Or… Et tu, Primum Non-Nocere!

A few weeks ago, I wrote a commentary titled Primum Non-Nocere; First, Do No Harm. The title comes from the opening line of the twenty-four hundred-year-old oath written by Hippocrates, the pioneer of modern medicine. He authored over seventy medical books, most notably treating the patient and the malady, not just the disorder. Hippocrates understood that the patient and illness are inextricably linked.

That post was about an encounter with factory medicine as an observer. Today I want to relate a developing saga as the participant – my point of view.

I call this a comedy of errors because, in 2003, I made the inexcusable error of making my way to the Emergency Room (ER).

Yes, Maisy, I drove to the hospital.

I didn’t know I had a heart attack. I could still drive, so it couldn’t be that serious.

Right?

This experience sounds pretentious and cavalier, but it is a fact. Thus began my ‘love affair’ with the Industrialized Medical, Pharmaceutical, and Insurance Complex – and what I now affectionately call ‘Factory Medicine.’

I invite you to read or reread Primum Non-Nocere for context.

These past thirteen years were not a sweet musical interlude by any stretch of the imagination. There were contrapuntal interruptions and a few major and minor dissonances. It was like Lawrence Welk playing Queensreich or Snoop Dogg’s greatest hits.

Interesting. Right?

I’ll resist my urge to launch a philosophical discussion on the esoteric juxtapositions of good and evil.

Maybe next time…

Anyone preparing for surgery knows a checklist of approvals is necessary to obtain pre-approval from all parties involved for the medical insurer. It’s an exercise in patience, persistence, and the ability to follow directions to the letter.

Any deviation sends you back to the beginning. Really!

In my case, I needed notes and approvals from:

1. Insurance Carrier Notification of intent to seek permission for surgical procedure

* Approved (in-network) surgeons, practitioners, and venues lists

2. Orthopedic Surgeon – A conversation and documentation to my medical insurance provider to inform them that I would request their permission to have the aforementioned repair and the contact information of all the parties involved to ensure that I am following the prescribed procedure by the numbers.

3. Notifications to all involved that I am seeking permission to proceed with asking for permission to move forward

* An explanation of the proposed procedure to the other practitioners and the insurance provider

4. General Practitioner for Pre-Approval and corroboration that the proposed procedure could provide medical benefit

5. Pre-Approval from Cardiologist

Requesting permission is required if you even think you want the insurance carrier to pay – even partially – for the service you’re requesting. You need their consent to proceed. Remember, these are the people you pay thousands of dollars annually to cover and manage your medical costs.

To purloin a line from an ancestor’s writing, “Please, sir, I want some more…”

These next steps require additional and multiple visits to:

1. Orthopedic Surgeon for a list of necessary tests and procedures needed to ensure that I’m healthy enough to survive the surgery

2. The General Practitioner

* requires a physical exam, blood test, X-rays, and EKG – see #1

3. The Cardiologist for pre-pre-approval.

* EKG, Nuclear Stress Test, and Echocardiogram see #2 & #3

4. The Orthopedic Surgeon will need a CT scan or MRI of the defective part or damaged area – but ONLY if the preliminary approvals from steps 1 through 3 are affirmative (or a definite, maybe in my case). See #2, #3, & #4

5. Insurance Carrier’s notice to proceed – Only if the above is completed and in the prescribed order

You realize that each step necessitates a separate appointment and up to two weeks – schedule lag-time between to find a convenient time and appropriate doctor’s office AND an individual co-pay for each.

Catch-22 – Yes, there is a catch-22!
The surgical authorization is only valid for 45 days from the date of the original request to the insurance carrier requesting permission to have the surgery.

Oh, did I mention that I work full-time… and these offices operate from 8 AM to 5 PM – regular business hours – NO WEEKENDS in most cases – which means that any appointment costs me lost hours – I run my own consulting business.

It’s now four days to surgery. I’ve lost count of the number of office visits – I think it’s over twelve.

During my latest cardiologist appointment, I discovered that the doctor I’ve worked with for 12 years retired, so I have a new doctor I’ve never spoken to, interviewed, or been introduced to, who walks into the examining room and begins his soliloquy:

“I have some concerns about the results of your nuclear stress test. Your heart function is deficient, in fact, close to the danger zone. As I read these results, it appears that your heart function is below the 30% range – 10 points below the lower end of the moderate zone, which indicates you are at risk. I may allow your surgery, but you are a risk, and I see that you are obese, are diabetic, have coronary heart disease, myocarditis, and a litany of things I can’t spell – all serious concerns, and do you know your BMI is…”

He then launches the canned cardiologist’s weight-loss lecture for ‘lower life forms’ about portion sizes, high-carb diets, exercise, etc. I was so thoroughly insulted that all I heard was Charlie Brown’s teacher – Wa wawa wawawa wa wawa wa…

It might carry more weight if the professor wasn’t hauling 50 extra pounds himself or his staff didn’t resemble waddling technicolor parade floats.

