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talkpoliticsFor those who know a bit about me but are not on my friend list, let me front load this post with a clear statement: my two year-old son is entirely healthy.
New York State requires that all children be tested for lead in their blood stream by the age of two. Considering how pandemic lead poisoning was in previous decades and how many homes still have residual lead paint dust and chips in them, it is a good guideline...and it has certainly helped many children over the years.
But when he took our son's blood draw, our pediatrician decided to order a full spectrum of tests back in July. He had not with our daughter before, but apparently, it was more common among NYC pediatricians to do so since you have to draw the blood anyway. The results that came back from the lab, however, indicated that a number of our boy's kidney function levels were way off and that his cholesterol was elevated. That led to another full blood test, indicating lower but still elevated levels in kidney function indicators. Puzzled, his doctor sent him to Mt. Sinai Hospital to get a full sonogram done -- which indicated that he has perfect little toddler kidneys with no deformaties or growths.
By this time, two months of tests, return trips to our doctor and more tests had taken place. Our boy, meanwhile, showed absolutely no signs of anything wrong -- he was still wetting his pull up heavily, eating and drinking normally, had no unexplained fevers or lethargy. So we wait some more time, and collect urine samples...by now we are into November. The boy had a series of colds that prevent him from really continuing the testing and after another check up, our doctor wants him to be seen by a specialist at Mt. Sinai Hospital.
My wife and I, of course, were in stages puzzled and worried about what all of this could possibly mean. After all, our doctor has decades of experience and is not the type to worry needlessly about matters of minor concern. That's one reason we've stuck with him despite having to schlep the kids up to Riverdale for routine appointments. I kept trying to play like our son's continued OBVIOUS health (he's grown two inches through all of this too) meant we had no reason to worry at all -- and my wife was losing sleep over the possibility that our boy had kidney disease.
We finally get him the pediatric nephrology department at Mt. Sinai -- and have our Dr. send over all the records. After meeting us, the nephrologist spends all of a few minutes looking over the records and pronounces that there is nothing in them to worry about.
Nothing. In. Them. To. Worry. About.
So what the HELL happened?
Well, he tells us, that until the past few years NOBODY ever ordered blood work like that on toddlers and just stuck to the blood lead levels. He doesn't know why it became more and more common for pediatricians to order a full work up on the samples -- But he doesn't think either the general practice doctors or the labs know how to read the results and the labs try to peg the numbers by adult standards even though little kids are completely different. One number that was flagged by the lab was actually impossible for them to calculate because they did not have our son's height and weight. His bottom line was that there was nothing in any of the numbers, including cholesterol, that worried him in the slightest. He was mostly amused by how often he is starting to see referals for this.
Our son, meantime, spent most of the appointment rolling around on the floor and giggling. The doctor pointed to him and said, "See? This is not a child sick with kidney disease."
Now, after a week or so of being delighted by the news, there is a nagging question of political concern: America's health care system spends a lot of money per person per year. Any look at the rate of medical cost inflation should be alarming.
And my family spent several months contributing to the problem.
The specialist we spoke to does not know why NYC pediatricians have been ordering such comprehensive blood work on toddlers when neither they nor the labs have experience reading numbers for young children on these tests. Perhaps the labs have been pushing for it because they see a new billable revenue stream. Maybe malpractice insurance has been pressuring doctors who have to draw blood for the lead test to cover their asses by running everything. Maybe some bureaucrat in Albany wrote a new line ofr regulation that "strongly suggests" the lead test is a good opportunity for comprehensive blood work. Whatever the reason, the specialist says he is seeing more and more kids my son's age coming in with numbers that are perfectly fine for toddlers, but getting flagged by the labs. And the result is what my family went through -- 1000s of dollars in unnecessary health care expenditures for a perfectly healthy child.
Some critics of employer based health insurance have suggested that the kind of insurance my family has is part of this problem. Namely, we followed this all the way to the conclusion because each doctor visit was a $20 co-pay rather than a $150, $200 or $300 out of pocket expense...and whatever the tests actually cost that we never saw. There's something to that, but I given what would be at stake if our son had kidney disease, we'd have paid, borrowed, gone to our parents -- basically anything for an answer. After all, we trust our doctor. He's never been one to panic or overtreat. And he was genuinely worried by the tests. We'd have figured out a way to get an answer.
