NON-COMPLIANCE IN THE MEDICAL CONTEXT

Last summer a letter arrived from Medicare that urged me to take advantage of a very generous offer they had for me:  a free checkup!  No cost whatsoever, a one time good deal.  So I signed up.  I blogged about the result:  a questionnaire on a laptop administered by two Physician’s Assistants, one with a Ph.D. on health issues and the other a long-time experienced RN.  It was almost entirely about safety issues: did I have a nightlight, any loose throw rugs, etc.etc.  Only at the last moment when I complained, did they actually check ears, throat, lymph nodes, joint flexibility, etc, listen to my heart and lungs.  They never took my temperature, nor did they wash their hands.  I did not undress at all.  I am pre-diabetic but they never checked my feet, and I am fair-haired but they did not look for melanoma.  I was disgusted.

Even more disgusting was the cost:  I had to pay for the blood panel and the new meds suggested. (The Ph.D. was quite trendy and had many non-prescription recommendations -- total OTC cost was about $25.)  In the end, when I objected to some of the recommendations, the Ph.D. said she would no longer write me a prescription for my diabetes metformin unless I did exactly what she said.  I went back to the previous MD to get my necessary meds. (The other PA was only a visitor and did not come back.)

Notice the subtle conflation with patriotism.

Homeland Security is On the Job!

The new trend in medicine is to treat only healthy people and frame it as prevention, which cannot prove effectiveness.  http://www.upi.com/Health_News/2015/11/03/One-in-five-pediatricians-reject-unvaccinated-patients/3661446555850/  From the beginning doctors have been refusing to treat patients who have HIV.  The silver lining is that HIV treatment has been so complex and controversial that specialty docs and practices have developed, but the evil side is that publicly compelled and supported clinics for this epidemic have employed people who associate the disease with stigma welfare and treat their clients with contempt.  The reverse of this medical pessimism and abandonment is a bonanza for cheerful reassuring quacks and those who wish to discredit the establishment -- any establishment.  We are possibly looking at the end of professionals who are well-paid because they are respected and trusted.  Then what will their expensive educations be worth?  The professional medical school people are looting the futures of their own people in more ways than one.

"Do you really need this many books?"

Evidently the strategy of prevention works so well for Medicare that Blue Cross has taken up the idea.   This time they want to give me a checkup RIGHT IN MY OWN HOUSE!!  (They try to mix it with the idea of spending your dying days at home, as no doubt you would wish.)  For years the gas company has been trying to get into the house to evaluate my insulation.  Is the day going to come when they tell me that unless I insulate their way to their degree that they will shut off my gas?  I suspect they will.  Since I have no money at all for insulation, the result will be living in the street which I guarantee will begin to be chilly about now.  (It snowed in the night.  Good thing I hoard windfall branches.)  To be honest, some of my resistance comes from parental instruction to NEVER let the fire department come in to evaluate the house, because the one time they did get in, they were upset by my father's books and papers.

"Do you really need this many books?"

The prospect of some overeducated little princess coming into my house to criticize my housekeeping, my cat wrangling, my eating habits, my assortment of alarms (fire, carbon mono, water rising in the basement) the way my books are on my shelves and WHAT BOOKS THEY ARE -- well, it’s Orwellian, it’s dystopian, it’s quite terrifying.  But they can easily shut off my insurance or even Medicare for noncompliance.  Compliance is the big echo word.  And then the issue becomes who makes the rules to which one must comply.  I have the answer:  Big Pharma. Plus the marketing programs for all those little night lights, alarms, non-trip rugs, etc.  That thing you wear around your neck in case you fall down -- though how helpful it would be if you are unconscious is never discussed.

Will it work in Valier?

