Wellness & Prevention

When I first wrote about this elsewhere a few years ago, few people had experienced what I was talking about. Now, a lot more people have run into this phenomenon as primary medical care changes over to “preventive” services. The following is a fictional account, but it bears resemblance to actual experiences.

A trip to the doctor’s office nowadays:

Doctor: “Hello, I’m Dr. Smith. How can I help you today?”

Patient: “Well, I’m here about my foot. As you can see, it’s swollen and black and blue. I tripped going up the stairs a few days ago, and it’s steadily gotten worse.”

Doctor leans over to look at the foot. Winces. “Uh-hmm." Straightens up and focuses on patient record. "I see here on your record that you’re a few months overdue for your annual PAP smear. Lets make sure you get scheduled for that before you leave.”

“Um, we’ll see. Now, about my foot…”

“Yes, it does look bad. Maybe you should elevate it.”

“I have been every chance I get.”

“I see here on your blood tests that your blood sugar is nearing the pre-pre-diabetic stage. We’ll need to schedule a series of tests to see if you might be a good candidate for medication.”

“You know, my foot really hurts.”

“Hmm, yes. Oh, I see here that you haven’t had a mammogram recently. Just tell the receptionist and she’ll get you set up for one.”

“Look. I’m having trouble working because I can barely put any pressure on my foot. I can’t even get my shoe on. I’m afraid that I might have broken something.”

Doctor shrugs. “Uh-hmm. Now, I’m concerned that your cholesterol numbers are little on the pre-high side. We’ll need to monitor them every month to see if you might be a good candidate for cholesterol medication. You don’t want to develop heart disease now, do you?”

“I came here to get help for my foot. It’s very painful. I’m getting really concerned. There’s a red streak going up my leg. I’m scared.”

Sighs. Rolls eyes. “We’re getting away from the disease treatment model. We’re a wellness organization now and we focus on finding diseases you don’t have yet.”

“So what about my foot?”

“We want patients to take responsibility for their health and realize that there are consequences for poor decisions. You really should be more careful, you know.”

“Do you mean to tell me that I can’t get treatment for illness and injury here anymore?”

“We believe that prevention is the very best health care. Make sure you see the receptionist about scheduling those tests on your way out, after you pay your bill. Nice talking to you. Goodbye.”

“But what about my foot?”

“Oh, and don’t forget that mammogram. You don’t want to get breast cancer, do you?”

Dr. Smith disappears.

“Hello? Anyone?”

Unspecified assistant-type arrives.

“Miss, we need you to leave so the next patient can come in. Do you have any questions before you leave?”

“Yes. Can you point me to the nearest Emergency Room?”

Politics As Usual

I did my very best to avoid the As the Stomach Turns/Debt Ceiling Follies headlining the DC Congress-theater this summer. I did not succeed. Everywhere I turned there was a new headline blaring the latest installment of Budget-Hostage Negotiations: 2011.

I didn’t agonize over “will they/won’t they?” I already knew the ending. The debt ceiling would be raised, just as it has been every year since it was “established”. I viewed it as history repeating itself. It reminded me of the “hold the budget hostage’ follies in the mid-1980’s, (and mid 1990's and...) when federal paychecks were delayed so they could be added to the next year’s budget instead of the current one. That clever accounting sleight of hand sure fooled everyone, right?

And then a really appalling realization hit me: I’ve been around long enough to see history repeating itself. I have been around long enough to conclude that things will never change. The players may change, but the nauseating show just goes on and on and on.

I used to believe that Congress was making progress in running this country. Now I don’t think they’ll ever fix anything. They’ll only make it worse.

I’ve come to appreciate the irony applied when naming new laws. I know that one (hypothetically) named “Widow & Orphan Assistance Act” would ultimately cut benefits to widows and orphans while increasing subsidies to life insurance companies. I know that one (hypothetically) named the “Automobile Safety Act’’ would have little impact on passenger safety while making sure that well-connected car makers are safe from competition. Wonderful, wonderful irony.

Whatever moniker they give a bill, I assume it achieves the opposite. Makes life simpler. That way I don’t get my hopes up.

I know I’m echoing almost any member of the populace who’s been paying the slightest bit of attention when I express my disgust with the latest show. Few of us have emerged from this travesty without a really bad taste in our mouths. It has been one of the most depressing episodes of As the Stomach Turns in recent history.

Beer, anyone?

Nah. I think this calls for Tequila.