Monday, February 18, 2008

February 18, 2008 - When Worlds Collide

This afternoon, I stop off at the gym where I’m a member, to work out on the exercise machines. As I step out of my car, I notice the car that’s parked in the place in front of mine.

It’s hard not to notice this set of wheels. It’s a Rolls Royce. A real beauty.

Then, I look down and notice something else about it. This chariot is sporting an “M.D.” license plate.

On impulse, I take out my trusty cell phone and snap a picture of it. It’s an image that seems emblematic of the problems and paradoxes of our health care system.

I don’t know anything about the doctor whose car this is, nor what sort of paycheck this person pulls down. Maybe he or she has inherited wealth. Maybe this doctor does a lot of pro bono work for needy patients – earning much, but also “giving back” much. Not knowing any facts other than the license plate, I can’t judge the individual.

I will say one thing, though: driving around in a Rolls Royce with “M.D.” plates is a pretty gutsy thing to do, given the present state of frustration with the health-care funding system in this country. Most people around here are used to seeing their doctors driving around in a Lexus or BMW. But a Rolls? That seems to take in-your-face ostentation to new heights (or depths, depending on your perspective).

Maybe this sight is affecting me this way because I just finished reading an article about a new study funded by the American Cancer Society. The researchers found that uninsured cancer patients and those on Medicare are significantly more likely to be diagnosed with late-stage disease than patients who have medical insurance. From the article:

“The widest disparities were noted in cancers that could be detected early through standard screening or assessment of symptoms, like breast cancer, lung cancer, colon cancer and melanoma. For each, uninsured patients were two to three times more likely to be diagnosed in Stage III or Stage IV rather than Stage I. Smaller disparities were found for non-Hodgkins lymphoma and cancers of the bladder, kidney, prostate, thyroid, uterus, ovary and pancreas.”

Did you catch those numbers? The uninsured are two to three times more likely to be diagnosed only after their cancer has reached an advanced stage. In the case of certain cancers, like colorectal cancers, the prognosis for such patients can be grim:

“The study cites previous research that shows patients receiving a diagnosis of colon cancer in Stage I have a five-year survival rate of 93 percent, compared with 44 percent at Stage III and 8 percent at Stage IV.”

How likely are uninsured people, in the absence of any symptoms, to go to a gastroenterologist on their 50th birthday for a routine colonoscopy? Not likely, I’d say, if they have to pay the full sticker price for the test. Yet, if there’s a malignancy silently growing in their digestive tract, a Stage I detection – when the likelihood of cure is 93% – is highly unlikely without a colonoscopy.

The implication of the study is clear: lack of medical insurance is one of the leading risk factors for life-threatening cancers.

I wonder how often doctors who drive Rolls Royces think about that sort of thing?


Unknown said...

I hear ya re: the "ballsy" license plate!!! But docs aren't the bad guys here... they're being squeezed as bad as everyone with reduced fees from insurance companies/HMOS etc., more paperwork/process (meaning less time with patients since they need to turnover more to make what they did 10 years ago), pressure from hospitals to reduce fees...and exhorbitant med school bills that take longer and longer to pay down. No question that quality cancer and heart specialists are invaluable! But most MDs struggle in today's world in a field that doesn't have the same cache as when we grew up. (many actually feel downtrodden by the system...and the new world of patients who pull the latest "internet printout" challenging their expertise and diagnosis.) Plus the doc could have been a high-priced plastic surgeon meeting consumer demand (sad as that is...)
Now that I'm off my "defend docs" platform" (you know how I get when I get going...) I agree with you 100%. It really is all about getting access to diagnostic tests FOR ALL and it's a crime that the uninsured and struggling patients face such a dire situation. All parts of the system are broke and I've appreciated your entries highlighting areas that need to be corrected! (And I'm SO THRILLED that you are doing well...)
Cuz Andy

Carl said...

I hear you, Andy. I realize the doctors are feeling mightily frustrated by the medical-insurance mess, and with good reason. They're really being squeezed, and are finding that they're practicing less and less medicine, and doing more and more paperwork. Wasting time on a telephone hold queue to beg some insurance-company middle-manager to allow a patient to receive treatment is not what they went to medical school for.

That's why I qualified my statement, in saying I have no idea what this physician's individual situation is. It's just that the combination of a Rolls Royce hood ornament and M.D. plates seemed jarring to me, particularly so in light of all the heartbreaking stories I hear nearly every day, about people who are sicker than they ought to be, because they can't afford timely treatment. And, a Rolls, after all, is more than just a luxury car. It's a super-luxury car.

It's symbolic, to me, of how money seems to drive the whole system. Yes, I know "money makes the world go round," and that many people at the pinnacle of other professions, who've spent years in graduate professional school, pull down the big bucks, too (not ministers, of course !). Yet, medicine as a profession has, at its core, a charitable ethos that seems harder and harder to discern these days. The first hospitals, after all, were places of "hospitality" run by members of religious orders. (In Britain, they still address nurses as "sister," a holdover from the days when nuns did most nursing.) The mega-corporations that run most hospitals today are pretty far removed from that original vision. More and more, health care resembles a business, rather than a calling.

I have great admiration for those medical professionals who still hold onto the vision their profession as a servant occupation, in the face of powerful pressures to regard it otherwise.