How often do we have this interaction: “My wife was here yesterday for belly pain. That doctor didn’t do nothing! Told me she just needed to get over it. I am not happy and something needs to be done about this!”
(Frequently spoken by spouse.)
Records are reviewed. Treatment: Included numerous doses of morphine and phenergan, as well as fluids and Zofran. Frequent warm blankets were applied. Labs included: CBC, comprehensive metabolic panel, lipase, urinalysis, pregnancy test. All negative. Imaging: CT scan of abdomen and pelvis with contrast, followed by ultrasound of pelvis. All negative. Discharge medications: Hydrocodone, Naprosyn and Phenergan. Discharge follow-up: Despite lack of insurance, an appointment has been arranged with general surgery (or gynecology) who will see the patient in one week, whereas it would normally take eight.
When confronted with this fact, patient and family say: “Well yeah, they did all that. But nobody did anything!”
It’s a peculiarity, I suppose, of our society that even the most aggressive, compassionate and thorough care is considered “nothing.” Perhaps it’s frustration, or perhaps it’s a need for more prescription medication. Maybe it’s all somatization. But on some level, I have to believe that we have transcended “science.” People simply don’t believe in the wonders and effectiveness of the very system they count on every single day. And in a subset of the population, there are two other phenomena.
One, the striking disappointment that seems to emerge with negative CT scans or tests. As the husband of a cancer survivor, a negative CT scan is enough to bring me to my knees in songs of praise. To many, it’s simply a failure. Two? This is tricky. But when you don’t feel the cost of any procedure or test, whether because of outstanding private insurance through an employer (typically a public employer), or through Medicaid, the value of the testing, the treatment, the thought processes involved, can all seem as cheap as dirt.
Odd times indeed. The more we do, the less we are perceived to do.
Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test and Life in Emergistan.
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