![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
muck_a_luckThose of you who have been here a while know that for a healthy person I have had a pretty large amount of interaction with the health care system in the last four years or so.
There was there was the pregnancy. The Barbarian's asthma trip to the emergency room. The Barbarian's croup trip to the emergency room. Various miscellaneous things for all of us. My hernia trip to the emergency room. In at least two of the last four years we have received more benefits as a family than we have paid in premiums, and because of Husband's compensation at work, I believe we pay nearly 100% of our "cadillac" plan. Actually, I don't know if we have a "cadillac" plan, but I do think we have a damned good one.
But I have rarely over these last four years really felt like we generated wasteful health care. I mean, I got lots of tests when I was preggers with The Barbarian. But none of them seemed wasteful to me. Luxurious, yes. Waaaaaay more than millions of pregnant women in the world get, yes. But medically justifiable, also yes. Same with our emergency room care and primary care. Excellent, but not wasteful.
This week, I got my first personal view of where the system has serious problems.
I have very fibrocystically active breasts. I had my first (and only) lumpectomy at age 19. I had a later needle biopsy in my early 20s.
The lumpectomy was done with very little diagnostic screening. Lump was identified, I went under the knife. General anesthesia, the works. Lump was not anything to be concerned about.
I think treatment was already becoming more sophisiticated a few years later when I found the second lump. This time, I was sent for a sonogram, and the radiologist flat out told me, "This is the only time a doctor will every tell you this, but that is not cancer." He then explained that it had characteristics of shape and growth pattern that were unmistakable. It was a cyst. The doc ordered a needle biopsy anyway, I think just to be cautious, and yes, it was just a cyst.
Fast forward ten years or so.
Just before my period two periods ago, I had tenderness in a specific area of my breast. This is unusual for me. But I figured it was just before my period, it was probably related to my cycle. Well, after my period, I kept having discomfort in that area. Plus, some localized soreness in the other breast. So I got on the ball and scheduled my annual, and let the doc prod those areas. She seemed mostly unconcerned, but said, "Let's go ahead and get a sonogram to lay down a baseline so we know what's going on."
Totally reasonable.
So I troop over to the breast imaging center of a large local radiology practice.
They do both a mammogram and a sonogram. The radiologist found three "focal points" in the sonogram. She said, "Those could be adenomas/benign tumors. But I recommend you get biopsies." She then said, "You can have them surgically removed. That would mean general anesthesia and surgery. You can also get needle biopsies. The results will be the same."
Then I met with their breast consultant nurse and she set up the bioposies for today with another clinic in their practice. I was given two back to back appointments, since I needed to have three biopsies, and was told to plan to take the whole day off from work. However, she also said, be sure to consult your GYN and be sure that is what she wants you to do.
I walked away from this experience somewhat bemused. First, I was *shocked* that the first option suggested to me was full on lumpectomies. I guess if you think you HAVE cancer, you can get those lumps out ASAP. But knowing what I know about my breasts, and what they could clearly SEE about my breasts in their imaging, the liklihood was that these were going to be benign objects. Why would anyone suggest general anesthesia for a diagnostic technique when there was a much less invasive and dangerous and EXPENSIVE option available? I mean, if someone got squeamish about the needles and DEMANDED to be put out or whatever, that's one thing. But to suggest surgery for my situation seems insane and irresponsible to me.
Second, I was surprsied that the radiologist, working in a breast clinic, couldn't be more definitive about whether she was seeing a cyst or and adenoma or a cancer in teh sonogram. I figured maybe my UNC radiologist might just be cheeky. After all, after he told me it "could not be" cancer, I still got a biopsy that time. Still. I thought she was being kind of weeny.
Anyway, I called my GYN. She said, no way, she wanted me to see a breast specialist. No prob. I cancelled my procedures for today, picked up my films and made the appointment to see the specialist. (On a side note, I was appalled at the FIRST specialist I called who told me I couldn't be fit into her schedule until September 2, but didn't comment clearly on whether it was a good or bad idea for me to wait that long, considering we were talking about the second step in a possible cancer diagnosis, but that is beside the point.)
So specialist sees me yesterday. She looks at my films with me and says immediately, "There's nothing in these images that I find very compelling. I certainly don't think you are going to need any biopsies."
Then she gets out her sonogram and starts showing me stuff. She shows me the object on the left and explains what she sees and what she doesn't see. Basically, she says exactly what UNC radiologist told me, back in 1992 or whenever. She says, "The chances of that being malignant are extremely small. We can check it again in four months and be sure, but I don't think you even need a biopsy on that today, unless you really, really want one to help you sleep better." I told her I *thought* the radiologist was being kind of a chicken and described my experience in NC. She said, "Yeah. Radiologists have gotten reluctant to make final judgments. The number 1 medical malpractice lawsuit in this country is for a missed breast cancer diagnosis. Radiologists prefer to let someone higher up the ladder make the call."
Then she moves to the other breast and she mutters to herself, sounding somewhat annoyed, "OK, boys and girls..." She doesn't even bother to sound like there's the slightest bit of reason for concern about this object. She just says, "Look, that's a fibro-adenoma." She explains to me what that looks like. She says, "We'll check it in four months, but htat's a fibro-adenoma."