I hear a variation of this lecture from every new factory medical carpetbagger I encounter. It’s never a conversation – This was a fucking lecture.

Why are factory medical practitioners so sanctimonious? I have eyes. You’re no Arnold Schwolenpecker. Where do you get off haranguing me?

AND… you don’t know my medical background. And from the 10 minutes you spent with my thirteen-year chart, right before you blessed me with your presence, you gleaned your from your now detailed knowledge of my medical history and contributing environmental factors that I deserved a lecture?

REALLY?

I spent the remainder of that afternoon and evening processing Dr. Empathy’s information dump during my inspirational ten-minute audience.

Oh, Shit… I think I forgot to genuflect and kiss his ring as I withdrew…

The missing component in all of this is compassion. Being treated as a defective unit is not only dehumanizing but demoralizing.

I am not a 1951 Hoffman.

“If you prick me, do I not bleed” If you tickle me, do I not laugh? If you poison me, do I not die? And if you offend me, will I not revenge?” ~ William Shakespeare

Somewhere we abandoned compassion, trading it for expedience in the quest for the almighty dollar.

Ego tantum non modo finem.

I understand being jaded by a chosen profession, having your heart set on being a lifesaving cardiologist only to discover that you are FORCED to interface with the lower life forms and owners of the defective part you’ll repair. After fourteen years of education and over two hundred thousand for tuition and loans, what a crushing realization.

I am NOT the means to your end. I am a person with feelings and significant trepidation about surgery in general. You will take me to the edge of oblivion, cut on me, repair me, then hopefully bring me back.

What could possibly go wrong?

I’m well educated but in an entirely unrelated field. AND… Do we not owe each other some courtesy as professionals and human beings?

Dehumanizing me into an object is why I have no trust in the Industrialized Medical, Pharmaceutical, and Insurance Complex. They removed humanity from the equation to pursue record profits and efficiency – Factory Medicine enables and supports this end.

Effective communication requires and sender, a receiver, and a common language, something I consider each time I launch into an explanation for a practice I know well.

I try to understand the people in the conversation.

Can we create a relational bridge to support our discussion?

Explain the operation of the wireless radio to a farmer in China. Better yet, ask this farmer to explain his theory of crop rotation and how it prevents the depletion of soil nutrients. Even if you speak the same language, there are technical terms and nuances to consider and address. Now, superimpose any medical practice onto this model.

I have enough anecdotal experience from seventy years of medical encounters to understand roughly 60% of the lecture. I can spot sanctimonious condescension in an instant. I’m also a whizz at the reading annoyance in someone who doesn’t want to be there.

This is the eleventy-ninth time Dr. Empathy has given the same lecture to the fat slob across the room – the one who resembles a nervous deer in the headlights of the converging technicolor parade floats.

The defective unit hears every third or fifth word – they make little sense – it’s a foreign language. Why did I ask that Chinese farmer about crop rotations?

What was I thinking?

Do I know enough to take the next step?

Can I trust someone that doesn’t care about me as a person – to whom I am only a malfunctioning unit…

Should I make this leap of faith?

In the end – that’s the determining factor, the point of all of this.

Why are we subjected to this baffling battle of units per hour? I want to heal, not be castigated.

What happened to “First do no harm?”

Is it now really about the throughput and billing?

Are we just defective units with a busted what-cha-ma-call-it?

Ego tantum non modo ad finem.

I am only the means to an end.

May 12, 2022

~ The Author ~
Charles R. Dickens was born in 1951, is a veteran of the Vietnam war, for which he volunteered, and the great-great grandson of the noted author, whose name he shares.

He is a fiercely proud American, who still believes this is the greatest country on the planet, with which we’ve lost control and certainly our direction. He grew up in moderate financial surrounding; were not rich by any stretch, but didn’t go hungry – his incredibly hard working father saw to that. As most from that era, he learned about life from his father, whose story would take too long to tell, other than to say that, he is also a fiercely proud American; a WWII and Korean war, veteran Marine.

Charlie was educated in the parochial system which, demanded that you actually learn something, and have capability to retain it before you advance. He attended several universities in pursuit of a bachelor’s degree, and chased the goose further to a master’s, and has retained some very definite ideas about education in this country.

In addition, Charlie is a retired blues guitar and vocalist – a musician. This was his therapy career. Nothing brings him as much joy as playing music, and he wishes that he could make a living at it… but alas… life goes on!

That’s Charlie… a proud, opinionated, and passionate American.