by Walter Mallon
As the youngest of eight children of parents who both lived to 92, I have an advanced view of my genetics and what is coming as I age, and I've observed which kinds of treatments are most effective. Based on my observations, I have become more cautious about prescription drug use. In a half dozen instances, for conditions which had caused my older siblings to go on life-long medications, I was successful in finding and dealing with underlying causes without medication. "Drugs are what doctors give to their patients so the doctor doesn't have to address the problem and the patient doesn't have to address their bad habits," my long-time doctor once chuckled to me in private.
Unfortunately, well into his 60's, our beloved doctor became ill and chose to give up his practice while he recovered and subsequently retired. A new doctor, Dr. X., took over temporarily and then permanently joined the practice under the administration of our large regional medical center. Under new administration, things changed. The charge for an office visit went from $80 to $275, and that was just the beginning.
I scheduled a get-to-know-you appointment with Dr. X and I thought it went satisfactorily. Most of the discussion was about the results of a blood test. In light of my known high cholesterol levels, I pointed out that I would probably not personally be a good candidate for statins for three reasons: 1) though high cholesterol levels run in my family, my parents both lived into their 90's with no heart disease, and there has been no evidence of cholesterol-related heart disease in any of my siblings, 2) one of my co-workers died from liver damage from statins and I had heard of one additional documented statin death involving a friend of a friend, 3) I had personally read the studies and had doubts that statins would live up to their early promise. Dr. X. expressed that he would respect my general desire to find non-pharmaceutical solutions when possible.
Looking at the rest of the blood test, he noted that there was some evidence of liver damage. Since I have never been a heavy drinker, we decided that it was more likely that I had had some hepatitis exposure while traveling in the Orient ten years prior. There was no action to be taken on any matter. That was on a Thursday.
On the following Wednesday I received a call from Dr. X's receptionist/office manager, who along with a PA had been part of my previous doctor's practice. "I'm embarrassed to have to ask," she began, "but in transferring your records over to Dr. X., somehow we lost your pharmacy of record, and now I don't know where to send these three prescriptions."
"What three prescriptions?" I asked cautiously.
"Well, you know... whatever you and Dr. X. agreed to when you were here," she replied.
"Actually, no prescriptions were discussed, and by the way, the reason you don't have a pharmacy of record for me is because I haven't had a prescription in over 20 years."
Not having any explanation for the prescriptions, she put me through to the PA in hopes that in Dr. X's absence, perhaps she could provide some explanation.
After pulling up my records, the PA said, "Oh, I see an additional entry made on Monday," and she read the entry to me: "This patient does not comply with our statistical goals for pharmaceutical use. To meet the goals for his age and BMI he needs to be on a minimum of three drugs."
The drugs selected were 1) a statin, 2) a niacin-based drug which by coincidence had made the news the night before because it was being banned from sale in Europe due to harmful side-effects, and 3) I don't even remember what the third one was, because by now I had stopped listening. Instead of accepting the prescriptions, I asked to set up an appointment with Dr. X. to discuss why he was prescribing medications without my knowledge and why he would prescribe for me a statin known to be fatal to persons with liver damage.
When I met with Dr. X. a couple of weeks later, he tried to smooth things over, saying it was all a misunderstanding, that his PA should not have spoken to me, and that the problem was being addressed as a "personnel matter." When I calmly asked about the danger of persons with liver damage taking statins he seemed distracted, re-running his finger down the blood test results, "Wait! Wait! It gets even better than that!" he exclaimed. "Your testosterone levels aren't really low, but they're below average, which means I bet I can get your insurance company to pay $350 a month for testosterone treatment!"
"You would prescribe testosterone to a patient who has no symptoms which testosterone is approved to treat?" I asked with some puzzlement, trying to let my brain catch up with something I must have missed in the discussion.
"Oh, don't be embarrassed. I know that guys don't want to bring these things up."
"I can assure you that I have no issues related to testosterone. If you aren't willing to believe me, perhaps I need to go home and get a note from my wife?"
Although I actually liked Dr. X. personally, the experience generally un-nerved me about the state of American health care delivery. Because I believe that everyone is reasonable according to their own training and experiences, I was curious to learn more about Dr. X. Doing my own research, I discovered that some of his residency work was related to work for one of the pharmaceutical companies to approve and advertise new medications. I wondered how much such an association would influence a future physician to have a favorable bias toward medications relative to other therapy, and how many new physicians now entering practice have been involved in such associations as part of their training years.
I have also thought a lot about that note that mysteriously appeared in my chart. Did Dr. X. change his mind between Thursday and the following Monday? Was it a business manager for the regional medical center who reviews files and looks for missed opportunities for revenue? Was it a risk assessment officer who believes as long as they give the same treatment to everyone they can't be sued? I don't know.
At age 63 I found myself sitting at my phone, cold-calling doctors' offices trying to find a new primary care physician (PCP). After six or seven calls, I gave up. My beloved doctor may have been the last independent practice doctor. Now all the PCPs in our area are controlled by fewer than five administrative organizations, none of which would accept a new patient near Medicare age. During the two years I have been without a PCP I have discovered that I am just one of a growing but statistically invisible group who can still get acute care (expensively) through the emergency room or immediate care clinics, but have no access to things like chronic follow-up care or regular checkups and tests that find the bad things early.
I can only assume that the problem will get worse as the ratio of Medicare patients increases, and as business administrators further limit the number of new Medicare patients they will accept as Medicare reimbursement rates continue to fall relative to commercial insurance reimbursement rates.
Walter Mallon is a life-long resident of Oregon. Due to the personal medical information in his story, he has chosen to use a pseudonym.