If you have been reading this blog for any period of time, you know the title Defiant Wellness comes out of my frustration for how ineffective the “healthcare” system is in actually making patients healthy.
Now don’t get me wrong, if I break a leg, or get shot by a terrorist, I trust I could find a good surgeon at the regional hospitals. If there is trauma, I can find competent care. But if I suffer from any chronic condition, it’s like playing the lottery.
Today I was reminded of this by a real-time example. As I am writing this I am suffering from severe gut inflammation. For the past several days, every meal I have eaten has bloated my stomach severely. Those who know me personally know I am slim and fit, yet for days I have been sporting a pot belly. I am in severe discomfort from this ongoing condition.
Six weeks of anti-inflammatory diets never revealed a specific food sensitivity. Yet, inflammation continues to flare up for no apparent reason. That is why I wrote an e-mail to my General Practitioner requesting that he set up some tests for the possibility of some infection. Read between the lines here – I would like to know what the problem is.
What was his response? “I don’t think you need any tests. It’s fall in New England, you’re probably eating to many apples. Soy causes gas. Maybe you’re eating too many vegetables.” Then there was my favorite comment, and a good reason for being Defiant, “At your age you should expect to have problems with digestion”.
By now you can imagine I wasn’t too pleased with this response, but it gets better. He then adds, “I don’t really think you need any tests, but if you want I’ll prescribe some antibiotics for a couple weeks.”
Call me old-fashioned, but I remember a time when doctors made an effort to arrive at a diagnosis before prescribing treatment of any kind. Why is it a person can watch a television commercial for Lunesta, Rozerem, Celebrex, Zoloft, and a host of other things, imagine they have the symptoms, and just get the drugs? As one commercial says, “Talk to your doctor about Pristiq, and I’m sure he’ll prescribe it.”
Yes, I am on a rant. I have spent almost two years, turning my life upside down with a complete diet and nutrition overhaul. I rise before the sun to work out to maintain this body. I have weaned myself off of three-quarters of my medication. I track daily statistics on Calories consumed, Protein, Fat and Carb ratios, Blood Sugar and Blood Pressure. I think a casual observer would notice that I am serious about my health and wellness.
Why is it I can walk in and ask for a prescription, but I can’t ask for a test and a real diagnosis? Am I missing something here? C’mon! Tell me! Am I wrong to expect a doctor to actually make an effort to determine the cause of my symptoms, rather than simply offer to treat the symptoms?
My guess is because your GP is aware of test imperfection expressed in form of sensitivity and specificity. Just by briefly googling for “gut inflammation test specificity” I found a link that shows “The most sensitive test for Crohn’s disease was ASCA IgG-positive or IgA-positive in sera that were ANCA-negative. The pooled sensitivity was 55% with a specificity of 93%. ” Meaning that the test mentioned above is no better than a crap shot. Yes, it is quite possible that the condition you have may reveal itself via a more accurate testin, meaning with sensitivity and specificity closer to 100%. However, even such omnipresent and well -advertised test as mammogram has specificity of 94.9% which translates to the following. Only 10% of women diagnosed positively using the mammogram ACTUALLY have cancer( assuming the base rate of .123%)
At the same time, the efficiency of antibiotic is extremely high. So why would your GP bother himself with unreliable diagnostics if he can help you by prescribing something works extremely well?
Just a few side comments. I am surprised by your choice of “getting shot by a terrorist”. Statistically speaking – an extremely low chance. One has a much better chance of being shot by a neighbor who doesn’t know how to properly handle his gun than by a terrorist. (Matthew Miller, Deborah Azrael & David Hemenway, Firearm Availability and Unintentional Firearm Deaths, 33 Accident Analysis & Prevention 477 (July 2001). )
Finally, I cannot not like your comment about “a television commercial for Lunesta, Rozerem, Celebrex, Zoloft”. There are only 2 countries that allow direct marketing of drugs to consumers. New Zealand and the USA . Try to change it in the land where corporations are people.
Andrew;
To address your comment regarding reliability of the specific test I requested, I provide the data from PubMed: ” Mean sensitivity, specificity, positive predictive value and negative predictive value were (96%, 97%, 96% and 97%, respectively)” I think is is more reliable than a crap shoot.
Furthermore, regarding accepting a prescription without a clear reason, I am not eager to kill off all my gut bacteria on a whim, if I do not know if there is an actual reason to ingest antibiotics.
Regarding getting shot by a terrorist, I trust you know issue was to illustrate trauma, not statistical probability.
Lastly, I don’t expect anyone to LIKE pharmaceutical lobbying and television, that was my whole point. They are negatively impacting the was “medicine” is practiced.
On Facebook, some folks seemed to think I was being unreasonable with this post. Others related to my frustration. The fact of the matter is I am spending almost $13,000 a year for health insurance, and I get very little for my money.
Furthermore the quality care that I have sought, “outside the system”, from Dr. Garcia has not been covered by insurance, it’s all out of pocket. So when Dr. G suggests if my GP orders the test it can be covered by my overpriced insurance, it is annoying that I come up with more of nothing.
I will contact my GP one more time, and if he still is uncooperative, I’ll order it though ChiroPro Performance and pay out of pocket (and I begin looking for another primary care physician).