Could malpractice reform put less pressure on doctors to order tests? Maybe, but my intuition tells me that aggressive consumers of medical services are not likely to back off of their desire to check for everything. And medical testing and drug companies that have responsibility to shareholders to run at a profit are required to look for new streams of revenue. Government oversight can make mandates on the private enterprise of health care in this country, but my suspicion is that a government mandate sent us down this path for the past few months to begin with.
And then, of course, the final question -- to what degree does anybody, or indeed everybody, DESERVE whatever medical services it takes to come up with an answer when it comes to our basic health?
New York State requires that all children be tested for lead in their blood stream by the age of two. Considering how pandemic lead poisoning was in previous decades and how many homes still have residual lead paint dust and chips in them, it is a good guideline...and it has certainly helped many children over the years.
But when he took our son's blood draw, our pediatrician decided to order a full spectrum of tests back in July. He had not with our daughter before, but apparently, it was more common among NYC pediatricians to do so since you have to draw the blood anyway. The results that came back from the lab, however, indicated that a number of our boy's kidney function levels were way off and that his cholesterol was elevated. That led to another full blood test, indicating lower but still elevated levels in kidney function indicators. Puzzled, his doctor sent him to Mt. Sinai Hospital to get a full sonogram done -- which indicated that he has perfect little toddler kidneys with no deformaties or growths.
By this time, two months of tests, return trips to our doctor and more tests had taken place. Our boy, meanwhile, showed absolutely no signs of anything wrong -- he was still wetting his pull up heavily, eating and drinking normally, had no unexplained fevers or lethargy. So we wait some more time, and collect urine samples...by now we are into November. The boy had a series of colds that prevent him from really continuing the testing and after another check up, our doctor wants him to be seen by a specialist at Mt. Sinai Hospital.
My wife and I, of course, were in stages puzzled and worried about what all of this could possibly mean. After all, our doctor has decades of experience and is not the type to worry needlessly about matters of minor concern. That's one reason we've stuck with him despite having to schlep the kids up to Riverdale for routine appointments. I kept trying to play like our son's continued OBVIOUS health (he's grown two inches through all of this too) meant we had no reason to worry at all -- and my wife was losing sleep over the possibility that our boy had kidney disease.
We finally get him the pediatric nephrology department at Mt. Sinai -- and have our Dr. send over all the records. After meeting us, the nephrologist spends all of a few minutes looking over the records and pronounces that there is nothing in them to worry about.
Nothing. In. Them. To. Worry. About.
So what the HELL happened?
Well, he tells us, that until the past few years NOBODY ever ordered blood work like that on toddlers and just stuck to the blood lead levels. He doesn't know why it became more and more common for pediatricians to order a full work up on the samples -- But he doesn't think either the general practice doctors or the labs know how to read the results and the labs try to peg the numbers by adult standards even though little kids are completely different. One number that was flagged by the lab was actually impossible for them to calculate because they did not have our son's height and weight. His bottom line was that there was nothing in any of the numbers, including cholesterol, that worried him in the slightest. He was mostly amused by how often he is starting to see referals for this.
Our son, meantime, spent most of the appointment rolling around on the floor and giggling. The doctor pointed to him and said, "See? This is not a child sick with kidney disease."
Now, after a week or so of being delighted by the news, there is a nagging question of political concern: America's health care system spends a lot of money per person per year. Any look at the rate of medical cost inflation should be alarming.
And my family spent several months contributing to the problem.
The specialist we spoke to does not know why NYC pediatricians have been ordering such comprehensive blood work on toddlers when neither they nor the labs have experience reading numbers for young children on these tests. Perhaps the labs have been pushing for it because they see a new billable revenue stream. Maybe malpractice insurance has been pressuring doctors who have to draw blood for the lead test to cover their asses by running everything. Maybe some bureaucrat in Albany wrote a new line ofr regulation that "strongly suggests" the lead test is a good opportunity for comprehensive blood work. Whatever the reason, the specialist says he is seeing more and more kids my son's age coming in with numbers that are perfectly fine for toddlers, but getting flagged by the labs. And the result is what my family went through -- 1000s of dollars in unnecessary health care expenditures for a perfectly healthy child.
Some critics of employer based health insurance have suggested that the kind of insurance my family has is part of this problem. Namely, we followed this all the way to the conclusion because each doctor visit was a $20 co-pay rather than a $150, $200 or $300 out of pocket expense...and whatever the tests actually cost that we never saw. There's something to that, but I given what would be at stake if our son had kidney disease, we'd have paid, borrowed, gone to our parents -- basically anything for an answer. After all, we trust our doctor. He's never been one to panic or overtreat. And he was genuinely worried by the tests. We'd have figured out a way to get an answer.
