Wednesday, June 17, 2015

Some Thoughts on Medicine

I have two thoughts that struck me today. (I will explain the background later, when I am in a more even tempered frame of mind. Suffice it to say that, due to circumstances, I was forced to change doctors once again, and all the ills of pain management I described in "Standing By My Principles", "Who Does it Harm?", "It Doesn't Matter to ME..." and "Morbus non Gratus" have come back to haunt me once again.)

First, it has struck me how, thanks to our strange system, where insurance is ubiquitous and prescription requirements make doctors the gatekeepers to required medicines, we have produced some odd and unforeseen side effects. I was speaking to my son about this, and it struck me just how much the current system forces us to treat doctors not as employees or contractors we hire to see to our health (as they truly are), but as masters we pay to get what we need. For example, twice now, I have had pain doctors basically accuse me of being a "drug seeker" (more on that later), treat me in a condescending way and generally act in a way I would not tolerate from anyone, but, because I need medicine to remain pain free and working, I have to accept it. Even if I told them what I think, when I went to the next doctor, he would request my records, and the last condescending doctor's opinion would be there, tainting things and making my next doctor see me in the same light. (I used to laugh at the Seinfeld episode where Elaine wanted to remove the description "difficult" from her medical record. Now I find it a bit disturbingly realistic.)

Or, there were the many times in the past when my pain prescription changed, and the pharmacy refused to fill the new one because my old one had not run out and insurance would not pay. I told them I would pay out of pocket, yet, because insurance said no, in every case, they continued to refuse to fill it.

Nor is it just prescription medicine, though that area is particularly troublesome because not only do doctors have inordinate power as gatekeepers, but they have mixed messages coming to them, as their medical opinion is second guessed by government drug regulators (in the case of pain medication) and insurers, so they often have to go against their own judgment as well.

But doctors also have incredible control over all aspects of medicine in many cases. For example, those who have insurance requiring pre-approval of any specialist or procedure cannot exercise their own judgment, and, say, figure out that a painful back may mean a trip to an orthopedic doctor, instead they have to get the approval of their doctor and then go, and, if their doctor disagrees, odds are good, since insurance has driven prices up to absurd levels, they will be unable to go unless their insurance pays. Thanks to the price inflation brought about by ubiquitous insurance and government regulation, most of us no longer have the option of deciding for ourselves, we must obey the gatekeeper doctor, which puts him in a position of being the boss, rather than an employee, as he logically is. (See "High Cost of Medical Care","Government Efficiency", "Medical Reform, An Overview", "The Absurdity of Mandatory Insurance", "Clarification of my Argument for a Free Market in Medicine", "Preexisting Conditions", "Misunderstanding Profits", "Government Quackery", "Two Examples of "Inefficiency" in Capitalism", "The Devil is in the Definitions (And Assumptions)", "Bad Economics Part 10", "Bad Economics Part 18", "Cutting "Costs"", "A Different Look at "Health Care Reform"", "Reviving Nonsense in the White House", "The Problems With "Safe and Effective"", "Again?", "Collective Ventures Versus Government")

My second complaint is a bit more personal and less broad, but it still seems important. I am sick of the term "drug seeker". Doctors use it in a pejorative sense, to indicate someone is looking for medicine for illicit reasons, but the term somewhat taints every interaction. If I go to a doctor and say I need painkillers, immediately I am a drug seeker, because I asked. And that is wrong.

If a diabetic came in and said he needed insulin, or a woman said she needed birth control, no one would call them drug seekers. But because I am in pain, I have to essentially lie, pretend I don't know what I need, probably even try a number of treatments that have already proved ineffective, all so I can get what I actually need.

I know, I am in a minority in thinking banning drugs is bad, and that it needs no medical justification, that if people want to use drugs recreationally that is no one's business ("Drug Legalization", "The Danger Inherent in Banning "Bad Ideas"", "Guns and Drugs", "Missionary Zeal and Human Discord", "Smoking Versus Sex -- Want and Need Take Two", "Common Sense,Philosopher Kings, Arbitrary Law and Dictatorship"), but, even if you do not agree with me on that position, let me ask you this: Do you think it is a good thing to leave perfectly ordinary people in pain, maybe prevent them from working or caring for their families, which they could do with proper medication, in order to prevent some people from getting high? Is that a good trade off? And if you say yes, then answer one more question, is it working? I mean, I know we definitely are keeping drugs out of the hands of those who need them for pain relief, I have met several and was one for a long time (and looks like I will be one again), but is it really stopping drug abuse? Even reducing it? I know I could find heroin in under an hour given a few dollars, yet I am have an incredibly hard time getting adequate legitimate pain medicine. Does that not suggest our system is broken and we are not succeeding?

Well, I have had my rant. Nothing new, I said the same in "Medical Regulations" and "Medical Regulation II" among others ("Consumer Protection", "How the Government Corrupts Relationships", "Consumer Protection, Cartels and the Failure of Regulation", "Consolidation and Diffusion", "For Your Own Good", "Business Licensing and Regulation", "Inspections, Regulations and Bans" "On the Side of the Angels... Yet Completely Wrong"). And I doubt I changed any minds. But at least it let me get a bit of my stress out of my system, so thanks for reading. Now back to my normal political rants, at least after I get a bit of sleep.

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