The Patient Speaks!

It’s that time of the year again when with weather changes and various obligations make my head really, REALLY hurt.  Below, in no particular order, are just a few of the things that trigger massive migraine attacks for me.  And yes, I am being facetious on a few.  OK, perhaps all of them.  This will be a work in progress as new things give me a headache on almost a daily basis.  As my oldest granddaughter delights in pointing out, I’m a “scruffy old coot” so that may explain a few of these.  By putting these complaints in writing, I immediately begin to feel better!  So, here goes…

• Any time a politician begins a sentence with “The reality of the matter is…”
• Any time a politician begins a sentence with “The truth of the matter is…”
• Any time a politician begins a sentence with “The facts of the matter are…”
• Instructions for medical equipment with statements such as the following (that are taken verbatim from a Finger Pulse Oximeter I just purchased for $129.99 from an American distributor. The product, as well as instruction sheet is imported) :
  ”Your finger do not tremble during the Oximeter is working.”
  “After turn on the oximeter…”
  “Please put or remove batteries in right order, or is likely to damage the device bracket.”
  “Index 2 that made by xxxxxxx Company is a function tester.”
  “Please go to a hospital timely for exact diagnosis.”
  This is a medical device used to monitor potentially life-threatening conditions.  Proper English in the instruction sheet would be a good idea!
• E-mail spam.
• Telephone spam.
• ring…..ring…..  Hello?  “Honey, remember the street you told me to never, ever speed on as the police have a standing radar patrol there?  Well, I was ONLY going…”
• Clamshell packaging that requires an engineering AND demolition degree to open.
• Advertised prices that, when you add the costs of the seventeen asterisks never, ever looks remotely like the big, huge “All this for only $…..”.  Real life example: I credited 180,000 very hard earned frequent flyer miles for two Business Class seats to Europe.  My two “free” tickets cost $565.80 in taxes, airline service fees and airport service fees.  That is in addition to the $180,000 I had to charge on my Mastercard to get the miles.  Am I complaining about two Business Class seats for only $565.80?  No.  I am complaining about two tickets advertised as FREE that were not free.  Here’s another: Airline advertised price for a flight from Indianapolis to Chicago is $45.00.  Not so!!  When you begin clicking the purchase routine, taxes, “PFC” whatever that is and Security Fee(s) are added so the $45.00 magically becomes $55.40.
• Gas stations that sell fuel to the 9/10’s of a dollar.
• The idiot retailer that ran Christmas advertisements on the radio the day after Halloween.  Yes, I said Halloween, not Thanksgiving.
• Speaking of the holidays, the whole “politically correct” movement.  Everyone knows that if it’s political, it is impossible to be correct!  Oxymoron, eh?
• Presidential & Congressional campaigns.  They have degenerated into glamor photo-ops and an “I’ve got more money than you do” negative spitting contest.
• The taste of Go-LYTELY.
• Another oxymoron: Customer Service.  Too many companies have “Customer Service” departments that apologize profusely (too profusely), then fail and fail again and fail yet again to deliver on whatever the promised remedy is.  Or, the ever popular “blame the customer” approach.
• “Honey, I’ll only be in the Jewel (or Marsh or Meijer’s or Publix or Sainsbury or Tesco or Safeway or…) for just five minutes to get a gallon of milk.  That’s my cue to get lunch, stop at the library and read the entire book of War & Peace, then fuel the car then visit my sick Aunt in hospital then have open heart surgery and finally a root canal.  As I Pull back into the grocery store parking lot, I hear “See?  I told you – only 5 minutes.”

To be continued…

Made a huge mistake today.  I opened the mail.  No bills thankfully, but something far worse.  It was a “notice” from my health insurance carrier that the terms are, once again, changing.  Between wife’s policy and my own, this seems to be a common thing.  In the insurance companies quest to drive down costs, a lot of pressure is brought to bear upon its clients to use generic medications.  As a generality, I have no problem with that.   The insurance company is in business to make money.  That is the whole point of being in business.  My frustration is two-fold:

After decoding insurance-speak of “non-formulary brand”, “formulary brand alternative” and “tier 1, 2 or 3 payment levels”, it seems that an ever escalating list of medications I take are “tier 3″ meaning my copayment is at the highest level – meaning an ever increasing dent in the family budget.  Plus,

As a generality, I get along fine with generic medications.  However there are two in particular struggle with.  I take great issue with the following statements in the insurance company’s notice: “Remember, the generic medications work the same as brand name drugs – in dosage, strength, performance and use….”  Well, no, they do not in my personal experience.  One drug I take is a statin for which there is no generic.  I have taken other brands and generics of statins with severe allergic results.  In my case, there is no alternative.  Insurance company response?  While diplomatic, the end result is “tough”.  For another medication, I have better results with the brand name but have chosen to tolerate the generic as there is a huge difference in the cost, so I deal with the side-effects.  So, if the medication is “the same”, why does my body react differently?  Apparently it is the “fillers” used to package the active ingredient(s).  Treating the human body is not an exact science as everyone reacts differently.  In my experience, every medication, including over the counter, has side-effects.  Even an aspirin.

Do I have a magic solution?  Of course not.  No matter what type of healthcare system we have there will be rules.  If there are rules, someone will be an exception (I excel at that).  If a rule was written that was so broad it included every human contingency, there would be no point in writing the rule.  Plus, an open-ended system would be impossible to fund.  I told you I made a big mistake today by opening the mail.  Now I have a headache.

