My doctor, my friend?

“Don’t you feel violated?” Peggy asked when she saw the bill, $250 of it for glancing up my nose.

I feel violated every time a doctor’s bill comes, but $250 for a ten second glance up the old snoot does give the phrase pay through the nose a whole new meaning. The average medical specialist makes more money for the few minutes that he spends with the average patient than a minimum wage worker makes all week, and more than what most everyone else earns all day. American doctors make nearly twice as much as doctors in other “developed nations” (see first graph), and their fees are increasing at seven times the overall cost of living, yet America is falling further and further behind in life expectancy (see second graph) and nearly every other measure of quality care. Over the past several weeks, I’ve felt cheated by six doctors and a dentist (I paid $520 last week for two small fillings that took 25 minutes total), and it doesn’t set well. In fact, I’m enraged. I mostly get along well with doctors, but it isn’t because I respect them, but because I want to get the best service for the least aggravation. Besides, they would charge me for the time I spent complaining that they overcharge.

Doctors argue that they deserve their inflated salaries and more too* because they went to school for a long time, but doctors in other countries go to school for a long time without feeling the need to charge so much that millions of people (most of whom have insurance) can’t afford them (“In 2013, 37% of U.S. adults went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs, compared with as few as 4 percent to 6 percent in the United Kingdom and Sweden. **) “Only in America, land of opportunity…”  Yes, only in America, a nation that considers it no more immoral to deny someone medical care than to deny her a yacht.

Regardless of what a few politicians might say, under the value system by which America lives, whatever you can afford, you have a right to, and whatever you can’t afford, you don’t have a right to. For example, millions of Americans oppose abortion on the grounds that life is sacred, yet those same people--and the country itself--base one’s post-birth right to life on personal wealth. It is for this reason that, when we refer to a person’s worth, we follow the word with a dollar sign. “Mitt Romney is worth $250-million”; “Joe Blow is worth $500.”

Do you ever wonder why the number of years a person goes to school should be the determinant of his or her income? Why not pay the most for the jobs that are the dirtiest, or most dangerous, or most boring, or the hardest on a person’s body? Watch a carpet installer crawl around on a floor, breathing filth from the carpet he’s taking up, and dust and formaldehyde from the carpet he’s putting down by kicking a stretcher with his knees; and ask yourself how long anyone’s body can survive such work, and reflect on the reality that, when his body gives out, he’ll be facing decades of pain and disability without adequate medical care.

What follows is a further sampling of my problem with doctors. They provide an essential service, but they don’t compete cost-wise, and if you can’t afford insurance, they charge you more because you lack the clout to negotiate their fees. With or without insurance, a doctor won’t see you without charging you hundreds of dollars, and you can’t decide if a particular doctor is right for you without paying it. To make matters worse, it can take months to get in to see a specialist, only to find him in such a hurry to get you out again (20% of physicians see more than 100 patients a week***) that it destroys any hope you might have had that he would care about your welfare. If worse comes to worse, and you mistrust your doctor to the point of wanting another, you have to start the wait--and pay the hundreds of dollars--all over again, and that’s assuming that every area specialist of the type you need doesn’t work in the same clinic, in which case, they won’t allow you to see another doctor because they care a great deal about their egos and little about your health. In short, a patient’s relationship with a doctor is one in which the doctor holds all the power and comes out richer no matter what, while the patient, more often than not, receives inferior care and is forced to pay through the nose for it. 


It’s not by accident that when a person’s independence, self-confidence, and bank account, are assaulted by bodily failure, they are also assaulted by the very people he or she turns to for help. It serves doctors well for their patients to regard themselves as beaten, helpless, compliant, ignorant, out of their league, and dependent upon their betters, because such patients will accept rudeness, arrogance, and substandard care as just the way things are, and pay their bills without complaint. I know from experience that it gets ever harder to fight the system when your days are filled with pain, you’re unable to work, your mind is increasingly befuddled by drugs, and your life savings are being poured into the pockets of people who don’t need them. My greatest problem with every serious health problem I’ve ever had wasn’t the problem itself, but my impotent rage at my supposed caregivers. Considering that I’ve been through, that’s quite a statement, but the truth of the matter is that an injury or an illness isn’t rude, pompous, greedy, or callous, and it won’t betray me for money. 

