YOUR BUSINESS AUTHORITY
Springfield, MO
by Clarissa A. French
When it comes to managed care, I find myself wondering who's doing the managing, and do they really care?
My cynicism is not without basis. Allow me to share.
First, my own experience.
Last fall, I awoke in the middle of the night, itching, a rash breaking out on my hands and my lips swelling. I called a 24-hour health line, and the operator recommended I go to the emergency room.
It turned out I was having an allergic reaction. The ER staff shot me up with epinephrine, gave me an antihistamine and steroids, and sent me home.
What no one told me, or even intimated, was that my reaction was typical of a drug reaction. Not being a doctor, I assumed I was reacting to a new aerosol spray I'd been using (even though there was no respiratory involvement).
I made this assumption because I'm not a doctor. Yet the doctor who saw me never offered any details on the kind of reaction I was having, its possible cause or any precautions to take once I got home. As a result, I continued to take penicillin weeks later identified as the most likely cause of my reaction for another three days. Because of this, I got two additional steroid shots, a week out of work, a rash over my entire body and hands so swollen I could barely make a fist.
Prevention and wellness are supposed to be the emphasis of managed care. Prevention would have saved me a week of agony and saved my managed care plan the cost of office visits, steroid shots, prescriptions and specialist referral.
Almost a year later, I am still on (non-formulary) antihistamines because if I stop taking them, I break out. My allergist says the type of reaction I had can last up to a year and a half or longer.
Not a very efficient job of managing care or resources, was it?
This next case is more recent.
A few months ago, my best friend's mom found out she had developed an aggressive form of breast cancer. In this sense, her health plan and its yearly mammogram worked.
She had a mastectomy, but in order for her health plan to pay for reconstructive surgery, the reconstruction had to be done at the same time. Sent home a few days later, she received no in-home follow-up care. After days of terrible pain, there was a rush of blood from the surgery site and, happily, relief. It was a blood clot.
Yet no one in the health system knew anything about it until she called in to say she was bleeding. They reassured her that this was normal.
All right, not too much harm done. But, in subsequent weeks, she didn't heal properly. She developed a fever. After it was at 103 for three days, her doctor finally had her come into his office. He prescribed antibiotic pills and sent her home.
That night she was in the hospital with a fever that spiked at 104. She was in the hospital for a week and on an IV even longer.
Not a very efficient management of health services and resources, was it?
When I heard a doctor sent a patient with a post-operative infection and a high fever home with pills, I went nuts.
OK, I'm no doctor, but let's talk common sense. You don't send a patient suffering complications from major surgery home with pills. You give her a shot.
Finally, another glowing example of just what managed care is managing to do. My friend, the daughter of the lady with the post-op problems, found out that along with her mother, her aunt has breast cancer, as does my friend's cousin, who is only 27, the same age as my friend.
After learning this, my friend tried to get a mammogram done. I mean, there are obviously some nasty risk factors here. Seems like a logical request, doesn't it?
She did finally get her mammogram and a lumpectomy for what it found (benign, thank God). But just getting the mammogram took days of red-faced arguing with bureaucrats who kept reiterating that, despite everything she told them about her family history, she didn't need a mammogram until she was 35.
Excuse me?!
This stuff is scary. And the scariest thing to me is that I'm not running a big investigation here. These are merely anecdotal experiences, things that I and people close to me have experienced firsthand but shouldn't have.
And maybe these experiences are of no significance maybe everyone except me and some of my friends is 100 percent satisfied with managed care. Maybe we caught the system on a bad day.
I just don't know.
I think that managed care has some noble goals, and some rational ideas about achieving those goals. But personally, I have not seen either nobility or reason in its application.
My conclusion? Be nervous. Be very nervous.
Meanwhile, I hope that local health and managed care professionals will respond to this column. Because I really want to know what's wrong with this picture?
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