Posted on 11/01/2013 3:26:12 PM PDT by 6ft2inhighheelshoes
"I'm still tired, Jay, and I'm scared," said my friend of 15 years. Fatigue is a brutally difficult diagnosis for us doctors to pin down because it can come from any organ systems, as well as from psychiatric sources. The man in question has anxiety, a distant heart attack in the RCA (inferior right side), apnea, inflammatory arthritis, conditioning issues, diet issues, and potential medication side-effect issues.
I have done everything and consulted every specialist. The heart test was equivocal, showing only a subtle difference from the last one. Best practice, as currently defined, is medical management. This in an obese, statin-allergic, anxious, slow-moving guy—but the flow sheets say all you should do is prescribe more pills.
The world of medicine we're moving towards has nowhere for a person like this besides a cemetery, for he would soon be dead or on his way. Life is a percentage game.
I talked with his cardiologist, a man I've known for 18 years, about this difficult case. I informed him of the issues I've ruled out, the drugs I've tried, and the hours I've spent trying to nail down the cause."We know the man isn't lying and we know there is a subtle change in his heart. I can't think of anything beyond a critical lesion just barely presenting itself causing this." Well, this cardiologist is just about the best medicine makes: he's talented and he cares deeply for his patients. He knows I'm serious (about medicine at least) and understands what I'm asking—for him to push the flow sheet aside and do an cardiac artery catheterization.
Well, the call came this morning. Near closure of the LAD from an unstable lesion. This would have shortly blown out the entirety of the left ventricle, resulting in death or the life of a cardiac cripple.
There's no place for people like this cardiologist in this brave new world apart from true private medicine. Luckily for him, he is retiring soon. In the future, who could I call that actually cares?
There is no place for me in the future either if all I do is interface with an intractable system. I won't watch my friends suffer while I'm helpless to do what I think should be done. Single-payer, the ultimate intractable system, is where we are inevitably headed. Single-payer would have such a man die for the greater good of the flow sheet—a man who's only in his sixties, by the way.
Every day that passes makes life harder for me to get things done. The insurance bean counters, the paperwork, the rules, the government. You better have money, brains, good health or connections in this brave new world or you are probably going to die early. But for now, this day, one friend is saved.
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Right on the mark, sadly.....
Great website! Thanks for introducing me to it. And what a great article!
You are welcome!
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