Almost Healthy
Part 1 - A Tale of Three Patients

by Amy Zidell
09.03.09 - Part I in a series analyzing, evaluating, and exploring the humorous, political, and social implications of the state of health care.

[Disclaimer: This article is not attempting to, nor should be construed to be providing or trying to provide professional or unprofessional medical advice or health care. This article should not be used as a substitute for professional or unprofessional medical advice or health care. This article should not be used to probe any part of your physical being. Be aware it may lightly tickle your funny bone. If the topic aggravates you, it may raise your blood pressure, which could be bad. Read at your own risk.]

While news of the raging debate over Obama-care is temporarily replaced by news coverage of raging fires in Southern California, my burning eyes, throat, and lungs prompt my observations on the state of health care in part one of Almost Healthy.

As a Southern Californian resident doing my best to avoid the smoky polluted air, I've eagerly listened to TV and radio news broadcast segments detailing what experts advise in how to deal with the extra unhealthy air. There were conflicting reports on whether simple, disposable, "#95" dusts masks were beneficial or not. Of course, area residents are advised it's best not to exercise outside and to spend as much time as possible indoors with the air-conditioning on. Apparently, those with asthma or allergies, can experience burning sensations, just as I noted above. The clear recommendation in an in depth report when experiencing such burning is to see one's doctor. I imagine such an intermediate office visit for an existing patient would consist of the following:

Doctor: Hi, how are you today?

Patient: My eyes are burning, my throat is burning, and my lungs feel like they're burning.

Doctor: I'm seeing a lot of that lately.

Patient: Uh huh.

Doctor: You're probably reacting to the smoke in the air.

Patient: Right.

Doctor: There's some nasty particles that can irritate your mucus membranes. Have you been sneezing?

Patient: A little bit.

The Doctor puts a sterile pointy tip on the lighted hand-held instrument [a.k.a. otoscope] and approaches said mucus membranes.

Doctor: Let's have a look.

The Doctor looks in each nostril. The Doctor quickly changes the tip and looks in each ear. Out of nowhere, the Doctor produces a wooden tongue depressor. The Patient compliantly open their mouth.

Doctor: Say ahh.

The Doctor depresses the Patient's tongue.

Patient: Ahhhhhh.

The Doctor inserts the listening end of their stethoscope in their ears and has a listen to those burning lungs via the back.

Doctor: Breath in.

Patient: Mmmhh.

Doctor: And out.

Patient: Hhhhhh.

Doctor: In.

Patient: Mmmmhh.

Doctor: Out.

Patient: Hhhhh.

Doctor: In and hold it.

Patient: Mmmmhuh.

The Doctor listens while the Patient wonders how long they can hold their breath.

Doctor: Okay, now breath normally.

Patient: Woohhhh. Sigh.

Doctor: Your lungs sound clear. You have some minor sinus and throat irritation. I don't see any obvious infection. You should avoid being outdoors in the smoke. You could try nasal irrigation. There's various designs. They all do the same thing. You can get that at any drugstore. Some patients find the process unpleasant, but many find it helps a good deal. I could write you a prescription for a nasal spray that will help with the swelling.

Patient: What's in it?

Doctor: It's a cortisone derivative. Of course, it can take a few days before you will see a reduction in swelling, and by then the air may have cleared out, so you may not want to bother with that. A saline spray or rinse will keep the tissue in your nose soothed. You could try gargling with warm salt water for your throat.

If you are already are taking an allergy pill, stay with that. If not, I can write you a prescription for an allergy pill. Depending on which one, it could make you tired or wired.

The Doctor hands the Patient two prescription sheets.

Patient: I think I'll stick with the saline and salt water.

Doctor: They're actually the same thing.

Patient: Right.

Doctor: Some people find drinking hot tea with honey to be soothing.

Patient: That sounds good.

Doctor: If the irritation continues over a couple of weeks, gets worse, or you develop a persistent cough, or a fever I'll want to see you right away. We don't want anything to develop into an infection. It's good you're healthy. Some of my patients with heart or lung disease are having serious trouble breathing in these conditions and can have complications.

Patient: What do you recommend for them?

Doctor: It's best if they can avoid smoking, heart disease and start out healthy. Healthy patients usually have best outcomes.

Patient: That makes sense.

The Doctor scribbles notes in the Patient chart and checks off things on the patient diagnosis form and hands the paper to the Patient.

Doctor: Give this to the receptionist. Take care.

Patient: Thanks Doc.

If the patient in this scenario is someone with private insurance they would leave the exam room looking over the form with mysterious number codes and little boxes with even littler lettering. Two or three things are checked. In the ten seconds it takes to arrive at the counter, 'Allergic Rhinitis,' is the only recognizable phrase. Having paid the insurance co-pay when checking in, the time at the doctor's office is over. The office doesn't validate and, in any case, the Patient parked on the street, so they're back to their office or home in search of hot tea and honey.

Out of curiosity, the Patient stops at the pharmacy in the lobby to see what it would cost to fill the two prescriptions. Answer: over $100. No generics are available. Out of pocket budget concerns aside, because this patient likes to avoid steroids whenever possible, and doesn't generally have good reactions to prescription allergy pills, they don't fill the prescriptions.

Now let's explore the scenario of the super rich Patient who has a doctor that makes house calls. Assuming the similar fitness and health level here's how that visit might go:
[See above doctor/patient office visit.]

After the exam, the super rich Patient will have an assistant locate special super expensive tea and sea salt that an executive private chef will prepare for the super rich Patient. Also, they are not troubled by such mundane things like paperwork. All billing is handled by the accountant. The cost of the prescriptions is of no concern to the super rich Patient who will have the prescriptions filled, whether they use them or not. As the super rich Patient is attending a vintage Bordeaux tasting later that evening and it's not recommended to mix wine or other alcoholic drinks with allergy medication, they will not take that medicine. The patient information sheet with the steroid derivative nasal spray indicates one possible side effect of is nasal irritation. The super rich Patient sometimes experience dry nasal passages when flying. One never knows when the super rich Patient may jet off somewhere, so they don't bother with the steroid based nasal spray. However, the thought does enter their mind, that perhaps they should fly to a less smoky area for a few days.

So how about the patient with no insurance and no money. They show up at the local emergency room and wait several hours to see a doctor. Assuming similar fitness and health levels here's how that visit might go:
[See above doctor/patient office visit.]

After their exam, the penniless Patient goes home with a goodie bag of free prescriptions and saline nasal spray. They stop by the hospital cafeteria and find salt and honey packs in the condiment counter and stock up. These additional freebies, along with patient information and paperwork is stuffed in the bag. Not included in this paperwork is any invoicing or billing statement, as that will be handled by the taxpayer.

In this non-scientific, hypothetical analysis no one is denied health care. In fact, each patient receives approximately the same level of care.

    Personally, I'm still getting the hang of my new Nasal Cleansing Pot, a.k.a. Neti,
    which I got before these fires. I did really well at first, but the last couple times
    I used it, things didn't go well.

    I've got the hot tea with honey down pat though.

     [ Part 2 - Don't Bus My Healthcare | Part 3 - What's With All The Insurance (Or, See The Great Obama Perform A Magic Trick)]

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