Not long ago, I became a patient. I was sitting at my desk, writing in a journal, when suddenly things became unsteady. I’d had a previously dizzy spell a couple of days ago, and since I’m a doctor, I recognized it as vertigo, and knew that it most likely represented age-related changes in the balance center in my inner ear. Most likely. This time, the dizziness was prolonged and severe, and I could not walk. At last, with a differential diagnosis of bad stuff swirling in my already-swirling head, I asked my wife to take me to the emergency room.
The doctor in me had quickly self-performed a neurological exam, which confirmed that there were no signs of serious brain injury, but the patient in me remembered my brother, who died five years earlier of a brain tumor that had declared itself with subtle, strange symptoms that belied its aggressive, lethal nature.
At the emergency room, after a brief wait that probably shouldn’t have happened, there was a flurry of alarm as my chief complaint triggered a “code stroke.” This happens because rapid response to stroke is important for ideal outcomes; it happened to me because, in America’s quest to identify and reward quality health care, we have created a system that is willing to cast a very broad net in order to avoid missing something.
What’s wrong with that? Well, after nearly twenty thousand dollars in tests which excluded a brain tumor, a stroke, arteriosclerosis, and numerous other things, the patient in me felt reassured, but the doctor in me knew that the same result could have been achieved for far less expense if the physician had taken a more thorough history and performed a very thorough examination, including a few tests that cost only time.
Shouldn’t we focus on the patient? Perhaps, but if we continue like this, we will continue to overspend, and unless we develop some political courage, we will continue to make up for it by cutting services to our most vulnerable populations, who often do not receive the basic primary and preventive care that is essential to health and well-being.
This is a complicated issue that deserves prolonged consideration and debate. Sustainable, effective, and moral solutions will require courage and consensus-building, two characteristics that have been lacking in our country’s “leaders” for a long, long time. We deserve better. The health of our people, and our economy, is at stake.