Shingles Does It, Health Affairs, Sept/Oct 2009
"After a doctor-professor with a bad case of shingles arrives in the ER, he discovers what it’s like to be a patient in pain during this age of aggressive medicine."
Dr. Coulehan is professor emeritus of preventive medicine and senior fellow at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University, NY. He advocates against excessive medical testing. Given his position and experience, he "felt fortunate that there was absolutely no way I’d ever be stuck in such a scenario."
Stuck he was. On Easter morning, 2008, while experiencing intense pain from shingles, Coulehan visited an emergency room to confirm his diagnosis and get prescriptions. He left 12 hours later after seeing 2 physicians, a neurologist, an ophthalmologist, and undergoing 2 MRIs and a CT scan of his head. The hospital ER bill: $9000.
"By the time I learned the total of that ER bill, I’d also come to grips with my feelings about the Great ER Caper. At first I felt angry and embarrassed about spending a whole day at the hospital, subjecting myself to multiple expensive and unnecessary tests and playing along with the culture of medical overkill that I’ve spend decades teaching students to avoid. How stupid!"But he realized what he was up against - entrenched profit-based medicine:
"In today’s medical culture, we almost always consider that more is better. Each new machine creates pressure to expand the ways it can be used. In most health care settings, the doctor has far greater incentive than disincentive to order excessive services."And the trust we are compelled to place in that system when we fall ill:
"I learned how difficult it is to remain objective when you’re feeling very sick."