure enough, she was neither working nor going to school.  When you are an adolescent, you think you are going to be strong and healthy forever.  I remember looking at patients and never thinking I would be as ill as they were. I remember seeing patients in intensive care in comas, never thinking for a moment that I would have three of them in my life before I was able to figure out the hereditary metabolic that had caused them.

I chronicled this in a book about the experience.  I lost a large amount of weight and fixed the problem that first hit me when I was age 40. It used to be that people who were going to have heart attacks got them in their fifties.  I remember a woman cardiologist, who worked in the emergency room at Massachusetts General Hospital.  She told me she had told her mother about how she had spent all of her time taking care of overstressed rich executives in their fifties.  Her mother’s response was “Marry one!” Now, according to the research, people get their first heart attack in their thirties. In general, it seems that people are getting sicker when they are younger.  This is mostly blamed on obesity. I do not think that obesity is the fault of the individual; it is the fault of a food industry that overprocesses, presumably to earn more money. I think that is a part of the American way, and something that is amenable to corrective action by a populace who will realize and know.  I followed a bunch of links to try and figure out how increased illness in younger folks and their attitudes about health were shaping what is going on with medicine.

People in their twenties do not appear to be interested in health insurance, even cheap health insurance.  If you are healthy with no spouse or kids, well, it just does not look like a good deal.  As they say in the guerilla marketing classes, prevention is an awfully tough thing to sell. A single health crisis can cause economic disaster for the uninsured.  I do not know how to convince kids in their twenties of this before it happens. I worry less about the insurance companies who may need healthy young folks paying low premiums to support care of the aged.

I worry more about the young people.  I can only hope that they will see enough health problems in older members of their families to believe in prevention.  So what happens if these young folks actually get something that needs medical care, like a sore throat that won’t go away?  They take advantage of a new medical system called “retail medicine.”  I have heard a little about it on the fringes, but only recently started to learn about what is happening.

More people are using these health clinics that are in drugstores or supermarkets or retailers.  They are cheaper and their prices are more
“transparent” (read “predictable”).  Except for Texas, where such clinics cannot exist without a doctor on-site, the health care provider is usually a nurse practitioner or physician’s assistant, providing healthcare without a physician present, and guided by lists and decision trees about their scopes of practice.  I have already heard my share of touching stories about people in such facilities assisting people with strokes and heart attacks get to fully equipped hospital emergency rooms.  I must establish that I love nurses and I love Physician Assistants.  Any doctor who does not state that they were assisted in their first learning of practical skills (such as getting and intravenous access into a vein) by a nurse or physicians’ assistant is probably lying.  I cannot count the number of times nurses or other folks with licenses that did not say “medical doctor” on them helped me learn how to do practical and necessary things.  This does not mean that getting everything done at this level of care is the best way.

I will also freely admit that I, like everyone else who trolls the internet, tend to read with curiosity things like conspiracy theories or references to allegedly previously withheld information that are relevant to my interests.  There are still hidden costs; insurance may or may not cover, etc.  There are maybe referrals for products within the drugstore where the place is located.  Family doctors may repeat tests if results are not available.  Family doctors may be going broke.  400 doctors a year commit suicide in these United States, and I have seen some recent references suggesting that more of them are smart enough to make it look like an accident. Being a doctor and feeling devalued is not just a feeling. It is becoming, and may already have become, a fact.  Has it occurred to anybody at all that the quality of medical care may sometimes be less good in this kind of facility?  That missing a diagnosis may be “less important” when the patient visit is a one-time economical move, than it is when you talk to a doctor.  Even if you don’t believe that doctors have any extra dedication, you have to believe that they sat through more classes and took more exams.  Recently a patient told me she went to one of these places only when she needed an “antibiotic.”  Excessive use of antibiotics since their discovery has gotten us to a point where the bacterial organisms we try to kill with them have developed resistances and become harder to kill.  Sometimes antibiotic use is not a really good strategy; sometimes, a combination of them is needed to get rid of an invading organism.  I don’t know if, for example, the nurse practitioner who sits in this kind of office is ready, willing, and able to make this kind of decision in a way that is good for the patient as well as other inhabitants of the planet.  I do not doubt such a person’s dedication nor their practical skills.  I have not seen the “decision trees” or lists they use for treating.  People need to take as much responsibility as they can for their health care.  Thomas Jefferson expressed the idea a long time ago that an intelligent electorate would be the safeguard of freedom.  I beg and pray that we have patients intelligent enough to safeguard their own health.