Could malpractice reform put less pressure on doctors to order tests? Maybe, but my intuition tells me that aggressive consumers of medical services are not likely to back off of their desire to check for everything. And medical testing and drug companies that have responsibility to shareholders to run at a profit are required to look for new streams of revenue. Government oversight can make mandates on the private enterprise of health care in this country, but my suspicion is that a government mandate sent us down this path for the past few months to begin with.
And then, of course, the final question -- to what degree does anybody, or indeed everybody, DESERVE whatever medical services it takes to come up with an answer when it comes to our basic health?
(no subject)
Date: 23/2/12 22:16 (UTC)Another issue is that these doctors and labs didn't bother to look up tables for todlers, not menitioning that a pediatrician should have known better.
Also a shout out to Mt. Sinai! I've worked there back in the days and my parents are still employed there. :D
(no subject)
Date: 23/2/12 22:21 (UTC)(no subject)
Date: 24/2/12 04:08 (UTC)(no subject)
Date: 24/2/12 04:23 (UTC)As I've shared before, while uninsured I had labs done to determine a basic vitamin deficiency, being in no condition to navigate the difficult pathway to learn maybe/perhaps/could be costs in order to make a decision. Seven hundred dollars later I was happy with the results, but shell-shocked and economically on the hook for the few blood draws ordered casually (and correctly) by my physician.
Costs aren't a factor because it's a foreign concept to those who pay just about nothing. As I do now, insured.
(no subject)
Date: 24/2/12 20:56 (UTC)Absolutely. That's a big part of what really needs reformed in our currently broken system.
(no subject)
Date: 24/2/12 14:27 (UTC)I'm a big free market fan, I just don't see how we can let people make a cost benefit analysys of their health care when the cost is generally unavailable and the benefits are unknown.
(no subject)
Date: 24/2/12 21:03 (UTC)(no subject)
Date: 27/2/12 07:20 (UTC)(no subject)
Date: 27/2/12 22:30 (UTC)(no subject)
Date: 27/2/12 22:30 (UTC)That is something for the patient to decide for themselves.
(no subject)
Date: 25/2/12 20:28 (UTC)(no subject)
Date: 26/2/12 09:20 (UTC)(no subject)
Date: 26/2/12 14:56 (UTC)(no subject)
Date: 27/2/12 07:24 (UTC)(no subject)
Date: 27/2/12 14:20 (UTC)(no subject)
Date: 27/2/12 22:31 (UTC)(no subject)
Date: 28/2/12 01:09 (UTC)(no subject)
Date: 28/2/12 19:19 (UTC)(no subject)
Date: 28/2/12 20:11 (UTC)(no subject)
Date: 29/2/12 07:12 (UTC)(no subject)
Date: 29/2/12 07:17 (UTC)The problem was that the physicians and labs are unable to tell if there is a problem based on the lab results, expecting the parents to pick up the slack and decide if the cost is warranted kind of misses the point of having professional health care providers.
I'm a big free market fan, I just don't see how we can let people make a cost benefit analysys of their health care when the cost is generally unavailable and the benefits are unknown.
and also:
people are not qualified to make medical decisions and should trust their doctors.
(no subject)
Date: 29/2/12 17:38 (UTC)And this isn't relevant. People are in control of their money and have to make that decision, regardless of their qualifications. They can trust the doctor, but they still need the information to be able to choose whether to spend the money or not.
That's my point, the cost and benefit information needs to be available.
(no subject)
Date: 29/2/12 20:45 (UTC)Its literally the point. Your argument is irrelevant unless you deal with it.
(no subject)
Date: 1/3/12 06:05 (UTC)(no subject)
Date: 1/3/12 16:32 (UTC)(no subject)
Date: 1/3/12 18:15 (UTC)(no subject)
Date: 1/3/12 18:18 (UTC)(no subject)
Date: 29/2/12 07:21 (UTC)And that's actually the fundamental flaw in libertarianism too.
(no subject)
Date: 29/2/12 17:39 (UTC)(no subject)
Date: 29/2/12 20:44 (UTC)(no subject)
Date: 1/3/12 06:04 (UTC)That's an incorrect analysis.
(no subject)
Date: 1/3/12 16:32 (UTC)(no subject)
Date: 24/2/12 04:09 (UTC)(no subject)
Date: 24/2/12 14:32 (UTC)This is the part where you should be allowed to punch the pediatrician.