If you don’t take your meds, it’s not good for profits.  There is beginning to be resistance to the popular medicine regimes from those who truly understand statistics, all those menacing percentages.  Or at least big questions about the experimental evidence they use to scare us into taking stuff we don’t even understand, to make us eat as they say, give up our naughty pleasures, improve our posture, and all that stuff.  When the statistics are translated, they boil down to years of compliance in order to add maybe two weeks to your life.  Today one of my medical monitoring email sources had statistics about food poisoning that identifies the sacred fruits and vegetables as a major source of food poisoning because of bad handling practices.  There is no money to properly staff the grandiose hospitals enough so that basic cleanliness is provided.

Kevinmd.com  is a daily newsletter for docs.  I’ve taken this doctor’s name off the post, because I think doctors are naive about the consequences of saying these things.  http://www.kevinmd.com/blog/2015/11/emergency-physician-goes-er-shocked-care-receives.html  Even the shocking news that indigent old urban street people are dumped back in the gutter wearing only their hospital gowns and a urine catheter (They did include the collection bag but nothing to hang it on) -- as was recorded by someone with a smart phone -- doesn’t seem to shake some doctors up.  But the real life experience of taking a broken finger to an ER and getting standard negligent care was a shock to this one.

“Well, not only was I billed for an exam that never occurred, but I was billed way too much — totally out of proportion to any value received. The PA failed to examine my hand. . . I sat in the ED for 90 minutes, and no one bothered to ask me where my pain was on a scale of 1 to 10.

“But after 90 minutes, my ibuprofen was wearing off, and it would have been nice to have someone ask — maybe a nurse?. . .[She asked for a Tylenol and was given “Norco” which is acetaminophen and the notorious hydrocodone.]

“For this, I received bills of approximately $1,500.  The hospital customer service representative implied that if I had not been paying the bill personally, the charge would not have been disputed. Well, as a taxpayer, I think it’s time to start disputing these absurd charges. . . As far as the finger exam, it didn’t happen; he never got within 2 feet of my finger. And I never got a reading of the x-ray, except for this: ‘It’s broken.’” 

Let the blaming begin.

The chaplains are now a frill, since faith healing didn't work.

Veterans’ and public health clinics have tried to raise hell, but when one’s life -- not just a finger -- is at stake, it tends to dampen troublemaking.  So many of the people who work in hospitals are low-pay, low-status, unempowered people that they don’t report what they know.  Doctors themselves are no longer a unified body and the younger ones work in chains of debt.   Chaplains, who used to be a monitoring body (though they were intended to encourage compliance) are no longer on the scene.  Much of my attitude comes from what I saw as a student chaplain.  Now, following on the heels of bakers who object to providing same sex wedding cakes, come doctors who will not treat people whose religion is different from the doctor's.  Lepers?  Same sex conjugal bacteria?
http://religiondispatches.org/philly-gives-doctors-wide-leeway-with-religious-exemption/?utm_source=Religion+Dispatches+Newsletter&utm_campaign=e3d5b2c753-RD_Daily_Newsletter&utm_medium=email&utm_term=0_742d86f519-e3d5b2c753-42405913

The idea of the visiting nurse --  even a doc who makes house calls as I remember from my childhood -- sounds so reassuringly retro.  It never enters most heads that some people have no residence. Couch-surfers, dumpster-dwellers, students who live at the library -- they may be the most needy of care.  I’ve always admired the tough public health people who get TB and AIDS meds to the coyote-hole dwellers under bridges and in abandoned houses.  They actually manage to DO it.  Or did.  Are there any of those people left or have they been unfunded along with everything else?

On the same newsletter was a story about how the death rate among middle-edged prosperous white men is rising.  Mostly due to suicide and alcoholism, including many doctors.  In spite of being tightly supervised by their high-cost insurance programs.  Fat lot of good it did them, eh?  Take notice, politicians.  Suicide and alcoholism are noncompliant afflictions.

When one decides to be a hell-raiser who longer eats shit, first you have to check your gut about the reactions of those around you to make sure you’re not just making trouble for its own sake.  But once you get past that, the next step is harder.  You have to face the possibility that you might die.  Or suffer, whether or not meds and attention may be withdrawn.  They won't realize you're smiling because you don't want shit on your lips.