Posts Tagged ‘healthcare reform’

A Paradox?

Monday, February 15th, 2016

NOTE (22FEB2016): Today, we mark the anniversary of the birth of George Washington (1731-1799). Actually, he was born on the 11th of February, but the colonies switched calendars from Julian to Gregorian; thereby, advancing the date of his birth.

“As a very important source of strength and security, cherish public credit. One method of preserving it is to use it as sparingly as possible;” -George Washington’ Farewell Address (1796)

How does ObamaCare correspond to that directive of the Father of these United States of America? How can we employ a system of medical delivery that does? How can we protect the future of our youth, who represent the future of this nation now on fire?

“Life outside society would be solitary, poor, nasty, brutish, and short.” -from Thomas Hobbes (1588-1679)

What can be more important to an individual than life and health? In that regard, what single advance most has improved the human lot — for the individual and for society? Sewage.

Ah, but what about medicine? Has it, too, not improved the human lot? Yes, for the individual. For society? Yes — and no.

It may seem paradoxical that a physician would give such an answer. It is not.

The well being of society depends upon the overall health of its truly creative and truly productive members. The goal of Public Health is to have maintained the health not of the individual but of the society, as a whole. Sewage has done more to fulfill that goal than any other, single measure. Moreover, the cost:benefit ratio had been enormously favorable.

In contrast, the goal of Medicine is to have relieved the suffering of the individual as a consequence of disease and trauma. All well and good until one looks at the cost:benefit ratio. It has become dreadfully unfavorable.

The average American now expends half the cost of his medical care during his entire lifetime during the last year of his life — a year in which kindness often becomes cruelty — a year that, from the perspective of society, typically is pathetically uncreative and unproductive; from the perspective of the patient, typically is progressively enfeebling and painful; from the perspective of family and friends, typically is unrelentingly burdensome and depressing.

You might comment, “Wait! In these United States of America, the individual has no obligation to be either creative nor productive. We are not Nazi Germany where the individual exists for the State. Here, the State exists for the individual — doesn’t it?”

Even so, does the individual have the right to rob his productive neighbor to pay for his own medical care, the end result of which will be of no use to that neighbor or to society and likely of little use, if any, to family, friends, and himself? If so, what are the limits of such theft?

Should the individual be paying with his own money, he very well may be entitled to the most expansive and expensive care that he can afford. Is he so entitled when it is his productive neighbor who is paying — and paying involuntarily via taxes collected by the government at the point of a gun if need be?

When medical care is limited to basic care at a primary level — especially of acute medical problems such as fractures and infections — the cost:benefit ratio becomes tolerably favorable. When medical care is expanded to advanced care at a secondary level — especially of chronic medical problems among the elderly, problems  such as non-healing wounds; failing hearts; and, worst of all, dementias — the cost:benefit ratio becomes intolerably prohibitive as witnessed by Medicare/Medicaid well on the way to bankrupting this declining nation now of fire. Once having bankrupted the nation, Medicare/Medicaid will leave precious little medical care for any but the richest.

You might ask, “There must be some humane alternative between callous disregard and misguided ‘humanitarianism’, mustn’t there?”

Fortunately, yes. The alternative is a medial system that delivers care universal but affordable, partially governmentally funded, provided by the private sector under medical supervision, acceptable to insurance companies, and scientifically based and scientifically driven.

For a description of such a system of medical delivery, see Chapter 17 in the semi-fictional novel, Inescapable Consequences. It is drawn from a detailed plan initially presented in the non-fictional book, Healthcare Reform D.O.A., nominated for two, national awards by The American Risk & Insurance Association — an academic arm of the American insurance-industry.

Americans need not be saddled with the ill-conceived ObamaCare favored by the socialistic, irresponsible Democrats nor the hodgepodge of misguided proposals by the feckless, inconsistent Republicans. The choice really is theirs. It is yours.

Choose selflessly and wisely, and your grandchildren will bless you. Choose selfishly and foolishly, and your grandchildren will curse you.

