What to post

March 22, 2013

I was writing a post yesterday about what happens when life’s excessive difficulties result in a person’s implosion or explosion instead of a “faith experience.”  I called it “Foxholes,” in reference to the old saw, “There are no atheists in foxholes.”  (I think there are.)  After reading David Brooks’s column about foxes and hedgehogs, I didn’t want to post something called “Foxholes,” even if I had written most of it before I read his column.

So I’m going to add a little here about my adventures Wednesday night with our medical system, which I mentioned in a reply to a comment to Timothy Egan’s column on The Five Guys restaurant and its relationship to health insurance.

I had been taking an antibiotic, and after taking a dose, a short time later I felt awful.  Waves of chest pain, nausea, retching, a red itchy rash on the back of my neck and shoulders, including a couple of hives.  The antibiotic was minocycline.  I think what I had was probably a side effect reaction, not what we call an allergic reaction.

I’ve had allergic reactions to other medications, as well as side effect reactions to both meds and vaccines (or their bases, or both).  I was once told by a Dr. Melchinger, who was an internist in New Haven Willy and I both used, that I apparently have a body that will eventually if not sooner react negatively to medicine, and that I should not take any unless absolutely necessary — to save my window of tolerating them for when it’s especially critical.  So I’m a veteran of medication reactions.

I would have called the pharmacy, but they were closed.  I called the prescribing doctor, tried to page her, didn’t hear back, made some other calls, one of which told me try a local hospital and that they should have a nurses line to advise me.  They didn’t.  I tried the nurses line on my health insurance card.  They told me to go to the ER as I might be having a heart attack.  I didn’t think I was, and I thought an ER visit was “overkill” and a waste of resources (including my time and energy).  I tried paging my doctor again, then eventually I went to bed.

At 6:34 a.m. the next morning my doctor called me in response to the pages.  (The second page had been at about 11 p.m.)  To make a longer story shorter, she told me to come in at 11:30 that same morning, at which time we agreed (for slightly different reasons) that I shouldn’t continue taking the minocycline.  She made a new diagnosis and gave me a topical medication.  When I went to fill it, the pharmacist chatted me up, and when he heard its relationship to the minocycline Rx he had filled for me before, he seemed to recognize the reaction as one associated with minocycline and said immediately that I should avoid the med in the future.  It helped to hear that from him.   (Of course, he and I are old chums after discovering our mutual affinity for the Stop & Shop Friday special on rotisserie chicken.)

I am underwhelmed by a health care system in which even when I have good insurance, I can’t get helpful advice in the situation I was in.

When I told my mother about my adventure the next evening, she said she thought the hospital ER would have gotten excited over the heart attack idea and run lots of tests and even insisted on keeping me overnight.  I hope they could have done a differential diagnosis better than that, but who knows.

I’ve had the opposite experience, though, which was even worse: knowing I was seriously ill and being refused an examination, despite multiple requests.  It turned out to be a post-partum infection and the consequences were terrible, both short term and long term.

So the other night’s adventure was, to be sure, unpleasant, but not horrible.  I write about it mainly to point out that we use the ER in inappropriate ways not just when someone is uninsured — it’s as if it has given us an “out” in all sorts of situations, kind of like that Life cereal commercial in which the older kids have Mikey taste it:  “I know, we’ll just send the person to the ER,” as if there were no downsides to that approach.  And I also wanted to point out that having good insurance may be necessary but insufficient to gain access to appropriate care when necessary.  The system does not work as advertized.  Some of it is less-than-stellar implementation, some of it is structural.  Paging systems break down, 24-hour “urgent care” is not available, a patient’s history does not produce adequate planning for pretty predictable negative outcomes, etc.

Instead of patient satisfaction surveys, the system needs a feedback mechanism to transmit more complex information from people with actual experience of the system.  Actual care providers may have this complex information, too, but I suspect both experts within the private system and policy experts in the public sector don’t.  I sometimes think they want to solve the problems they want to solve, not the real problems that actually exist.

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