I just got back from the ER with Ezra who is having a bout of croup. While I was sitting there, I had a lot of time to think, mostly about how our health care system works, or doesn’t depending on your point of view.
I knew going into the ER what we were dealing with because croup has a very distinctive sound, but since Ezra was having a hard time moving air into his lungs, and since his lips were turning blue, I figured he couldn’t wait until tomorrow to see the pediatrician. Luckily, the hospital is close and we were able to be seen right away. The PA came in and had a listen to his chest and throat. He said, “yes, it sounds like croup to me. We’ll give him some humidified oxygen, and some oral steroids, and I’ll do a throat culture to make sure there isn’t an infection. He’ll be fine.” So, imagine my surprise when, about 10 minutes later, 2 x-ray techs came in to take Ezra for a chest x-ray. “Really?” I asked. “Yeah,” one of them replied. “The PA just wants to make sure his lungs are clear.”
Now, I have no problem getting tests done if they are warranted, but the PA just got finished telling me that Ezra’s lungs sounded clear and he was pretty confident that it was croup and not pneumonia. What bothered me the most is that he just ordered the test and didn’t even mention it to me, so when the x-ray techs came in to wheel Ezra away, I didn’t really have much say in the matter. I would much rather have had the PA discuss it with me before hand. I probably would have opted out, saving a chest x-ray for if his cough got worse.
I know a large part of it is that the PA was covering his butt because we live in a litigious society, but the other thing, the thing most people don’t think about, possibly the real reason that so many tests are run, is that money for health care is largely seen as someone else’s. People say, “well, my insurance will cover testing, so go ahead and run every test imaginable”. But in my case, insurance will only cover 80%. Which means I’ll end up paying 20% of the bill on a chest x-ray I’m not convinced was needed. If the PA had just talked to me about it, made me a partner in our health care decisions, we could have saved me, and my insurance company, a little money. Not to mention, we could have spared Ezra (and me!) a hefty dose of unnecessary radiation.
I admit to being a huge socialist when it comes to health care. I honestly believe that we need to have a national system similar to that of Canada or the UK. That said, I also think it would help a whole lot, even within our current system, if, rather than being mindless consumers of health care, we became educated, active participants. And yes, I mean health professionals, too. If they were to stop treating patients like uneducated brainless idiots and actually had a conversation with them about their options and the reasons for doing things (or not doing things) I imagine we could make the health care system just a little less of a money pit.
The good news: Ezra will be fine. I can hear him in the living room right now, fighting with his brother.
Poor Ezra! Maybe the unnecessary radiation will give him cool super powers when he’s older, though.
…also, I like how you had a camera with you on your trip to the emergency room.
why, why, why do those big huge beds have to make our babies look so very, very tiny???? lots of get better vibes from us to the big E! let me know if we can get anything for you guys so you don’t have to go out.
OMG Poor Ezra! Im glad hes ok. Otherwise, fucking doctors. another reason why he wanted that test? MORE MONEY. Fee for service, after all. fucking doctors should be sued for GOUGING, not only the patients (parents) but the insurance companies also. Litigious society or not, over-testing is a major part of the whole damn mess we have as it is.
Your blog is always so cool. Now face it. You love treasure hunting on the internet. ;-)
About the x-ray – you ALWAYS have a choice and can refuse. If that makes you a pain in the a%#, so be it. Then the PA will have to come back and discuss it with you.
I once had some persistent back pain. The physical therapist said he really thought it was muscle spasm but should see a specialist. The specialist did an x-ray, examined me and said it was a muscle spasm but ordered an MRI, just in case. I did not have the MRI as it was clear to me that it had been ordered to “cover butt”. (I’m fine)
I’m with Patty on this one. You will likely catch a medical professional completely by surprise when you do it, but you absolutely can tell them “no”. Medicine is a product or service just like any other. Most of us would not hesitate to tell a stylist “no” to highlights or a perm if we didn’t want them.
Also, I have learned to ask what test alternatives are available and the pros and cons of them and what will be learned. My main doc is very good about keeping testing to the minimum, but the couple of times I have gone to the ER, they wanted to test some very strange (relative to the cause of the visit) things. It was interesting to see how many tests became “not really necessary” when we started asking questions.