Mentally, I’ve been away.  On a vacation where I’ve prioritized my health above all; rather, my health has forced me to pay attention to my body, and nothing else.  This explains why, since Wednesday night, with brief forays into trying to go to work (with varying degrees of success) I’ve not been up to my usual bloggity self. 

My health care, and my treatment options, have led me to think at some length about the health care legislation Obama is trying to pass, and the mess our insurance companies have us in.  I have reasonably fair insurance.  That is to say, I have to pay $50 to go to a specialist, but I can get any care I need, my prescriptions are affordable, and I can fight to get coverage for things that are medically necessary.  I am lucky.  In facing my choices this week, I began to realize what would happen if I did not have choices, or if my insurance company tried to make them for me.

Option a) Take medication, which would probably cost me $8-10.

Option b) Have a “minor” procedure, which falls under the subheading of “minor surgery” which involves “general anaesthesia” and other things in “quotation marks”. 

I chose the medication.  And I’ve been in acute pain or discomfort all weekend long, unable to sleep, distracted when I tried to go out and do normal people things, and bound to the couch or bed for much of my waking hours.  Then I went to the doctor yesterday, who informed me my condition had not completely resolved and I have to go through a modified version of the medication again.  I asked myself if I’d made a bad choice.  Didn’t I choose the “responsible” thing, the thing with less burden to myself, my loved ones, my insurance company, the hospitals of this country, and the doctors who are now free to attend to emergencies?  Didn’t I choose the thing that should be effective enough in most cases that people with my condition shouldn’t have to go under the knife?  My choice didn’t take up a hospital bed, require the attention of several doctors, nurses, and support staff, make tall piles of paperwork, or cost me more, yet I still question it, as I sit here in still more, unrelenting pain. 

Had I opted for the surgery originally, I don’t know what the outcome would be.  Would I even have a surgery date yet?  I hadn’t even bothered to find out what my copays would be for an inpatient “procedure”, nor what the recovery would be like.  I don’t know if the pain level would be any better, or how long I’d miss work recovering.  I didn’t ask about any of these things because surgery — minor or not — is not something I go into with a light hand.  Less work for me?  Less time in my home in pain?  Nurses with real pain meds at the press of a button?  I just didn’t consider it. 

But I’m glad I had an option.  There are those who would rather take the medication, and deal with the side effects at home, with loved ones there to bring them tea or ice cream, and a sympathetic dog to bring comfort and warmth.  There are those (perhaps without such soothing animals or attentive humans) who would rather have their issues taken care of medically, surgically, hospitally, with as little patient involvement as possible.  But we need that choice.  Medicine is not just about money ($8 pill vs. thousands for a hospital procedure), nor about efficacy (and here I have no idea how effective the two treatments are). 

They talk on the TV, on the radio, in the newspapers about the blue pill and the red pill.  If for 95% of the public, the blue pill works great and costs less, then fantastic!  But for the 5% who cannot tolerate the blue pill, or for whom the blue pill does not work, we need the red pill.  Even if it costs more.  Beccause it’s also about treating the patient, not just the disease.  We didn’t just learn that from Patch Adams either.

Mr. Apron used to work as a standardized patient, posing as a “patient” for medical students learning how to interact with and diagnose patients.  The most important aspect of this job was not to play 20 questions with 3rd year medical students trying to guess that he had had a closed head injury 2 weeks ago; it was the doctor-patient interaction.  The way the doctor makes you feel, treats you, listens to you, will inform your care, guide your decisions, perhaps more even than cost, or efficacy, or the reputation of your health system’s “top docs”. 

In all these efforts trying to quantify medicine, trying to rate doctors on the number of expensive tests they order, tabulate the experences they have with procedures, and count the number of sick patients they see, they are forgetting that, even in the midst of a healthcare system weighed down by debts, inefficiency, and abuses, there will always be good doctors and bad doctors.  There should always be tough decisions to be made, informed decisions to be made by a patient and her family, because that means there are choices, and that we as consumers/patients/human beings have the ability and the right to take care of our bodies and our minds.  No insurance company, no HMO, no hospital, no doctor, no flashy billboard can tell us otherwise. 

With any luck, I should be back to myself within 24 hours.  The advil seems to have finally kicked in (or maybe it was the Fresca, with its magical “citrus” powers), and I thank you all for listening to my rant.  It’s been difficult not to share my experiences this past weekend, but I do need to keep some parts of my life private.  When there’s something more exciting — and less gross — you know I’ll fill you in on all the details.

Until then, feel better soon.