As bad as it sounds, the truth of the matter is that every time I hear of some mass murderer shooting shoppers, theatergoers, or school children, I wish the dead had been doctors because their greed has put blood on their hands, and their callousness constitutes a betrayal of their medical oath. According to the first-person accounts I’ve read, even doctors come to hate doctors when they are ones who have a severe enough problem that they’re able to get an outsider’s view of what a nightmare it is to profoundly need someone only to find that his or her main concern is with running up a bill. Yet, the situation wasn’t always this bad. $5 to $10 for an unhurried doctor’s appointment might have represented a lot of money when I was a young man making a buck-ninety an hour (30-cents above minimum wage at the time), but it was nowhere close to the $350 quickies that I’ve been paying for recently. Specialists in America make twice as much**** as general practice doctors. They also look down upon them nearly as much as they look down upon their patients, and they dump as much of the low paying work on them as possible. This is why most of my complaints are about specialists. They are to other doctors what a rabid wolf is to a Pekingese.

For reasons that completely escape me, when the already exorbitant and ever-exploding costs of medical care are discussed, doctors rarely receive any of the blame. Liberals blame Big Pharma and Big Insurance (“The U.S. spent the most on insurance…$606 per person, compared to $277 in France and $266 in Switzerland, the next-highest countries.”*****); conservatives think that everyone should make all the money possible by any means possible so that some of their wealth will trickle down to the little people (meaning leprechauns, I suppose); and doctors are perpetually rated by both groups as belonging to the most respected of professions. What the hell is there to respect?

Call me a damn fool (it wouldn’t be the first time), but I think we need universal medical care or, at the very least, price controls. If the government has an obligation to cap what the utility industry can charge for an essential service, surely it has an equal obligation to control the medical industry, but to do so, it must rid itself of the notion that those who can't afford the cost have no more of a moral right to healthcare than Donald Trump has to another  mansion. 

*http://medicaleconomics.modernmedicine.com/medical-economics/news/survey-report-what-doctors-want-most-practice

**http://www.commonwealthfund.org/Publications/In-the-Literature/2013/Nov/Access-Affordability-and-Insurance.aspx

***http://www.medscape.com/viewarticle/782575_1

****http://www.beckershospitalreview.com/compensation-issues/200-statistics-on-physician-compensation-2012.html

*****http://www.commonwealthfund.org/News/News-Releases/2013/Nov/New-11-Country-Health-Care-Survey.aspx

Here are two more links.

Doctors’ salaries: http://www.healthcare-salaries.com/physicians

Healthcare Costs in the U.S. compared to other countries: http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html

“There's a road to everywhere except where you came from.” Bryan Charles

“Miss you....and worry about you...and miss you....”

It's one hell of a brace for an atheist.

I hope you like my new Goodwill PJs.

I don’t like talking about my health endlessly, but enough people have inquired that I feel badly for not checking in sooner. I have written a few posts about other things, but didn’t use them because I don’t trust myself to make sense. I thought I had done pretty good on a business letter, at least, only to be so embarrassed by it later that I wouldn’t even make a phone call for days. My memory is shot, and my thoughts run in non-sequiturs that I’m unaware of until later when they don’t make sense even to me. Making sense of other people’s thoughts is just as hard. I can read an email repeatedly and come away with a different interpretation each time without being able to understand how I arrived at previous interpretations. I think the Fentanyl might be to blame. The drug makes me delightfully high when I increase the dosage, but after a day or two I can’t tell I’m stoned until I try to think clearly. 

I’m taking naps for the first time in my life, sometimes two hour naps, two and even three times a day, but I’m still sleeping good at night until the customary pain in my shoulders awakens me. I often go to sleep during the day even when I don’t want to, which is something I’ve never done. I’m down six pounds, and, for the first time I can remember, am going days between showers.

