Resources

With a medical system (a great medical system with flaws) starts to feel the crunch of financial issues along with increased wait times, everyone feels it. Everyone is trying to figure out a better way to do things; shorter wait times, opioid crisis reduction, addiction prevention, more efficient patient care, and more accountability in all aspects of healthcare. When funds are dwindling and so much more time is spent monitoring how patients use medications and how doctors prescribe medications, the resources get stretched thin. There's this movement towards accountability on all levels - including management, doctors, nurses, EMTs, patients, families, and even the general public. There are all of these news articles discussing the average amount spent per year on healthcare, and then petitioning everyone involved to take a step back and assess what steps EACH of us can take to reduce the burden.

I go back and forth in my mind all the time over how many resources I, as a chronically ill patient, use. The fact that I have several different chronic illnesses that were nearly all difficult to diagnose means that I have had more than my fair share of diagnostic testing done. I take several medications on a daily basis. I have 22 different doctors in my contact list, and a few more I see so rarely that they never made it into my phone. I get a colonoscopy at least once a year, I find myself in the ER several times a year, and I usually have to take a ride in an ambulance about once a year. None this year yet though. The undeniable fact is that keeping me alive is expensive. For me, for my family, for our healthcare system, and for the taxpayer - which includes me, by the way.

That time two years ago when I was taken in an ambulance because of a severe intestinal swell, I stayed in the hallway of the hospital for the most part. I was offered a room and a bed. I turned it down. I turned it down because I did not feel that it was necessary and that if someone else required more monitoring than I did, then why not let that person get the room and the bed. I was on a relatively comfortable gurney, the emergency part had been taken care of, and I was waiting on lab results and to see the doctor. I was comfortable staying in the hallway. Well, as comfortable as one can be sitting in the hallway of an emergency department anyways. But here's the problem - I thought I was doing the right thing.
But because I stayed in the hallway, the EMTs who had brought me in could not discharge me from their care until I was taken into a private room (which I did not know until it was too late).

So which is worse, according the public?
     Taking up a private room and a hospital  bed just to wait for results?
OR
     Having an ambulance and two EMTs unavailable for another's emergency?

Currently I am on some pretty heavy-duty medications that could become scarce. More than one of these might become more difficult to access. I always feel guilty about these situations. These medications, however, are helping to curb those frequent visits to the ER.

So, again, which would be worse?
     Being dispensed a medication that is not available to every person who could benefit from it?
OR
     Choosing to forego a medication that truly helps me and winding up in the ER at least 4 or 5 times a year?

There is a lot of testing that is required when a patient suffers with chronic illness. It doesn't just include diagnostic testing when things go wrong, but regular bloodwork, yearly colonoscopies and endoscopies, yearly eye exams with an ophthalmologist, yearly sets of scans to monitor the progression of my AS, and if symptoms are changing, even more tests are ordered. Even if I go into a clinic for something I have been treated for many times, they are still required to take basic bloodwork to make sure nothing else is going wrong. To add to that, if any symptoms seems unusual, because of the complex nature of my system, there is a lot of testing that eventually gets done to pinpoint the issue. Those expensive medications that I take help to curb additional testing that needs to be done on a regular basis.

So, which is worse?
     Taking up loads of medications?
OR
     Taking up loads of extra testing because my symptoms aren't regulated or predictable?

Here is the reality.
Having chronic illness costs.
If we were in a two-tiered system, it is a high likelihood that I would not be receiving much treatment, if any, because we would not be able to afford it on our own. My medical history is so long and complex that insurance companies would laugh at an application to be covered. So where would that leave me? Dying slowly by my body's own immune system and my body's own organs? Or homeless?
I still pay taxes. I still contribute as much as I can to programs and charities and to society in general. I do whatever I can to reduce the amount of 'wasted' resources, and I do not take medication if I do not see any improvement from it.
As a patient, I try to make decisions that reduce the stress of an already thinly-stretched system, but it is impossible at times. If specialists do not know how to approach something, if I require emergency treatment or care, and if I require medications to live a certain quality of life, then that is what my body needs.
Yes there has to be accountability.
Yes we have to make a few changes and help reduce the amount of wasted resources. The problem is that we never truly know what tests or medications or treatments or interventions are, in fact, a waste of resources.
Hindsight is 20/20.
When you are in it, it is impossible to know if you are being unreasonable - as a doctor, a nurse, an advocate, a patient, a specialist, a radiologist, an emergency room physician, a family doctor, a family member.

Every illness - every symptom that is treated - costs. Every time someone steps into a clinic or urgent care or the ER to be treated, is going to cost money. Each symptom that is individually tested and treated will cost money. There is no way to know for sure that a symptom requires no treatment, apart from experience. That is what our family doctors are for. We are all feeling the strain and we could all make some better choices, but without a crystal ball, we don't often know if the choices we are making will wind up costing less or more in the long run.