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MEDICAL DELIVERY: A TALE OF WOE

Monday, August 6th, 2012

“An error lurking in the roots of a system of thought does not become truth simply by being evolved.”
– John Frederick Peifer

Forward: Will Mr. Obama’s “Patient Protection and Affordable Care Act (PPACA)” improve the American system of medical delivery, or will the nation slide from American-style medical care into Soviet-style “healthcare”?  Given the data from its model, RomneyCare in Massachusetts, the answer is the latter.(1) The following is a highly abridged excerpt from the semi-fictional novel, Inescapable Consequences; “The Doctor” and “Uncle” are two of the characters therein.‘Tis the kind of tale likely to be told and retold millions of times:(2)

The patient, a thirty-eight-year-old, married, obese, mother of three had a past psychiatric history of a single brief psychotic episode ten years previously, treated successfully with complete remission and without recurrence. Her recent health had been good until the current presenting complaint of several days duration characterized by abdominal pain with nausea and vomiting.

The morning prior to admission to the hospital, she had complained to her husband of a slight sore throat and a persistent mild but increasing nausea. She had declined to accompany the rest of the family to services at church. Upon his return, the husband found the patient still feeling ill. Her nausea had intensified somewhat, and she continued complaining of diffuse, dull abdominal pain.

Through his employer, the husband subscribed to a “healthcare-plan” issued by a “health-maintenance organization” or so-called HMO, the premium representing a significant portion of his wage. He telephoned the number provided by the HMO for such occasions, receiving only a recorded message with the usual disclaimer instructing him to telephone “911” if he, a layman, determined that the situation was a life-threatening emergency. Then, pursuant to the subsequent instruction by the recorded voice, he left his own brief message with his telephone number.

Approximately one hour later, a woman identifying herself as a nurse returned his call. She had no records of the patient available. As best he could, the husband described his wife’s current complaints and past history including her psychiatric history.

Addressing him by his first name, the nurse quizzed him primarily about his wife’s past psychiatric history, neglecting her present illness.  She then suggested that he telephone the following morning, Monday, to schedule a regular appointment.

He informed the nurse that, since his wife had been feeling increasingly ill for several days, she herself already had called for that regular appointment. The soonest that the receptionist would agree to schedule one was three weeks hence.

The nurse replied by advising him, nevertheless, to try again the next morning and to inquire whether there had been a cancellation. She also prescribed bed-rest and a diet of clear liquids.

Concerned about the typically long wait at the Emergency Room of the HMO, he asked if he could take his wife to a nearby ER. The nurse answered, “You’re free to do whatever you think best, but we can’t authorize an Emergency Room visit ‘out -of-network’.”  Her parting words reverberated in his brain like car-brakes without a lining. “Have a nice day.”

Late that afternoon, his wife was feeling no better. He decided that he would drive his wife to the Emergency Room of the HMO and hope for the best. Upon arriving, he registered his wife with the clerk, who told him that there would be “a considerable wait”.

One hour later, a nurse approached them in the waiting room for a “screening evaluation”. After a brief conversation, she said that she did not believe that his wife’s symptoms warranted a visit to the ER but that his wife would be seen “in due course”. Three hours passed. Feeling as sick as she looked, his wife was pleading for him to take her home. Instead, he took her to the Emergency Room at their local hospital, the financial risk be damned.

There, the clerk advised him that, if his HMO should decide, in its sole opinion, that the patient’s case was not a true emergency, he himself would be responsible personally for all charges. He agreed. He allowed the clerk to take an imprint of his credit card.

Another hour later, a nursing aide escorted them into an examining room. She recorded the patient’s vital signs, noting a slightly rapid pulse and a slightly elevated temperature.

Another thirty minutes of waiting. Then, a man in a white coat with a stethoscope entered. He introduced himself as “Dr. Faki”. Neither patient nor husband understood that Dr. Mohandas Faki was not a physician with an M.D. from an American medical school but a nurse with a Ph.D. from a foreign nursing school, nor did either understand the right to be attended by a physician not a nurse.

The husband again reviewed the course of events and again made the mistake of mentioning that his wife tended toward anxiety and did have a past psychiatric history. Upon hearing about the patient’s psychiatric history, as had the telephonic nurse before him, the “doctor-nurse” focused his questioning in that area.

He then performed a brief physical examination, noting only a slightly injected pharynx and mild, diffuse, abdominal tenderness. He ordered some routine studies by the laboratory “stat”. The couple returned to the waiting room.

Two more hours passed. The nursing aide reported that the results from the laboratory returned as “non-specific” and that the doctor-nurse had said that they should return home then see the patient’s “healthcare-professional” the next day. At no time did a doctor-doctor examine the patient.

Having returned to their home, by late that evening the patient’s husband could see that his wife’s condition was deteriorating further. Her nausea had intensified. She had vomited. Her abdominal pain had intensified. Emotionally, she was becoming distraught.

Her husband tried calming her while he himself was feeling increasingly anxious. Risking the punitive cost, he decided to try a different Emergency Room. He happened to choose a hospital where Uncle’s nephew, The Doctor, held surgical privileges.

Viewing her presenting appearance, the hospital-staff quickly registered the patient then wheeled her into an examining room, where a nurse performed an initial screening. By then, the patient was complaining of increasingly severe abdominal pain in the right upper quadrant. Her skin was cold and clammy to the touch.

The surgeon-on-call that evening already was working on another case in the Operating Room, so a nurse telephoned The Doctor. He ordered her to prepare the patient for immediate surgery, including typing and cross-matching three units of blood, and hastened to the hospital.

By the time that he arrived, the patient was in the Operating Room but going into shock, which the staff, none of whom was a physician, feverishly was attempting to reverse. The Doctor hastily changed from “civvies” into “scrubs”, washed, gowned, and gloved. He took a moment to evaluate the situation before beginning an exploratory laparotomy while the nurse-anesthetist was doing her best to maintain the patient’s vital signs; no physician-anesthesiologist was available. Everyone but the patient was breathing the air of desperate urgency. On her own, she was breathing hardly at all.

Entering her abdominal cavity, The Doctor quickly discovered the cause of the patient’s trouble; a gangrenous gallbladder, now-ruptured. He began to correct the condition by cleansing the cavity of the spilt bile and pus. In the midst of his doing so, the woman suffered a cardiac arrest. Instantaneously, the cardiac monitor screamed its piercing alarm, an unnerving “bleeeeeee . . . .”.

Following a series of frantic efforts, the nurse-anesthetist admitted failure. “We’ve lost the patient,” she reported meekly, gazing fixedly at the floor.

“We?”  The Doctor angrily shot his question at her; his expression, grim; his emotion, impotent rage.

Masking his feelings, he reluctantly entered the hallway, where he found the patient’s husband pacing like the proverbial caged animal. He approached the man slowly and introduced himself. With a quiet compassion in his voice, he informed the husband that his wife had died.

He then attempted to provide what little consolation he could offer. It was difficult for The Doctor to find the right words; actually, to find any words. What could he say?  The wife’s dying had been avoidable. It never should have happened. The medical system had failed her directly and her husband indirectly.

The Doctor’s efforts at sympathizing were in vain; the husband remained disconsolate. The Doctor stood silently while the suddenly-widowed man sobbed.

Then, the tears stopped. Shaking his head, the man looked at The Doctor with a compassion of his own. Paradoxically, he began offering consolation to The Doctor, apologizing for the system foisted upon the country by politicians for whom he himself had voted. Looking into The Doctor’s eyes, he noted tearing.

Whereas the husband felt apologetic, The Doctor felt ashamed, not for himself as much as for his profession or what was left of it. “The medical profession . . . my profession . . . no longer controlled by physicians but by politicians, bureaucrats, lawyers, and profiteers. The consequences? Casualties. This man, his wife, and I are three of them,” he whispered silently to himself.

The husband gently took The Doctor’s hand and held it.“Go home, Doctor . . . get some sleep. You did your best. It wasn’t your fault.” He predicted that, with his wife’s death, the HMO would agree that his wife’s illness had represented a real emergency, after all.

 The Doctor put his other hand on the husband’s shoulder and gave it a slight squeeze. He turned and walked away, leaving the bereaved man behind with his grief-stricken widowerhood bestowed by a system of managed costs euphemistically characterized as “managed care”.

On his way to the locker-room, The Doctor stopped at the desk to request that an aide stay with the husband while the secretary summoned the husband’s brother from home. The secretary said that she would try but that the hospital was understaffed, as usual.

At the moment of the husband’s shock and grief, The Doctor had not wished to disabuse him of his financial fantasy. The Doctor predicted that the HMO would deny the charges, claiming that, in spite of its staff erroneously having told the husband by telephone and at their ER that his wife’s condition represented no real emergency, she should have stayed to be seen “in-network”. He assumed that the charges would force the husband into bankruptcy. Oh, the man would rant and rage and threaten legal action, but, given current law protecting the profiteers, he would find no lawyer to take the case “on-contingency”, and he ill could afford hourly fees.

As for The Doctor’s fees? He would never receive a penny. “The people’s right to ‘healthcare’ . . . their right to my labors . . .” would be his only response, silent and ineffectual.

That night, The Doctor managed to get an hour or so of sleep. Then, he was off to make rounds at the hospital; then, to see patients at the office.

Given the schedule of fees dictated by the government and by the various governmentally-promoted “healthcare-plans”, caring for many of those patients also would generate little financial gain, if any; caring for a few of them would generate financial losses; caring for all would risk unfounded lawsuits filed by unscrupulous, avaricious lawyers.

Months later, The Doctor’s prediction would prove valid. The premiums that the husband had paid to his HMO were for naught when an actual need arrived. His HMO had denied care by delaying care then had forced him, the subscriber, to take the financial fall. Ironically, the same day that the man filed for bankruptcy, the HMO filed a fifteen percent rise year-to-year in its profits.

© Gene Richard Moss (2009)

References
1) “RomneyCare 2.0″. The Wall Street Journal, 06 August 2012, p. A12.

2) Already, under “Expansion of Physician Assistants Training”, the PPACA is directing tens of millions of dollars to training paramedical personnel. Meanwhile, under Medicare, funding for physicians-in-training and payments to physicians-in-practice are being slashed.

MEDICINE: QUANTITY IS NOT QUALITY

Monday, July 23rd, 2012

To reiterate from a previous posting (1), so-called healthcare is not synonymous with medical care. The difference is not mere semantics. “Healthcare” is cutting your toenails. Medical care is treating a cancer with surgery then radiation then chemotherapy.

Recently, a fellow named H. W. Brock . . . neither a Medical Doctor nor a biobehavioral scientist but a financial type . . . wrote a piece claiming a resolution to the problematic situation of delivering medical care in the USA.(2) His resolution? Increase the supply.

Unfortunately for Mr. Brock, his postulates are invalid. As he confuses”healthcare” with medical care, he confuses quantity with quality.

The elements of his so-called supply-sided resolution? 1) Federal training of more physicians. 2) Financial aid for physicians-in-training. 3) Financial incentives for physicians going where shortages exist, medically and geographically. 4) More foreign-trained physicians. 5) Reformation of medical malpractice. 6) Fewer redundant diagnostic tests. 7) More nurses and other para-medical personnel replacing physicians. 8) Promotion of cheap, “retail”, quasi-medical shops.

As always, the devil is in the details. Let’s look at Mr. Brock’s recommendations.

1 & 2) Training more physicians may be a good idea, but who’d be financing the training? With monies from where?

The individual states? The concept of state-based financing is nothing new. State-based budgets, however, are strained . . . California, for example, is broke. Increasing state-based funding for training more physicians seems rather unlikely.

Who’s left? The federal government? The concept of federal financing also is nothing new. It’s been on-going for years through Medicare and other programs; e.g., Title VII of the

“Health Professions Educational Assistance Act” of 1976. Okay, why not just increase it and expand it?

Wait! Congressman John Boehner recently stated flat-out, “We’re broke!” . . . not that a lack of funds usually stops federal spending. Under ObamaCare, for example, Big Government ironically will spend tens of millions that it doesn’t have to train “physicians’ assistants” under “Expansion of Physician Assistants Training (EPAT)“. Meanwhile, current funding for training physicians through Medicare is being slashed. Music to your ears, Mr. Brock?

Stop! Look! Listen! Those who love individual liberty never should forget that government . . . especially Big Government . . . is a dangerous servant and a terrible master. “He who pays the piper calls the tune.” The federal government already is directing American medical care through Medicare and Medicaid. How would Mr. Brock block further empowering its dictatorial control over physicians via increased financing of their training?

Now, who’s left? Private enterprise? Only Big Business could afford financing medical training on a meaningful scale. What would be any reward to any business, say, to offer scholarships? What would be “the catch” for the physician?

3) Rewarding physicians financially for going where shortages exist, medically and geographically, also may be a good idea. Who should do the rewarding? The federal government? Individual states? Under-served municipalities? Private enterprise? Governments already do, to some extent. What must the physician promise in return for increased funding? Mr. Brock might consider that using oneself as chattel for a mortgage is unconstitutional.

4) Importing more foreign-trained physicians may sound like a good idea economically. Is it a good idea medically? On average, is an American-trained physician more competent than a Grenada-trained physician who passed the examination designed by The Educational Commission on Foreign Medical Graduates . . . even without the time-honored cheating?(3) Under whose knife would Mr. Brock care to put himself when his is the life at stake?

5) Reforming medical malpractice, unquestionably, is a good idea. America has become a nation imprisoned by lawyerism. Too many laws; too many lawyers; too many lawyer-politicians; not enough law . . . think the now-disgraced, lawyer-politician John Edwards or the honest companies bankrupted by greedy lawyers (4).

Who’ll perform the legal reform? A federal government dominated by lawyers? On what constitutional grounds . . . not that the federal politicians and bureaucrats care about the Constitution unless it suits them to do so? The fact is that both physicians and lawyers are licensed by the individual states not by the federal government. Isn’t reform a task for the states . . . but, ah, the ease and joy of central versus provincial (i.e., state-based) control; eh, Mr. Brock?

6) Who can argue against reducing the number of redundant diagnostic tests and procedures? Aren’t many of those tests ordered, however, to preëmpt unfounded lawsuits?

Defensive medicine aside, Mr. Brock neglects to tell us The How. Rap physicians’ knuckles? Fine physicians? Imprison them? Execute them? Nothing as quick and simple as negative versus positive control; eh, Mr. Brock?

7) Allowing nurses and other para-medical personnel to masquerade as physicians may increase the supply of “healthcare-related” services but can it maintain quality of service? Nurses aren’t trained to make diagnoses. Sorry, Mr. Brock, it’s true. With all due respect to nurses, essentially, they’re necessary, valuable, and hopefully caring technicians trained to carry out physicians’ orders. With the use of improving technologies, as time passes, they may become competent to do more. Even so, should nurses and other para-medical personnel operate with no medical supervision? Moreover, who, ultimately, should be responsible . . . medically and legally? Mr. Brock gives us no clue whom to sue.

During the days of the now-defunct Soviet Union, its dictators boasted having an ample supply of “physicians”. . . well, not exactly physicians but physicians-in-name; what we in the USA now call “nurse-practitioners”. The average Soviet citizen rarely was attended by a legitimate physician . . . only the politicians, high-level governmental bureaucrats, and military officers. Do we Americans really want the Soviet-style medicine that Mr. Brock is promoting?

Furthermore, will lower fees compensate for lower quality? Even if they do, won’t those lower fees gradually rise towards the fees charged by real physicians?

8) Promoting cheap, “Wal-mart style” quasi-medical shops to handle “common minor ailments” . . . shops already appearing in supermarkets . . . staffed by quasi-physicians acting in isolation from real medical support undoubtedly will increase availability of “healthcare-related” services. Mr. Brock neglects to state, however, who determines what is a “common minor” ailment. The customer? The nurse? The assistant to the absent physician? The check-out clerk? As a financial type, Mr. Brock might keep in mind that there’s a cost to everything. How about your life, Mr. Brock? Still a good value?

No, Mr. Brock, your “solution” won’t resolve the situation-in-question. Fortunately, however, there is a valid resolution, and it comes from biobehavioral science . . . not from the pseudo-science of economics nor from the polemic of politics nor from the mumbo-jumbo of mysticism (www.inescapableconsequences.com).

So, what’re the odds favoring us Americans resolving scientifically the current dilemma in delivery of medical care? After all, we have the way. We have the means. Ah, but do we have the will? What say, Mr. Brock?

References
1) Categories/Biology & Medicine/”Healthcare” Reform/ ‘Healthcare’ Is Not Medicine”.

2) Brock, HW: “A Supply-Side Solution for Health Care”. Barron’s, 23 July 2012, page 30.

3) Lyons, RD: “Cheating On Exams For Doctors Causes Alarm”. The New York Times, 03April 1984.

4) “The Tort Bar Burns On”. The Wall Street Journal, 23 July 2012, page A12.

Prostatic Cancer: One Man’s Story (Part Three)

Monday, January 31st, 2011

It had been one year since Don’s last visit to the local urologist. During the interim, he had been free of genital-urinary signs or symptoms except having noted diminishing, slight discomfort with ejaculation.

Two days prior to his follow-up, Don appeared on time for a phlebotomist to draw a sample to determine his PSA-level. He felt relaxed and optimistic. Three days later, the urologist’s receptionist telephoned with the report. His level had increased to slightly above where it had been when the nightmare had begun.

At the follow-up, the local surgeon reported that Don’s urinalysis was clear and that the DRE revealed no new abnormalities. He recommended a repeated determination of the PSA in four months. As the weeks passed, Don’s anxiety increased. Finally, two months later, Don himself requested a repeat. The repeat essentially was the same as its predecessor . . . high-normal.

Continuing to feel mounting anxiety, Don inquired about a repeated determination of his PCA-3. No, the local urologist did not provide that service. In desperation, Don telephoned Nurse Karen. His wife made arrangements for Don and her again to travel to “the big city”, which, as a consequence of respondent conditioning, Don had come to loathe.

Several weeks later in an examining room, Nurse Karen reported that Don’s PSA-level had risen a tad above the magical, normal level of 4.0 ng/ml. (Actually, depending upon the referential source, the upper limit of normal for men his age can run as high as 7.2.) Don’s anxiety felt as though it were shooting through the top of his head. Even so, he was there to measure his PCA-3 not his PSA. Nurse Karen obliged with a prostatic massage with Don contributing a sample of urine. He made an appointment to see the famous urologist while there.

“Why?” he later asked himself. He had no answer.

Two days passed. The result of the PCA-3 would not be available for several more days. It was mid-morning when a middle-aged physician’s assistant escorted Don to a different examining room. The anxious patient sat alone waiting. Then, the urologist entered, appearing less harried than previously.

“Six patients probably cancelled this morning,” Don silently joked to himself.

Given the patient’s refusal to undergo another biopsy, the urologist recommended a repeated determination of the PCA-3, employing a substantially more vigorous prostatic massage; and, in addition, obtaining an MRI of the prostate using the most advanced equipment. Don agreed. The MRI was completed late that afternoon. The following day, Don and his wife departed for home.

It took almost a week of leaving telephonic messages before Don made contact with Nurse Karen. The PCA-3 from her massage had risen from three years previously but still was less than half the upper limit of normal. The more vigorous massage by the urologist produced a result only a tad higher. The MRI showed some non-specific areas of concern; possibly an area of low-grade prostatitis but no definitive cancer. Nurse Karen suggested a repeated MRI in one year. Don felt relieved.

The following day shattered whatever equanimity that he had mustered. Nurse Karen telephoned. She had spoken with “the boss”. Instead of waiting a year, the famous urologist recommended an immediate biopsy. She offered no reason.

Anxious and confused yet again, Don made an appointment with the local urologist. After reviewing the results from “the big city”, the surgeon shook his head with a frown, informing Don that he was unimpressed with the validity of either the PCA-3 or the MRI. He recommended waiting and watching with a repeated PSA-determination in three months.

Three months of mental anguish later, Don again returned to visit the phlebotomist at the local surgeon’s office. Returning home, he took his own blood pressure . . . 180/100 mm; the upper limit of normal being 140/90, recently revised downward by some to 130/80. (The consequence of that downward revision has been to rob thousands of people who previously would have considered themselves to be enjoying normal pressures of their sense of well-being; place them onto expensive anti-hypertensive medications; and elicit chronic anxiety, depression, or a combination of both . . . all likely to aggravate their newly re-defined malady.)

