Remember Audrey II from “Little Shop of Horrors” whose appetite was voracious? As we age, entering a hospital can feel a lot like dining with Audrey II. The medical system, like Audrey II, may devour us in its self-perpetuating system, encouraging increasingly complex tests, and ultimately leave us broke, exhausted and with little relief from the original malady. No wonder so many of us are hesitant to open the door to medical testing.
My “breathless” story is an example of that. I run out of breath too quickly. Our 8th grade gym teacher chased us around the track with a paddle. Despite that very real motivation, I was always the last of the runners, hampered by breathlessness. In graduate school, I gave myself a pulmonary function test, and my FEV (Forced Expiratory Volume) was less than normal for my age. Later, I asked a pulmonologist acquaintance whether I should re-do the test, or investigate possible causes, explaining that I had grown up with heavy smokers and had lived for a while in military housing where insecticides were regularly dropped from the sky. My friend recommended that I simply let nature take its course, arguing that a baseline wasn’t useful.
Now in my 70s, the breathlessness is more severe, so at my request my primary care doctor sent me for a chest CT scan (June, 2019, $2300). A few days later, she called to say “Don’t move, don’t stress, but we think a heart attack is imminent, and it could be fatal.” I didn’t move for the 10 days it took to find a cardiologist (June, 2019, $500), who promptly scheduled an echocardiogram (June 2019, $2000) and a Nuclear Stress Test (July, 2019, $5800). “Never mind” he said in our follow-up appointment (July 2019, $250), “you are normal for your age. It was all a misreading of the CT scan.” The CT scan had also found a pulmonary lesion, but a second follow-up CT scan (September, 2019, $3500) revealed that it too was of no concern.
Skip forward past a broken leg and the start of a pandemic, during which the breathlessness did not abate. The next stop was a pulmonologist (May, 2021, $600) who performed a pulmonary function test (May, 2021, $400) and requested another CT scan (April, 2021 $2400). And then, suspecting small pulmonary emboli, he requested a perfusion test (June, 2021, $2700) and a CTA test (August, 2021 $4000), ending with a sleep study (October 2021, $6000). Today (May, 2022) the pulmonologist defined the results as “good news; there are many serious problems we know you don’t have” and recommended that I adapt to the breathlessness by taking breaks as needed. He and the cardiologist both noted that breathlessness could be impacted by arthritis, weight, conditioning, hiatal hernia, and age.
These medical bills would bankrupt many Americans. For me, with Medicare, I paid less than $1000 of the $30,000 in bills (note: these numbers are neither exact nor inclusive of all expenses; I left out a bunch). Some lessons:
- We in our insatiable curiosity have created a medical system which can give us many details about our bodies and make many diagnoses, but we still don’t understand how our organs function and dysfunction.
- The cost of our medical care is unfairly distributed. Those with the least amount of insurance are billed the highest rates in order to offset the negotiated prices paid by Medicare and insurance companies.
- Medicare is perhaps the best financial benefit of being over 65 years old.
Uncharted Waters 