The insurance and government dominated system is failing our patients. A physician friend of IP4PI shares this shocking example about the system claiming another victim:
A 59 y/o man presented to my last employed practice, with an almost elephantiasis swelling bilateral legs. He had pinpoint marks on the skin of his legs. He held up a jar with what looked like a couple of tiny maggots. He said, these come out of those holes every so often. I said how long has this been going on?? He said 1.5 years. “I’ve mentioned to several doctors, they just shrug and don’t do anything.” I said we would do something, and called the hospitalist immediately to admit for workup and treatment. I was directed to the nurse gatekeeper for approval for admission. What’s wrong, she asked. “4+ edema in both legs, which are also full of maggots.” Hmmm, she said. There is no medicare admissible diagnosis of ‘maggots in legs’. What about his rising creatinine of 1.7? Not bad enough to qualify under guidelines. Call us back if it gets worse. I did try to do some outpatient workup, but I think the man was disgusted. He never followed up. He was dead within the year.
A friend of IP4PI shares the story of another victim of government and insurance run medicine:
A 40 year old female, patient of mine in a previous practice, returned to me in my DPC practice. Her husband once had a good job and insurance, now with cardiomyopathy, and she is on medicaid. She returned to me with a 1.5 year history of intractable nausea and vomiting. I reviewed 800 pages of records. She had been to the ER 40 times, admitted 20. At 90% of these visits, she was misdiagnosed as having cyclic vomiting syndrome, given IV fluids, Reglan and antiemetics, and sent home. Buried in the 800 pages I found a markedly positive gastric emptying study. She has now been to the Cleveland Clinic, has received the correct treatment for her gastroparesis, and is finally improving. I guessitmate over $300,000 was spent on her (mis)care, when the proper care could have been given for well under 1/3 of that.
A friend of IP4PI shares this real life tragedy:
My good friend’s (deceased) son died in 2015 of MI at age 37, having visited the ER, one hospitalization, and his primary care NP 25 times with symptoms. Although his symptom complaints were by no means classic for coronary disease (that’s why we make the big bucks, right?), they included chest and arm pain, shortness of breath, fatigue, nausea and dizziness. I reviewed 1200 pages of records for the family. After one negative stress test (and a number of other noncardiac negative testing) he was told repeatedly that he was “anxious”, and sent home again and again with a benzodiazepine prescription. At every ER encounter, he was asked such government inspired questions as “Is your spouse abusing you?” (this was a strapping young construction worker), and told at the end of each visit to “return if you have concerning symptoms” (he did, 18 times) but only ONCE did anyone document the fact that his father had an MI in his 30’s !! He had an 8 year old son, whose mother is out of the picture, and a girlfriend of 7 years. They were married on Valentine’s Day, 2015. On March 28, he called the life squad again, telling them “I feel like I’m going to die!!” He was taken to the ED, told again he was anxious, sent home with Rx. On March 30, while making love with his new bride, he had chest pain. Squad called. His widow played the 911 recording for me. As she pleads with them to hurry, he can be heard yelling to them in the background: “I told you there was something wrong!!! I told you!!!!” His last words. Then he vomits and dies. For me, this case could not be more clear. His dad was cared for by unfettered professionals (1980s), who correctly diagnosed and treated him, and he never had another heart problem. 30 years of ‘progress’ later, his son was misdiagnosed and mistreated by “providers” directed by Washington and insurance companies. He is dead, his son orphaned (his widow has now gained custody. Despite whatever risk it might entail to her lawsuit, she is willing to speak publicly about this, in hopes of preventing similar tragedy for others.) Note that U.S. life expectancy fell in 2015, for the first time since the AIDS epidemic.
A friend of IP4PI shares yet another VA failure:
A VA patient came to me with a one month history of RUQ/R lower ribs pain. The VA had diagnosed him with “constipation” and prescribed laxatives, but despite a thorough bowel emptying, he was no better. I started with, “How did this begin?” He said he was shoveling some gravel on a hilltop, slipped and tumbled down. He had a rib fracture! I used to work at the VA, so I know how this went: “I’m having pain here (under R ribs) and..” (doctor staring at computer, knowing someone in admin is watching his screen too, making certain he clicks all the right boxes, so they get their bonus checks) “Yes, yes, RUQ abdominal pain. We’ll do an abdominal film” Showed constipation. Prescribe laxative. Next.. Most lay people can tell the difference between a fracture and a turd, but not (turns out) a doctor with their face in a computer and a gun to their head.
“I spoke to a friend…who is about 50. She is a psychiatrist who works part time and had to submit her “retirement” this year. Her husband who works full time is no longer covered by his employer for insurance so as I understand it, she decided to stop working so they could make less than $60,000 to qualify for one of the lower deductible ACA plans. So we are losing another physician to Obamacare.”
Posted with permission
“45 year old man. Known ophthalmic ICA aneurysm. Presents in 2014 with worsening headaches and blurred vision. Neurologist orders MRI March 2015. Neurologist RETIRES. Patient gets MRI November 2016. Canada.”
A Canadian physician writes: “54 year old woman. Diabetic, hypertensive, high cholesterol. On Atorvastatin, Ramipril, Metformin. Presents to me with HbA1C of 8.9 – I adjust Metformin. Next visit, HbA1c is better, closer to 7.8. But BP is 190/100. I adjust the Ramipril. Next visit A1C is 7, BP is 135/80. Patient tells me not to check cholesterol. Because, she finally admits, she can only afford 2 out of 3 medications at a time, and she’s picking and choosing which ones to take depending on how horrified I am at the visit. But the cholesterol drugs are so expensive and her heater broke, so she needs a new heater, and she doesn’t want to know my reaction if she stops her statin.”
Posted with permission from the across the border