Thursday, March 11, 2010

My American Medical Story

It was nearly 3 years ago and I blogged about it at the time. I had suffered from severe headaches for most of my adult life, but on the morning of Tuesday, March 27, 2007, I had a headache for the ages. It came on in the night and no amount of painkiller was enough to stop it. More alarmingly, my vision had become blurred and I was having trouble speaking clearly, although I had no trouble screaming in agony. There wasn't much that Mrs. D could do for me except to get the kids off to school and then get me to the doctor's office.

We'd been through the drill before but after I described the symptoms to the doctor at our clinic, he immediately ordered a CT scan. I'd had a CT scan about six years before but nothing came up. We drove from the clinic to St. Paul Radiology's location in Arden Hills, about a mile from my house. The scan was completed and sent back to the clinic. This time, the news was different. I can still hear his words now. We saw something on the CT scan. The good news is that you didn't have a stroke, but you may have a tumor. You need to get to United Hospital right away. We'll call over there and have you admitted. Can you go right away?

Well, yes, we could go right away. We got down there and I was admitted immediately. Shortly thereafter, I went to the radiology department and had an MRI done. At that point, the diagnosis was provided. Pituitary adenoma. The doctors were concerned about the tumor, which had grown to 2.5cm and was showing signs of bleeding, which would have required emergency surgery. I was admitted to United for 4 days while the medical team put me through a battery of tests. While the need for immediate surgery might not materialize, there was little time to waste.

One of the things that was most impressive about my initial stay at United was how doctors seemed to appear out of nowhere. In the course of the first day I met the neurosurgeon who would later perform the surgery. Then a neurologist arrived, and an endocrinologist and otylarynologist. Finally, I met an opthamologist. I later learned that a number of these doctors were regularly featured on the list of top doctors that runs in Minneapolis-St. Paul magazine each year.

What I learned was about my condition was troubling, especially from the opthamologist. I took a test of my formal visual fields, which measures peripheral vision, both left and right and up and down. While I hadn't realized it, I had lost almost 30% of my visual field, on the top and bottom. While I could see peripherally, the tumor was impinging on my optic nerve and I could not see things up and down. If the tumor were to grow much more, I would likely suffer permanent vision loss.

After consulting with the doctors, the surgery was scheduled for the following Wednesday. The surgery would be a six hour procedure. The otylarynologist (an ear, nose and throat surgeon) would clear a path through my nose that would allow the neurosurgeon to reach and remove the tumor.

The surgery was uneventful and successful. It helps to have some of the best doctors in Minnesota working on your behalf. I spent about a week in the hospital recovering. The timing wasn't the greatest, as it was Easter weekend and I wasn't able to spend time with my family except for a few short visits. But eventually I was able to go home and slowly recover. By the 4th of July, I was healthy.

Three years on, the change is nothing short of remarkable. I rarely have headaches anymore and my vision has returned to 100%. I have no limitations on my physical activities and while I have to take a lot of medications to maintain my hormonal levels, I can do whatever I want. I'm a lucky guy.


So why did I share this story now? I'm concerned. The primary basis of my good fortune is that I had immediate access to a team of specialists in a variety of medical disciplines, who were able to work together quickly to solve a serious medical problem. I did not have to wait for care -- if it had been necessary, I would have been on the operating table the same day as the initial diagnosis. Beyond the skilled and dedicated medical professionals who were available to help me, I also had the good fortune of living in a metropolitan area with a number of top-flight hospitals, all with state-of-the-art diagnostic equipment, including an available MRI machine. We did not have a "Cadillac" health insurance policy -- in fact, we weren't doing so well financially in early 2007. My wife had coverage through her employer, which was a good thing because I had been laid off from my job in 2006 when my employer moved its operations out of state. I had not been able to find a full-time job and my health had been complicating my job search. This diagnosis and the related medical bills could have been catastrophic, but we came out of it just fine. Although we had some good-sized deductibles, we were able to manage the expense. The insurance company paid the bills, which likely ran into six figures, and did not fight us in any way.

There are undeniable problems with the medical delivery system in this country, especially the reality that third parties end up paying for medical services. And it is true that millions of Americans do not have health insurance at any given time.

What we do have an incredible amount of capacity to deliver medical care in this country. I ended up having my surgery at United Hospital, but I could as easily have had the procedure performed at Methodist Hospital, or Regions, or Fairview Southdale, or any number of other hospitals in the Twin Cities. Or I could have gone to the Mayo Clinic, home to some of the best doctors in the world. If I lived just a few hundred miles to the north, I would have had to wait.

Why is that? In Canada, everyone waits. The average wait for an MRI in Ottawa, Ontario is anywhere from 52-173 days, according to this website. There would have been an alternative, which is to have an MRI done privately, but the cost would have been around $1,000, which would have been close to impossible for a guy who was unemployed at the time. I would have had to wait for an MRI and endure more headaches, with the potential that the adenoma would indeed start to bleed and cause other damage. And in any event, as the website notes, there isn't an endocrinologist who specializes in the pituitary in Ottawa, which happens to be the capital of Canada.

Meanwhile, in the capital of this nation, there are politicians who believe that our current medical system must be overhauled. These politicians are currently involved in some amazingly convoluted measures to fundamentally change the medical system that helped me. I'd be willing to stipulate that their intentions are good, even though I'm not really convinced of that. But do we really want to change the system we have now in unalterable, unknowable ways? I would hope that the next guy who wakes up on a sunny March morning with a horrifying headache, blurred vision and slurred speech can get the same level of care that I received in 2007. If we change nothing, chances are he will. If our politicians change our system, good luck to him.


my name is Amanda said...