Then she tells me to take a gigantic quantity of vitamin E, every day, without fail, and to come back to see her before she goes out of town in early November. She also educated me a little about caffiene, had a few other things to say about some other stuff, and I was out of there.
So, instead of needing THREE FULL ON LUMPECTOMIES, I really needed a three-month follow-up.
Thoughts I had about this.
1. That radiology group is using people's fear of cancer to run a racket where they do surgery on people who clearly do not need surgery.
2. That radiologist's fear of lawsuit is making her recommend expensive diagnostic procedures that are not needed. (And she is a breast radiologist, so I don't think the fact that she is not technically a "breast cancer specialist" is any excuse.)
3. Sometimes specailists are actually a source of savings in the system because they have the professional experience to say, you don't need three biopsies, you need some vitamin E and a 3-4 month follow-up to confirm that I was right in my diagnosis.
This is why health care reform is so complicated, as if we didn't know already. It's not as clear as, I dunno, making it more difficult to see a "specialist." Sometimes the specialist is the cost-saving option. Do we want to limit people's ability to sue for malpractice? On the one hand, those suits help hold doctors responsible for poor practice of medicine, but it's pathetic that the radiologist I saw couldn't just tell me to come back for a follow-up. And then the idea that a surgical biopsy and a needle biopsy are "the same." I'm sure sometimes a lumpectomy is the right thing to do, but jeez. Overreact much?
There was there was the pregnancy. The Barbarian's asthma trip to the emergency room. The Barbarian's croup trip to the emergency room. Various miscellaneous things for all of us. My hernia trip to the emergency room. In at least two of the last four years we have received more benefits as a family than we have paid in premiums, and because of Husband's compensation at work, I believe we pay nearly 100% of our "cadillac" plan. Actually, I don't know if we have a "cadillac" plan, but I do think we have a damned good one.
But I have rarely over these last four years really felt like we generated wasteful health care. I mean, I got lots of tests when I was preggers with The Barbarian. But none of them seemed wasteful to me. Luxurious, yes. Waaaaaay more than millions of pregnant women in the world get, yes. But medically justifiable, also yes. Same with our emergency room care and primary care. Excellent, but not wasteful.
This week, I got my first personal view of where the system has serious problems.
I have very fibrocystically active breasts. I had my first (and only) lumpectomy at age 19. I had a later needle biopsy in my early 20s.
The lumpectomy was done with very little diagnostic screening. Lump was identified, I went under the knife. General anesthesia, the works. Lump was not anything to be concerned about.
I think treatment was already becoming more sophisiticated a few years later when I found the second lump. This time, I was sent for a sonogram, and the radiologist flat out told me, "This is the only time a doctor will every tell you this, but that is not cancer." He then explained that it had characteristics of shape and growth pattern that were unmistakable. It was a cyst. The doc ordered a needle biopsy anyway, I think just to be cautious, and yes, it was just a cyst.
Fast forward ten years or so.
Just before my period two periods ago, I had tenderness in a specific area of my breast. This is unusual for me. But I figured it was just before my period, it was probably related to my cycle. Well, after my period, I kept having discomfort in that area. Plus, some localized soreness in the other breast. So I got on the ball and scheduled my annual, and let the doc prod those areas. She seemed mostly unconcerned, but said, "Let's go ahead and get a sonogram to lay down a baseline so we know what's going on."
Totally reasonable.
So I troop over to the breast imaging center of a large local radiology practice.
They do both a mammogram and a sonogram. The radiologist found three "focal points" in the sonogram. She said, "Those could be adenomas/benign tumors. But I recommend you get biopsies." She then said, "You can have them surgically removed. That would mean general anesthesia and surgery. You can also get needle biopsies. The results will be the same."
Then I met with their breast consultant nurse and she set up the bioposies for today with another clinic in their practice. I was given two back to back appointments, since I needed to have three biopsies, and was told to plan to take the whole day off from work. However, she also said, be sure to consult your GYN and be sure that is what she wants you to do.
I walked away from this experience somewhat bemused. First, I was *shocked* that the first option suggested to me was full on lumpectomies. I guess if you think you HAVE cancer, you can get those lumps out ASAP. But knowing what I know about my breasts, and what they could clearly SEE about my breasts in their imaging, the liklihood was that these were going to be benign objects. Why would anyone suggest general anesthesia for a diagnostic technique when there was a much less invasive and dangerous and EXPENSIVE option available? I mean, if someone got squeamish about the needles and DEMANDED to be put out or whatever, that's one thing. But to suggest surgery for my situation seems insane and irresponsible to me.
Second, I was surprsied that the radiologist, working in a breast clinic, couldn't be more definitive about whether she was seeing a cyst or and adenoma or a cancer in teh sonogram. I figured maybe my UNC radiologist might just be cheeky. After all, after he told me it "could not be" cancer, I still got a biopsy that time. Still. I thought she was being kind of weeny.