Here’s a headline that immediately caught my eye: USA Today Wednesday July 25, 2007 Communication now part of the cure – “Movement has begun to help doctors listen and patients understand” by Erin Donaghue.  My first thought was “well, duh”.  I mean, doesn’t everyone who sees the doctor communicate with him or her?  In a blink I answered my own question with a resounding “no”.  Thinking back to childhood (OK, way back), I can remember it took Mom or Dad to give their interpretation of what was ailing me to the doctor as I didn’t want to be there in the first place, never mind the medical dilemma.  Very little patient to doctor communication going on there and therefore I sometimes suffered just as much after the visit because I wasn’t being properly addressed.  After high school, I enlisted in the United States Air Force.  Only time I went to the doctor was when I was ordered to because, after all, I was an Airman and I can tough it out.  Therefore very little communication and a whole lot of flu.  Post military I met my true love and got married.  My outlook on life began transforming into an adult’s (very excruciatingly slow process according to some who knew me).  I started to open up to the doctors and explain just exactly what was ailing me.  Perhaps this happened as I was now responsible for the bill?  But I noticed a different phenomena happening.  Some doctors – not all – seemed to make a speed game out of the office visit.  The faster the doc could get into the examining room, scratch out a prescription and back out, the better.  I had a mental image that a nurse was just outside the door with a stopwatch.  Eventually, as I matured (again, questionable to some) in my medical travels, I began to understand that my physical – and mental – health was greatly enhanced by a good, solid line of communication between the medical professional and myself.  This includes the nurses, technicians, therapist’s and even the desk clerk.  I would leave the office satisfied that my questions were thoroughly answered instead of that nagging annoyance that I should have asked this/that.  Whenever I meet a medical professional that will not give my concerns the proper attention, I’m out of there and seek out one that will.  As I have written before, when seeing a new doctor, I come armed with a complete listing of my medications, who prescribed them, what the dosage is and what pharmacy I buy them from.  In my experience, the doctor takes me more seriously from the beginning.

As evidenced by the newspaper article, the medical community appears to be making communication more of a priority.  Faye Deich, chief nursing officer at Sacred Heart Hospital in Eau Claire, Wisconsin is quoted as saying “The main thing we’re trying to do is listen to our patients”.  Further, “We ask each patient what good care means to them, and that’s communicated to the staff” “If patients know you are there for them, they are more likely to tell you if something doesn’t seem right”.  For me, beyond the immediate care concerns, if I have a positive experience with the staff, I would be more likely to return if I have further need for their services.  In large cities, there are many choices for medical care.  Just as in taking my car in for repairs, I will go where I get the best attention and expertise.  That takes communication from both parties.  The mechanic can’t fix the car unless I tell him what’s wrong.

Just when I’m thinking my “headache life” has been fairly good for the past couple of weeks, I decided to clean my desk and came upon newspaper articles I had clipped and that dark cloud reappeared. Not a “pain” cloud, but an “annoyance” one. Examples:

November 03, 2006 Wall Street Journal
Front page, column #1 no less – Narcotic ‘Lollipop’ Becomes Big Seller Despite FDA Curbs by John Carreyrou. The article discusses how Cephalon Inc.’s Fentanyl containing lozenge Actiq® (oral transmucosal fentanyl citrate), originally developed to address cancer pain, is being used “off topic” more and more to address non-cancer pain. The first two paragraphs describe a pregnant woman who claimed “the strongest high she has ever experienced”. When her son was born, he was “cranky and wouldn’t sleep” and said “doctors told her he had become addicted to the drug and was in withdrawal”. Eventually, the woman ended up in jail for forging prescriptions as she was addicted to Actiq®. You can tell where this is going, right?

May 07, 2007 Newsweek Health
Lollipops & Lawsuits by Mary Carmichael & Samantha Henig. Words that jump out include “”…does not have cancer…” and “…in an average month he may suck on as many as 300… that its sugar content has corroded away all his teeth”. Now, here’s the biggie: “California Democrat Henry Waxman, chair of the House Oversight and Government Reform Committee, is looking into marketing at Cephalon and other companies.” To repeat, you can tell where this is going.

May 15, 2007 Wall Street Journal
Op/Ed page, Oxy Morons by Sally Satel. Ms. Satel is actually Dr. Satel, a psychiatrist specializing in addiction. The Opinion piece related the saga of charges brought by the attorney general of West Virginia for “misbranding”. The company, Purdue Frederick, paid $635 million to settle the charges. “Scores died as a result of OxyContin abuse and an even greater number of people became addicted” said Attorney General John Brownlee. However, in reading the piece, Dr. Satel believes (GASP!) that the people who abused the drug chose to do so. They, the abuser, had the responsibility. And who gets the short shrift? The legitimate pain patient, of course. Can you tell where this is going?

June 9, 2007 Chicago Tribune
Maddening movie migraines give experts real headache by Alexa Aguilar. While you don’t have to read the article to figure out that “movie migraines” do not reflect real life, I found the piece excellent. It has some interesting stats at the end. I highly recommend you read the article.

June 17, 2007 The New York Times
When Is a Pain Doctor a Drug Pusher? By Tina Rosenberg. Another good article that talks about addicts/abusers verses those of us with a medical need for responsible pain relief.

It seems that the “War On Drugs” is ever more targeting and restricting, in my opinion, the very people for whom the drugs can do the most good. As I’ve stated before in a previous posting, if a drug is developed for a specific use and later is found to address other issues, then amend the use and let people get relief. The classic example is anti-depression meds, widely used to treat consistent headaches. While I fully realize it is “not that simple”, I fail to understand why abusers and ner-do-wells can have an effect on available treatments for my ailments. Go after them, not us!

There, now my desk is momentarily clear. Makes me think something is terribly wrong as I can actually see the wood instead of stacks of paper. Wait! What’s that peeking out from under the keyboard? Drat! It’s a notice from my insurance company it’s denying payment for my last pain doctor visit. Everything is normal….