Sunday, October 7, 2007

Musing on healthcare

Last week I had a sore throat. I believe it was strep. I will never know for sure though.

See I'm not a fan of sick days. I pride myself on not taking them. I found a walk in clinic on Wednesday that I thought I would be able to make it to after work. I was not able to. So I decided Thursday to make an appointment with my physician.

My physician is actually an APN. Her name is Emma. She works in a practice under the supervision of a Doctor. The first time I went to this office I was given Emma. My experience was good so I always request Emma when I sign the clip board when I go there. Of course I've been there about three times in 5 years, twice in the same month, so it would be wrong to call her my regular primary health care professional in any other sense than she is the one I would go to if I went to the doctor for checkups.

They had no appointments available that day. Friday's I work from my girlfriends house and the distance prohibits me from seeing Emma that day. So I call a doctor's office in my girlfriends neighborhood I used once.

The doctor himself picks up. His receptionists apparenty stepped out. I ask to make an appointment on Friday. He claims he is closed on Friday but can fit me in today, Thursday. I say that is not possible for me. I inform im I believe I have strep throat so I ask him to recommend a walk in clinic of some sort where I can get the back of my throat swabbed. He asked if I had ever been to him. I say yes and he says he will have an antibiotic and a cough suppressant prescription sent to the local Walgreens for me to pickup. He then gives me the standard "are you allergic too?" litany of questions. Other than my concern for overuse of antibiotics I'm quite happy with this arrangement. The only negative is that the cough suppressant contains codeine and therefore is only good to me during the nighttime if I wish to function.

So this got me thinking of health care. Being I am in the last developed country in the world to my knowledge that has something resembling free market health care and I am a die hard capitalist, I do this a lot.

The big question is why can I not just buy a strep throat test like a pregnancy test. Its a simple enough idea. Sell the things that the doctor uses to the general public over the counter. Their disposable and benign. If I don't have a strep throat I save a visit to the doctors and everyone besides the doctor wins. Being doctors are just powerless cogs in the health care machine, there is no one in power that would stop this.

Secondly I got thinking about the cost of drugs. The problem with the cost of drugs is that pharmacies have greatly varying prices, and doctors don't have any idea what the drugs they prescribe actually cost, and prescribe whatever the drug sales rep pushes for them. I think the doctor that wrote me a prescription over the phone is not a victim of this. The cough suppressant appeared to be a generic and the antibiotic was. Also the cost for both at Walgreens before I gave them my insurance card was $69.99. Thats hardly what I would call unfordable health care.

Finally I was reminded of one of the greatest quandaries of health care I have ever had.

When I was a child, my health care was provided by a team of pediatricians at a relatively large office. There were 3-5 doctors employed by this practice at any given time. So it was small enough where my doctor knew me, but large enough where they could have a small lab onsite. One of the things in this lab was a centrifuge for doing bloodwork. I knew my cholesterol within 15 minutes of getting pricked when my parents took me for a checkup. However, when I had strep, my parents would get called a few days later after they looked at the culture.

Fast forward to adolescence. I went to a general practitioner, this was not Emma but another doctor. Most of the other patients were at least 30 years older than me. First time I had strep I knew right away. But she sent blood tests out to a lab so I had to call to get results.

This has always bothered me. Unless my switching physicians coincided exactly with the invention of the quick strep test, there was no reason for my pediatrician to still use the petri dishes. The new tests were faster and required no capital investment. You buy tests and you buy swab. Both are disposable items. Now my general practitioner, probably had more patients with high cholesterol than my pediatrician. Could she not afford a few grand for a centrifuge machine to be able to get people instant results.

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