Any medical bills accrued in January, I’ll have the pay the first $4,000 of (I go on Medicare in February, so that problem will go away), so I’m determined to not go to any doctors until February. My back doctor offered to see me for free if need be, but I’m optimistic that it won’t come to that, because I’m not doing anything to hurt myself. The urologist said the thing on my left kidney probably isn’t cancer, but there’s no hurry if it is since kidney cancer usually originates in the kidney and grows slowly (I didn’t ask him why a cyst three inches across couldn’t be a sign of advanced kidney cancer). The crushed thumb is healing nicely except that my sensation of touch is abnormal. The last time I saw my internist, I wore a big wrist brace and an arm sling along with my back brace and the large thumb bandage. I did this as a joke, because the time before last when I saw him, I was there for a broken back; then a week later, I came in for a crushed thumb, and he had kidded me about what I might do to myself next.

When he saw me in my sling, the two braces, and a large bandage, he asked what the hell had happened, and I told him the following, “I got bored—what with a broken back and a crushed thumb—and went for a ride on my high wheel unicycle. I was doing okay until I came to a steep downhill, and a squirrel ran out in front me halfway to the bottom. I tried to dodge the squirrel, but there was still ice on the road from the big snow, so I lost control and broke my wrist and shoulder.” It was late on a Friday afternoon when I told him this, and he just stood there with his mouth open, obviously tired and clearly at a loss for something to say to someone so unutterably stupid. I saw that things weren’t turning out funny like I intended, so I let him off the hook, at which point he pretended to have been onto me all along.

I can do light housework (dusting but not vacuuming, straightening but not lifting, and so forth), but I can’t seem to get it together to do it because I know the job would be half-ass when I was done, and because I would be putting myself in a position where I was constantly having to hold back, and that would tempt me to push the limit. I can do work on the computer, but that makes me stir crazy after a while. I’m not supposed to bend over or lift more than five pounds, so that eliminates damn near everything that I would call real work. I feel like a woos for lying around all the time, but I’m clear that I could worsen my condition quite a bit if I overdid something, and that makes me afraid to do almost anything.

I wish I could at least enjoy the drugs more. Marijuana had gotten to where it was pushing me ever more deeply toward psychosis, so I stopped it about four months ago, and now even Fentanyl won’t get me high unless I take so much that it might kill me, or else I combine it with liquor or oxycodone. I can understand how a lot of people die from narcotics, not exactly on purpose but not exactly by accident either. Not that I’m there or anywhere close to there.

The back doctor says that I should come through okay, although I’ll never be as good as new, and I might have to live with intermittent pain. I’m used to pain, so pain per se doesn’t scare me. It’s rather a question of how much pain. I have a limit, but I think that’s true of anyone whether they realize it or not. Most people seem to think there are drugs that will greatly reduce any amount of pain, but they’re wrong, and, of course, drugs have their side effects, and they can be hard to come by, what with doctors running scared that the Feds will raid them if they prescribe more than some drug cop—who makes his living raiding doctors—considers appropriate. Fentanyl is top of the line, and I tolerate it well, so I’m lucky to have it, but I know I won’t be able to keep getting it, and that’s a little scary right now if only because of possible withdrawal symptoms.

My stratagem regarding narcotics is to get all I can while I can because I never know but what I can’t get them at all tomorrow, although I might need them more then than I do now (if you ever need them, and can’t get them, you become almost phobic of being without). I doubt that it’s generally known that most heroin addicts start with legal narcotics, and only turn to heroin when their legal supply is cut off, and they find that it costs more to buy legal drugs illegally than it does to buy heroin. The system is set-up to make people feel weak and dirty for needing narcotics anyway, so that probably makes the transition a little easier...

I’m tired of sitting here, so I’m going to take some oxycodone and clean house...I think it’s it fair to say that I’m pretty bummed about my situation, but, hell, it’s winter in Oregon, so I would be bummed anyway. It’s impossible for me to sort my feelings out cleanly.