Okay, so I had some oxycodone — two on a Friday and one the day following. Why? Because I had shingles, that’s why, and the pain level was pretty high. The real story is the diagnosis process. My doc was away with her husband and kids for spring break (this saga started about three weeks ago), and so I went to the urgent care center recommended by my doctor’s office staff.
My complaint had to with what I thought was an injury to my right ribcage. I had been working out on a machine that employed a hydraulic compensator, and it, by malfunction, electronically increased my weight load to about four times the setting. So, a day or so later, when my ribcage began to hurt, I sought help.
Urgent care took x-rays to rule out any heart or lung problem, given my age, and I was given a diagnosis of strained ligaments and tendons and sent on my merry way. Given the diagnosis, I went to a chiropractor for some relief, and he used some hand kneading and a few machines to provide help. The problem was not resolved and my chest and ribcage hurt more than ever.
By this time, my family doc was back from spring break. My pain was increasing, and my wife noted that I had a rash around the right side of my chest. A quick trip to the Internet to confer with a New York customer, a chiropractor, suggested shingles. He got it in one and without looking at my chest or anything — just from the description. I then I went to my family doctor, and it was confirmed. No tendon or ligament problem at all — it was shingles the whole time. Shingles might as well be called Revenge of the Chickenpox, since, when one has chickenpox, usually at a young age, it leaves a little package of fun that opens later in life, much later.
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Since I have a fair complexion, I tend to get rashes from time to time, and I don’t think about them. If the doctor who had examined me at the urgent care outfit had looked at my chest, he probably would have been able to diagnose the condition almost instantly, since the rash was pretty specific and one-sided. If the chiropractor had looked at my chest, he, too, might have been able to diagnose my condition. The thing is that both men spent money on various tests and treatments that had nothing to do with my condition, and the cost (and the two visits to the chiropractor) could have been avoided totally if the urgent care doctor simply had looked at my chest.
I wouldn’t complain about this so much if it hadn’t taken my wife more than two years to get a diagnosis for her rheumatoid arthritis. We went to specialist after specialist, and she came close to death before, finally, someone got it right. Maybe the problem with Medicare isn’t so much the large number of people covered, but the large number of incorrect diagnoses.
Try to find the book “How Doctors Think,” by Jerome Groopman. It’s a wonderful book that spends a lot of time on diagnosis. He’s a Harvard Medical School professor who also writes for the New Yorker.
There’s a lot of waste in Medicare, and I suspect much of it comes from poor diagnostic ability. In an age of specialization, each doctor seems to try to make the illness of a person fit his or her specialty, at least until a number of expensive tests rule it out. I have not yet seen the amounts paid, but Medicare and my supplement probably paid close to $1,000, needlessly. The money spent on x-rays and chiropractic work was useless and, if my wife hadn’t noticed the rash, might have continued. My wife? Diagnosing her RA cost thousands and thousands of dollars. My guess would be at least $40,000 over two years, maybe more…
See also: House Kills Medicare Rationing Board
The oxycodone? I’ve had three tablets in two days, and I suspect I’ll be off — without going to Betty Ford — within the next two days.
Have a great week and find a good diagnostician. And you might read “How Doctors Think.” It’s a great book.
For more from Richard Hoe, see: