Wednesday, May 02, 2007

The High Cost of that Last 2% of Certainty

It is odd for me how one personal event can draw into crystal clarity both what is terribly wrong with the current medical systems (specifically here in Canada but, in general, all western nations), and the terrible medical risks before us as we slide down the downslope on the other side of peak oil. It is also odd to me the extreme contrast between how I viewed this event over the past few days and how I would have viewed it even five years ago. But five years ago I still hadn't evolved myself and my view of the world as much as I have now.

A little over a week ago I was developing what I thought were cold or hay fever symptoms; inflamed sinuses, difficulty breathing, dry raspy cough. Been there, done that, may times. By this past weekend, however, it blew way past being annoying and started to develop into a bit of a crisis. That shortness of breath was now into the extreme range. I was severely weakened. I had pains in my chest, which I assumed were from the dry cough. I was having difficulty sleeping at night because of the laboured, shallow breathing.

At 9:00am on Monday morning I walked (under considerable duress) into Emergency at the local hospital. I sat down in Emerg-Triage and, between frantic attempts at taking a breath, explained what was happening and answered all the questions of the Triage nurse. The very fact that Emergency has a Triage function is a sign of one of the things that is seriously with our medical system. They are there to sort out the sore toes and runny noises and overindulgent gassiness (all of those who should have gone to their family doctors or one of the numerous available walk-in clinics) from those small percentage of people who really do need Emergency services.

I was fast-tracked and deep into the bowels of middle earth Emergency by 9:30am. Over the next one and a half hours I was attended or examined by two doctors, three nurses, had been X-rayed, had my blood pressure checked three times, my blood sugar and blood oxygen levels checked twice, and had given up three vials of blood for them to run blood work. All of this was done by 11:00am. It was not until nearly ten hours later, around 9:00pm, after mildly displaying my impatience at the length of the wait, that a new doctor finally deigned to come talk to me about the results of the tests that had been completed ten hours earlier. About 8:00pm the night shift ER nurse had come and given me an injection in my stomach with no explanation as to why.

The doctor, when he arrived, explained that there was either a blood clot or fluid in my right lung and that they were going to have to run several more diagnostic tests the next morning. He told me he wanted to keep me in overnight so we could get right to those tests in the morning. I explained that unless there was a medical reason for me to stay in overnight, like maybe they wanted to keep me under observation, I would prefer to go home. I lived just five minutes away, after all, and was up by five every morning. Unless their diagnostic labs were up and running at 4:00am I would be up and ready long before they were ready for me. He quickly retreated from the suggestion that I stay overnight, said the lab would call me in the morning when they were ready. He prescribed me a water pill (because of the fluid build up in my lower legs) to be started in the morning.

I received two phone calls from two different departments before 8:30am. Over the next several hours I was put through a CT-cardiograph scan, an echo-cardiogram, an ultrasound, a PFT (Pulmonary Function Test) and had three more vials of blood drawn for more analysis, had my blood pressure checked a couple more times, as well as my blood sugar and blood oxygen levels, then had to go back through Emergency Triage and check-in (because I had gone home for the night and was now classed as an outpatient). A close friend of the family who is in hospital services (not at the same hospital) estimates that all of the tests I was put through add up to more than $8,000.

Another ER doctor sat down with me when the results of all of these tests were completed. He explained that they were still not certain what we were dealing with, that he had set me up with the hospital's Urgent Care Clinic for ongoing testing and observation and that they would be contacting me over the next couple of days to come in for a consultation.

Now after two days, several doctors and nurses and technicians and over $8,000 in diagnostic testing, I still knew no more than what the Triage nurse hinted at five minutes after I entered the doors of Emergency, a hint that conformed to the same uninformed self-diagnosis I had made before I even headed for the hospital. And I still very strongly suspect in the end, when they finally do make a diagnosis, it will pretty much conform to my own pre-hospital self-diagnosis made on Monday morning, actually Sunday afternoon.

Here's the rub. We have already spent close to $10,000 trying to close that gap between 98% certainty and an actual diagnosis. The best of a physician's diagnostic skills (assuming they are even taught true diagnostic skills in medical school) seems now to simply serve as a basis for deciding which expensive diagnostic equipment and technicians need to be scheduled to help close that 2% gad to arrive at a diagnosis. When did skilled hands and training of the physician go from being the difference between life and death to being just a part of the input stream to a technological process where machines are the trusted end authority in the diagnosis?

And here's the real rub? As we pass peak oil and the availability of energy begins to get prohibitively expensive, erratic, and increasingly unavailable, and all of that technology becomes an expensive pile of wires and electrodes that can't be run for want of power, where are the doctors that have the diagnostic skills to diagnose a patient's condition without all of those technological inputs? Just as modern day business farmers have lost touch with the soil and no longer know traditional, non-mechanized farming skills, our modern doctors have lost touch with the patient and the traditional, non-mechanized diagnostic skills that has made medicine such an important force in our lives since the Industrial Revolution. Health care has become the greatest single social cost we have and the bill has been growing at a super-exponential rate for the past half-century. Doctors have become slaves to all that technology that is intended to close that last 2% gap and in the process have been losing the skills responsible for that first 98% of the diagnosis.

As the technology begins to go dormant for want of energy there is going to be a dangerous and growing gap in our medical coverage that will, in my opinion, be exacerbated at a rate much more rapid than the rate of decline in energy. Medical dependence is going to prove a very risky condition.

End of rant.

1 comment:

Liz said...

Being pregnant, I have been thinking along these lines myself recently, with regards to childbirth. In those western countries like Australia and the US where there has been a fairly systematic attempt to destroy or drive underground the practice of independent midwifery, the vast majority of midwives have never attended a natural, non-medicalised birth. And women have been conditioned over the course of several generations to believe that hospital birth, preferably with pain relief on tap, is the norm. There's going to be an awful skills crunch when medicine is forced to decentralise and birth returns to the home environment, as it will inevitably be forced to do. The only sensible thing to do in the circumstances is to massively resource the existing homebirth movement and to make it as easy as possible for women to choose homebirth so that the pool of experienced IMs expands, but public policy in most industrialised nations is going in the opposite direction...