Public Health Interest, by Michelle Quirk

Kimberly opens up the mailbox to see another bill from the doctor.  She got the explanation of benefits (EOB) from the insurance company last week.  She will have to sit down with both and do a comparison to be sure they match up before she presents them to Jerry, her husband.  This is just another in a long series of talks they’ve had regarding Tyler’s medical bills.  In the past three years, Tyler has racked up an impressive $25,000 in medical bills.  He is 16.  He lives with his mother, Jerry’s ex-wife.  Tyler doesn’t have a rare medical condition.  He doesn’t suffer from a chronic disease.  He is inflicted with a mother who takes him to the doctor and demands medications for him as soon as he begins to sniffle with the early onset of a cold.  She also demands x-rays and tests when he has an ache or a pain.  She is setting him up for medical dependency.


Holly has a genetic degenerative condition in her spine.  She is at the doctor’s office at least once per week out of concern when anything irregular might signal a decline in her condition.  She is on no less than six prescription medications at any given time, including the highly addictive Vicodin.  This summer she developed severe stomach issues which the doctors are having trouble diagnosing and treating.  She blames it on the Coca Cola slushy she enjoys each day.  A quick perusal of my Food and Medication Interaction text would clearly suggest the stomach issues are related to a deterioration of her stomach lining from long term use of pain pills.


No one can deny Holly has a condition which requires attention and pain management.  Nor can one deny the occasional doctor visit of a growing Tyler.  Yet, these stories suggest an over-reliance on the medical community and the pharmaceutical companies.


Society gives credence to the media and the media deluges us with conditions and treatments.  If you take this pill, your pain will go away.  If you take this other one, your condition will be mitigated.  See your doctor.  Talk to your pharmacist.  You don’t need to suffer.  We, and only we, the medical community, can help you feel better.  And when medication doesn’t do the trick, they will prescribe another.  When the medication causes a long term complication, there is always a prescription treatment for that as well.  It is a vicious circle and Tyler is at the beginning of a road Holly knows all too well.


There is no argument of an absolute medical necessity or medication necessity.  The argument lies in where does necessity end and where does a manipulation of the public’s reliance begin.  Who, ultimately, has the back of the public’s health?


Do the insurance companies?  Historically, they were set up to act as mediators between the doctor and the patient and protect the patient’s pocketbook in a world of rising health care costs.  Somewhere along the line, though, this mission changed.  Insurance companies stopped putting patients first and began looking at their bottom dollar.  The challenge of sorting through EOB’s and benefit payments became the job of the patients.


Is it the responsibility of the pharmaceutical companies?  An evening watching television might present a picture of public health interest.  However, a quick look at the annual income statement of Abbott or Pfieser will show profits in the billions.


Is it the doctor’s responsibility?  In an average day, a doctor will see an average of four patients per hour.  A nurse will handle the intake, blood pressure and temperature.  The doctor will review the nurse’s information; listen to the patient’s complaint and heart rate.  He will then make a speedy diagnosis, write a quick prescription to fit the presented illness, and move along to the next patient to maintain the busy clinic schedule.  Very possibly, in an urgent care situation, the patient will not see a doctor with whom he has a relationship.

It is up to the patient, or the patient’s guardian, to take responsibility for his or her own health.  They must take steps to understand the common viruses and aches and pains and understand when to use an over-the-counter medication, or when to let time heal the wound.  They need to understand that not all ails deserve the attention of a medical professional or a prescription to cure.


This is the true public health interest.


In Holly’s case, it may be too late.  But it’s not too late for Tyler.

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