Accountability and Costs in a Broken Medical System
Yesterday I received a diagnosis of MRSA in my eyes.
Some, but not all, of what I have attempted in order to have my eye infections addressed since they first appeared shortly after my surgery of 10-30-07, is covered in The Back Story.
Allow me to fill in the details: I saw an ophthalmologist at a large teaching hospital in my city four times from January through October 2008. I saw a GP five times from September 2008 to June 2009. I saw an ophthalmologist in private practice one time in March 2009. I saw an oculoplastic surgeon, to whom I was referred by the second ophthalmologist, two times in April and May 2009. I saw an infectious disease specialist, to whom I was referred by the oculoplastic surgeon, one time in May 2009. I saw doctors at my local Urgent Care three times from March to July 2009. I believe that comes to sixteen appointments in nineteen months.
The first ophthalmologist, Dr. C., gave me a complete eye exam at every appointment, but he never took a culture from my eyes. He simply told me that I did not have an eye infection. He said that my eyes were dry due to the surgery, and they were producing mucous in an attempt to lubricate themselves. The first GP to whom I complained about my eye infections, Dr. S., ordered me to return to Dr. C. for a fourth visit. “He is a good doctor!” she snapped. Dr. S. is employed by the same large medical conglomerate as Dr. C. For numerous reasons, I switched to a different GP in the same practice. The second GP, Dr. N., ignored my complaints about my eyes. After all, he could clearly see, in the records, that I was yammering on about nothing. In this medical system, all the doctors can read each other’s notes. Thus, once disregarded, a patient is dead meat.
In a stroke of luck, my new GP was out of the country when I called about my eye infections in January 2009. I was seen by a third GP in the same practice. My right eye was swollen up like a cream puff, and she hadn’t read all the bad press about me, so she asked me if there was a particular specialist I would like to see. I said that I would like see a doctor at the integrative medicine clinic. I had been trying to get in there, for a while, and I hoped there might be a natural antibiotic I could safely use in my eyes. I got the referral.
Dr. K. was part of the same medical system, and she concurred with the other doctors that I did not have an infection in my eyes. The swelling was inflammation from the surgery more than a year earlier. I was started on an anti-inflammatory diet with supplements.
One morning in March 2009, I got up and looked in the mirror at my pus-filled eyes and the massive swellings underneath. A light bulb came on. I gathered some with a clean Q-tip and put it on the bottle cap of a never-used jar I had purchased for herbal preparations, and I took it to my local Urgent Care. The Urgent Care doctor, not privy to my long history of complaints about non-existent eye infections, did something miraculous. He scooped the pus into a culture tube and sent it to a lab. As well, he examined my eyes and gave me a diagnosis of conjunctivitis.
The lab result was klebsiella pneumoniae—heavy growth. I soon discovered I was allergic to the antibiotic ordered by the Urgent Care physician, and I made an appointment with an ophthalmologist in private practice, Dr. K. Good thinking on my part, except—when I got into her office, I sang like a canary. I wanted sympathy! I wanted vindication! I watched the focus in her eyes reverse to some inward point. “How was this culture obtained?” she asked. Omigod—she was not going to help me, either! I had made the mistake of identifying myself as a problem patient—in the eyes of other doctors. The issue here was not whether or not I had eye infections. The issue was getting me out of her office. “I really think you should see an oculopastic surgeon,” she said. “I can refer you to one.”
“Please,” I begged. “Prescribe something. I’ve had this infection in my eyes for a year and a half. Please.”
“I think the infection is coming from your sinuses,” she said. “Have you seen an ENT?”
More begging produced the prescription. I left with a referral to the oculoplastic surgeon as well. Dr. K. said that she thought the structure around my eyes should be evaluated. The right side of my face was caving in. I knew that.
The oculoplastic surgeon, Dr. F., repeated what Dr. K. had said. “Since this wasn’t a sterile collection, we don’t know whether or not you have an infection. I think you should see an infectious disease specialist,” she said, and she referred me to one. I was a hot potato that doctors kept tossing in the air.
Meanwhile, I finished the antibiotic that ophthalmologist, Dr.K., had prescribed. Initially, the infection cleared, but within two weeks, it was back.
The infectious disease specialist, Dr. K., was the biggest hoax of them all. He didn’t take a culture. “I don’t know,” he said. Patting himself on the back, he added, “I’m honest. When I don’t know something, I tell you.” (And how much do you charge for that?)
“You should be seeing one of the doctors at the medical center,” he added. “Your GP is at the medical center.”
I returned to the Urgent Care one morning, with the pus unwashed from my eyes. By the time I saw a doctor, it was crust. “How did you get to this point?” he asked. I told him. “They should be selling shoes!” he bellowed. “If you don’t want to treat patients, get out of the business!” Hearing that was like getting a good massage. He diagnosed me with blepharitis, an incurable inflammation of the eyelids caused, most often, by chronic untreated eye infections. Unfortunately, the culture taken that morning did not produce anything. Maybe the pus was too dried up.
In May, I returned to my GP, Dr. N. It was an emergency. Great globs of infection had been coming out of my eyes for several days, and the right eye, again, was badly swollen. Dr. N. prescribed an antibiotic, as he berated me for blaming the infection on the surgery. “Every time you’re in here, it’s something about the surgery,” he reproached. “Your problems were not caused by the surgery.”
No, of course not. I had battled acinetobacter, in my sinuses for four months immediately following the surgery. The eye infections had developed a month or so post-surgery. At fifty-five, I had never had a sinus infection or an eye infection, pre-surgery. The timing of all these infections was a coincidence. It certainly had nothing to do with an unnecessary surgery performed by a doctor.
The MRSA diagnosis came from a culture done two weeks ago at the Urgent Care. Every time I went to the Urgent Care, I was taken seriously, a culture was done, and I was treated with respect. I wonder if Urgent Cares are operating a little bit “out of the system.” Maybe they are free of the politics and B.S. that has taken over the medical system.
There are two reasons it has taken nineteen months and sixteen medical appointments for me to get my eye infection diagnosed. The first reason is that the infection was caused by a doctor who performed an unnecessary surgery on a patient with established autoimmune disorders. This fact had to be denied. Medical politics require it. No doctor can speak against the work of another doctor. God forbid, a medical malpractice case should arise. The doctor who diagnosed the condition would be called upon to testify. No doctor can testify against another doctor without being ostracized by the medical community. It would amount to career suicide. The medical profession is a club, with strict rules that deviate from moral considerations, much like the Mafia. So, my condition had to be denied. The second reason is that a respected ophthalmologist had made an initial incorrect diagnosis. Out of respect for his reputation, other doctors were required to honor his opinion.
It is all about the doctors. To hell with the patients. Besides the human cost, what is the cost to the health care system of all this back-scratching and patient neglect?
According to this article, it is not liability that inflates health care costs. It is too much medical malpractice. Tom Baker of the University of Pennsylvania Law School wrote, “Our medical liability system needs reform. But anyone who thinks that limiting liability would reduce healthcare costs is fooling himself. Preventable medical injuries, not patient compensation, are what ring up extra costs for additional treatment. … Just as we need evidence-based medicine, we also need evidence-based medical liability reform.” You can read the full piece by clicking here.
Baker is the author of “The Medical Malpractice Myth.” In that book, Baker counters that the real problem in the medical liability system is “too much medical malpractice, not too much litigation.”
Thanks to Jeffrey Roy, in his blog of 7-13-09, for the above references: http://ravechroy.wordpress.com/2009/07/13/further-debunking-of-the-malpractice-myths/