Anyway, I called my GYN. She said, no way, she wanted me to see a breast specialist. No prob. I cancelled my procedures for today, picked up my films and made the appointment to see the specialist. (On a side note, I was appalled at the FIRST specialist I called who told me I couldn't be fit into her schedule until September 2, but didn't comment clearly on whether it was a good or bad idea for me to wait that long, considering we were talking about the second step in a possible cancer diagnosis, but that is beside the point.)
So specialist sees me yesterday. She looks at my films with me and says immediately, "There's nothing in these images that I find very compelling. I certainly don't think you are going to need any biopsies."
Then she gets out her sonogram and starts showing me stuff. She shows me the object on the left and explains what she sees and what she doesn't see. Basically, she says exactly what UNC radiologist told me, back in 1992 or whenever. She says, "The chances of that being malignant are extremely small. We can check it again in four months and be sure, but I don't think you even need a biopsy on that today, unless you really, really want one to help you sleep better." I told her I *thought* the radiologist was being kind of a chicken and described my experience in NC. She said, "Yeah. Radiologists have gotten reluctant to make final judgments. The number 1 medical malpractice lawsuit in this country is for a missed breast cancer diagnosis. Radiologists prefer to let someone higher up the ladder make the call."
Then she moves to the other breast and she mutters to herself, sounding somewhat annoyed, "OK, boys and girls..." She doesn't even bother to sound like there's the slightest bit of reason for concern about this object. She just says, "Look, that's a fibro-adenoma." She explains to me what that looks like. She says, "We'll check it in four months, but htat's a fibro-adenoma."
Then she tells me to take a gigantic quantity of vitamin E, every day, without fail, and to come back to see her before she goes out of town in early November. She also educated me a little about caffiene, had a few other things to say about some other stuff, and I was out of there.
So, instead of needing THREE FULL ON LUMPECTOMIES, I really needed a three-month follow-up.
Thoughts I had about this.
1. That radiology group is using people's fear of cancer to run a racket where they do surgery on people who clearly do not need surgery.
2. That radiologist's fear of lawsuit is making her recommend expensive diagnostic procedures that are not needed. (And she is a breast radiologist, so I don't think the fact that she is not technically a "breast cancer specialist" is any excuse.)
3. Sometimes specailists are actually a source of savings in the system because they have the professional experience to say, you don't need three biopsies, you need some vitamin E and a 3-4 month follow-up to confirm that I was right in my diagnosis.
This is why health care reform is so complicated, as if we didn't know already. It's not as clear as, I dunno, making it more difficult to see a "specialist." Sometimes the specialist is the cost-saving option. Do we want to limit people's ability to sue for malpractice? On the one hand, those suits help hold doctors responsible for poor practice of medicine, but it's pathetic that the radiologist I saw couldn't just tell me to come back for a follow-up. And then the idea that a surgical biopsy and a needle biopsy are "the same." I'm sure sometimes a lumpectomy is the right thing to do, but jeez. Overreact much?
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
Date: 2009-07-31 01:00 pm (UTC)I am used to radiologists not telling me jack, but remember, I was a victim of the military health care system long ago. By victim, I don't mean they did anything tragic, but that I was consistently seen by a Flight Doctor who could be anything from a surgeon, to a pediatrician to a frickin' dermatologist and they were supposed to handle my everyday medical care. They were damn bastards across the board at being willing to refer out to someone who might know wtf they were talking about.
Cue fast forward to post-mil mommy years. Peds is even WORSE at being willing to let it go to someone else. I had to demand (and my kids saw docs in a really really good civilian practice in Colorado) that Thing Two be sent off to Peds Dermatologist because they so wanted to give him hydrocortosone for extreme eczema and act like it might someday work. The kid took the damn skin off his neck he was in such 2 yr old agony.
So...in answer to your question? Yes, I think the radiologist over reacted. They are so afraid of an incorrect diagnosis that their answer is to take it and take it all. I doubt it is strictly motivated by the desire to make $$ on the surgery. I think specialists are always a good idea and not a waste of health care funds. If the first line of family practice doc cannot take care of it easily, move on to someone who knows. I mean, really, did I want a dermatologist taking my PAP smear (they tried, I insisted on a gyn) when I had a history of atypical cells??? That is how people die!
I am glad you are good to go and I thought that was where you might be yesterday. You never did tell me when you got an appt! fyi - I'm off to pick peaches and will chat at you via comments later. Check paian on my circle in DW for prompt fic story you will love!
no subject
Date: 2009-07-31 01:41 pm (UTC)Have fun at the orchard! See you when you get back! :D
no subject
Date: 2009-07-31 04:40 pm (UTC)This is also timely because I have an appointment next week for a second mammogram. It sounded like a "we don't have a clear picture, we just need another shot" kind of thing, but if they think they actually see something in the new shot, I will definitely get a second opinion.
Go you, for sticking to your knowledge of your body!
no subject
Date: 2009-08-01 06:06 am (UTC)no subject
Date: 2009-08-01 03:45 pm (UTC)no subject
Date: 2009-08-01 12:02 pm (UTC)no subject
Date: 2009-08-01 06:05 am (UTC)no subject
Date: 2009-08-01 12:02 pm (UTC)