I'm happy to read that our hospitals, doctors and insurance system were happy to return you to excellent health, really! Insurance has worked great for me in the past as well. But how would this story read for a single mother working a retail job that doesn't offer insurance? (For example.) People who want to revamp healthcare in our country don't want the quality of care or access to change, but there must be *some* solution for the poor, working poor, and even middle class families driven into bankruptcy over medical bills - or using up tax payer money by relying on the emergency rooms as their only source of care, when they can't pay. What do we do?

my name is Amanda said...

"were happy to return you to excellent health" - I messed up that sentence - I didn't mean to write that twice - but you know what I mean, I think.

Mr. D said...


I agree, there must be some solution to the problems you describe. It's hard to see how inserting more government into the equation will improve matters, however. I have another post in mind on this topic that I hope to write over the weekend.

W.B. Picklesworth said...

I think it makes sense to think about how other expensive things have gotten less expensive. CD players and computers used to be ridiculously expensive, but something happened and they became less so over time. It's not an apples to apples comparison, but I think it suggests some principles. Likewise, remember how price controlled items or services in the old Soviet bloc were scarce and of shoddy quality.

The best thing we can do is protect and enhance competition in the delivery of medical services, medical training, medical devices. The worst thing we can do is accept "mandates" which will not have the benefit that is advertised (they won't actually protect care), but they will have unintended (if not unseen) consequences, like higher cost, fewer people interested in practicing medicine, less competent medical staff.

It is not enough to simply desire the end. That's not how economics works.

Mr. D said...

The best thing we can do is protect and enhance competition in the delivery of medical services, medical training, medical devices.


The worst thing we can do is accept "mandates" which will not have the benefit that is advertised (they won't actually protect care), but they will have unintended (if not unseen) consequences, like higher cost, fewer people interested in practicing medicine, less competent medical staff.

That last point is my largest fear. If you are a talented individual and you have the choice of (a) going to medical school and running up huge tuition bills, only to have your ability to earn a living from practicing medicine circumscribed by a bureaucracy on the Potomac, or (b) perhaps joining the well-compensated bureaucracy itself, what would you do? That's the sort of decision our kids will face.

K-Rod said...

Amanda, the story would read about the same for the single mother.


The other issue with ObamaNationCare is the reduction in Reaserch & Development of new medical devices and new medical device technologies.

Night Writer said...

A single mother working a retail job without insurance? She'd get the same care. So would a black, lesbian truck driver, or a Puerto Rican hermaphrodite with "Bush Lied" tattoed on his/her buttocks. Our doctors, nurses and specialists are focused on saving lives regardless of circumstances and the vast majority of the time they're very good at it.

Paying for this care, of course, is an issue. Hospitals do care very much about getting paid, but write off millions of dollars a year in charges for uninsured who can't or won't pay, or "cost-shift" these charges to those who are insured (raising costs for everyone). We had a pretty significant hospitalization once when we had no insurance, a situation that potentially could have run into hundreds of thousands of dollars, yet we received (and perceived) no less in quality of care or attention throughout. (It took a few years, but we did pay off what we owed - with a big assist from God and our church - and the hospital was very gracious about working with us during that time). Whatever it cost, I was very happy to have my wife and daughter alive and healthy.

Our hospitals have two driving motives; 1) to do good (or at least do no harm) and 2) profit. Profit is what makes all the technology and all the specialists and all the care possible - including the ability to focus on item #1. As talented a physician or nurse may be, and as good as his or her heart may be, without the tools and the resources they can do very little.

I believe very strongly that our current system desperately needs reform, but I believe even more strongly that the plans that are being proposed – in one form of single-payer, nationalized health insurance or another – is the exact opposite way that we should be going. I feel that the chances are good that this will be turned away (this time, anyway) but I’m discouraged that the result will be status quo, which is still unacceptable, and that there will be no stomach left for the good fight to bring about real, market-based reform. The Mayo Clinic does offer us, imho, a big headstart on that fight with a common sense approach outlined here:

It should be noted that the Mayo is doing very well under the present system, but it is a credible (if so far largely ignored by the administration) voice for reforming this system. In fact, they have long-since used their experience to make a series of proposals on how to go about doing this, including bringing the market incentives back into the insurance equation — not as a way to increase profits, but to improve healthy outcomes. Right now the only way a health plan or a hospital can improve its bottom line is to “save” money by denying care; a nationalized program would further degrade the system into a lowest-common-denominator approach that rations care. In a fair system, such as the Mayo advocates, where insurers and providers compete for the public’s dollars and confidence (the real “public option” in my opinion) there are rewards for innovation, successful outcomes and a culture of excellence. I hope we all live to see it.

Mr. D said...

Great comment, NW. Agree with every word.

Gino said...

i'm not in canada. but i've been waiting fo an MRI since the first week of january, with no set date yet, although i thought it was going to be febuary.

Mr. D said...

i'm not in canada. but i've been waiting fo an MRI since the first week of january, with no set date yet, although i thought it was going to be febuary.

Things are seriously screwed up in CA, Gino. I had a follow-up appointment with my endocrinologist at the end of January and he scheduled an MRI recheck for me. Had it done the next day. Maybe you need to come to Minnesota, dude.