Greetings dear readers! Today, as a public service, we are turning the N1303K blog over to Mr. Ben Dover of Hanover, Hampshire. Mr. Dover is a healthy, 49-year-old male and patient of the General Internal Medicine Department of Dartmouth Hitchcock Medical Center. Mr. Dover writes:
2008 is the year I turn 50 -- and in the eyes of my healthcare providers and my health insurance company, I am about to become, for lack of a better expression, a pain in the ass.
Why bother with euphemistic terms for the anal orifice when the subject at hand is the grim reality that every 50-year-old faces? I refer to the medical necessity of an annual colonoscopy to screen for colon cancer.
As the half-century mark approaches, I have found myself uncharacteristically attentive to discussions of colonoscopy. And, as a result, what I have been given to understand is that, in reality, the colonoscopy (as distinct from the preparation for it, which I understand to involve drinking unpleasant things and much time on the toilet) is an unremarkable experience, thanks to the wonders of modern anesthetic care.
Uh oh! Today's New York Times brings the following revelation:
Aetna, one of the nation's largest private health plan managers, is the latest insurer to clamp down on the use of a powerful anesthetic during an increasingly common form of colon cancer screening.
The company will send a letter to doctors on Friday, saying that it plans to classify the drug as "medically unnecessary" for most such procedures. As of April 1, Aetna plans to stop paying for its use inthose cases.
The change by Aetna covers about 16.6 million members and comes on the heels of similar moves last year by WellPoint and six months ago by Humana. Other insurers say they have no plans to follow their lead,including UnitedHealthcare, which has 26 million members. Medicareleaves coverage up to local insurers that administer its plans, mostof which cover the anesthetic, propofol, only in high-risk cases.
Critics say Aetna's decision would be a step backward in the battle against cancer of the colon and rectum, which trails only lung andprostate cancer as a cause of cancer death among Americans, accordingto the federal Centers for Disease Control.
The anesthetic eliminates the discomfort of undergoing a colonoscopy,a procedure in which doctors explore the lower intestine to identify --and if necessary remove -- developing tumors before they become dangerous.
. . .
A recent book looking at such patterns and at overuse of medical products and procedures -- "Overtreated," by Shannon Brownlee --concluded that they inflate health care spending in the United Statesby at least 20 percent. With millions of colonoscopies performed each year and specialists advising all Americans over 50 to be screened, the proper use of thisanesthetic could become a multibillion-dollar point of contention.
Oh really? Memo to health care providers and health insurance companies: That "point of contention" starts with the leading edge of the first colonoscope aimed at my nether regions!
A check with the friendly neighborhood anesthesiologist revealed that many colonoscope-wielding internal medicine docs treat the procedure the way dentists treated drilling cavities when I was a kid. Remember those dark ages? When the dentist encouraged you to see how much pain you could stand before he brought out the novocaine, implying that such stoicism was a sign of good character (and also a way of avoiding the unpleasant anesthetic syringe, which the dentist was more than pleased to offer a glimpse of to you)?
In other words, according to the anesthesiologist (who spoke on condition of anonymity) your GI doc is likely to see how much pain you can "tolerate" before offering you any anesthesia, much less something like propofol (which, as the Times explained, is not itself an expensive drug, but requires the presence of an anesthesiologist or a nurse anesthetist, who then expect to get paid for their services). Is that the right way to treat patients in the wealthiest and most civilized nation in the history of the planet?
Wander up to 5 East at Dartmouth Hitchcock Medical Center and you'll pass the home of a program known as "CHaD Pain Free." CHaD is the Children's Hospital at Dartmouth and its "Pain Free" program is essentially an anesthesia clinic, founded by a pediatric anesthesiologist, Dr. Joe Cravero, whose hypothesis is that kids should have hospital experiences that are -- pain free!
Okay, call me a whiner, but I say: Why shouldn't grown up colonoscopy victims have pain-free visits to the hospital as well?
So I am ready to found a nationwide advocacy group called "Patients for Pain-Free Colonoscopies," or PFPFC. And our guiding principle is this: The next time your doctor tells you it's time to schedule a colonoscopy, tell them you want propofol and you don't want to be billed for it if your insurance company won't reimburse the cost.
It's time to grab the torches and pitchforks! Where will we stick them and how pain-free will it be? Depends on what happens to the propofol.
Greetings dear readers! Today, as a public service, we are turning the N1303K blog over to Mr. Ben Dover of Hanover, Hampshire. Mr. Dover is a healthy, 49-year-old male and patient of the General Internal Medicine Department of Dartmouth Hitchcock Medical Center. Mr. Dover writes:
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