Don went to the cabinet, fetched a blue vial, then swallowed a five mg.-tablet of Valium to relieve his own anxiety. Two hours later, he swallowed another. He felt like Hell. “Maybe, the old, paternalistic model of letting your M.D. decide what you need to hear wasn’t so bad,” he commented to himself.

Three days later, the telephone rang. His PSA-level had risen to 4.05 ng/ml. The receptionist advised him that the local urologist now concurred with his famous colleague. Don’s prostate required a second biopsy. Would he like to schedule the procedure for the following week? Don declined the offer.

“What if it’s benign again?” he later asked his wife in a pleading tone. “How many biopsies should I have? The DRE is unchanged. The PCA-3 is normal. The MRI reveals nothing . . . well, maybe, some slight prostatitis, which, by the way, could account for my fluctuating PSA. What should I do? Damn . . . damn . . . damn! Tell me, what should I do?”

His wife listened silently but sympathetically. She sensed that her husband’s negative emotional strain was spiraling beyond his cognitive control.

Not waiting for an answer, Don continued, “Maybe, I’ll discuss it with the internist.”

That last comment exceeded his wife’s tolerance. “Don’t be ridiculous!” she exploded. “Your entire visit will last less than ten minutes, at most. Are you totally obtuse? Look at the consequences of his behavior . . . for him not for you. What does he get out of giving you the time and attention you want and need? Medicare pays him a mere pittance. He’ll have you telling your story to some low-paid nursing assistant.”

“I’ll offer to pay him more . . . out-of-pocket.”

“You know he can’t accept it. It’s illegal! You’re lucky he’ll see you, at all. You know, someday the few competent physicians remaining won’t be accepting Medicare anymore.”

“Well, I need to talk to somebody today not someday . . . somebody knowledgeable.”

“Don, face it! The days of the concerned physician giving his patients time to air their complaints are dead. The federal government began murdering them slowly in 1964 with Medicare and Medicaid. ObamaCare will put the final nail into the coffin. Can you imagine politicians’ voting for a radical change in American medicine without having read the legislation?”

“Yes. Anyway, what should we do . . . shoot them?” Don muttered.

“I’d not be surprised if people do,” her voice rising with exasperation.

“Hopefully not,” he replied seemingly without conviction.

Calming herself, she continued, “Politics aside, forget about seeing the internist. Nineteen seconds . . . nineteen seconds, Don. That’s how long the average physician listens to the average patient. The federal government has turned patients into customers. Like any other customer, you’ll be choosing your brand of treatment on your own.”

Don looked at her dumbly. He lifted the handset and pushed the numbers.

“You have reached our medical offices. Your call is very important to us. All personnel are busy helping other patients. Please remain on the line, and your call will be answered in the order it was received. If you have a life-threatening emergency, hang up and dial 911.”

After waiting ten minutes, he slammed the handset into the belly of the telephone. His wife watched as her husband began pacing the room between the window and the wall opposite. Her eyes filled with tears, which overflowed when he began mumbling to himself in an anguished, rhetorical perseveration, “What should I do . . . What should I do?”

Rising from her seat, she wiped her eyes. She walked toward her husband, blocking his path. With a smile, she approached him. She placed her arms around his neck and hugged him tightly. She released her grip and stepped back. Her smile vanished, replaced by a look of grim determination. Then, the force of her voice struck him like a slap in the face.

“Forget about seeing the internist. Forget about the biopsy. Forget about them! You don’t have cancer. Just schedule your next PCA-3 and MRI in six months. If there’s a definitive change, deal with it then. Are you blind? You’re a dentist. You have a medical background. Can’t you see? The real question is less what you should do about your prostate and more what America should do about its medical system.”

Don looked at her sorrowfully and muttered, “You’re right. I am a dentist.”

“So, Doctor Dentist, what’s your answer?”

“Science.”

“What?”

“Science. Employ science to reform the medical system [See Chapter Seventeen in the novel, Inescapable Consequences (www.inescapableconsequences.com).]”

“Science not politics . . . interesting idea. You may have something there, Doctor Donald.”

“Yes, but it won’t happen. ”

“Maybe not, but it can.”

– End –