JP at large: We can't afford this

July 24, 2006

There are people who actually schedule regular doctor visits as social events.

I did a little unscientific survey and came up with what I think is a monster figure. The drugs that they really probably do not need come to more than $250 per patient for a 30-day supply. Who is paying the freight for this overutilization? It's you, me, and everyone else.

Here's an example: A customer was prescribed Flonase (fluticasone propionate, GlaxoSmithKline) in May of 2002-allergy season. He has had it filled regularly ever since, like clockwork, the first of every month. It doesn't seem to matter if there is pollen in the air or not. So, I asked him, "Winston, do you still have a stuffy nose?"

"What about the Allegra-D [fexofenadine/pseudoephedrine, Sanofi-Aventis]. Do you think you still need that?"

"I don't know. I like taking the Allegra-D and the Flonase. They work. Why take a chance?"

"You may not need them, Winston. Try going without as a test."

"Why should I stop them? They are free."

And that, my friends, could be the biggest crisis facing the entire medical industry. It could be a significant problem for our society. Overutilization! Billions of dollars in totally unnecessary expenditures. Medicines that are not needed. Diagnostic tests that are superfluous. You have a little ache in your knee from standing up all day, and they put you in the machine for an MRI. How much does one of those cost? I could give you terrific advice for $19.99: Make sure you sit down once in a while during your workday. Take a lunch break to eat sitting down. The problem is you won't listen.

There are people who actually schedule regular doctor visits as social events. An elderly woman goes to the doctor every single Tuesday. She looks forward to seeing the same people, her friends, every week. She gets dressed up and takes the free senior citizen shuttle to the office. She gets there early so she has plenty of time with her acquaintances. She even takes a thermos of tea. The doctor sees her for a few minutes. I can only imagine how her visits go. "How are the grandchildren, Mildred?" The doctor listens to her heart and takes her blood pressure. She has no complaints, but the doctor bills Medicare anyway. Had she grumbled about a little dizziness, perhaps another MRI would have been ordered. Did I mention overutilization? Our civilization is footing the bill for Mildred's social life.

A good friend of mine and his wife are so well insured that they see their doctor for some of the damnedest complaints. They are Internet hounds and read about their ailments, both real and imagined. They are informed consumers when they confer with their doctors. My friends even know what tests to ask for ahead of time. They both are well educated and have retiree medical insurance until they enroll in Medicare. They have what we call good insurance.

Their co-pays are minimal, for specialists, diagnostic tests, and prescriptions. You and I and everyone else is paying for their cost-free tour through the medical system.

Perhaps I am just overreacting again. I get something like this caught in my head and I think about it too much. Maybe not; I know that our society just cannot afford to keep going on like this. It is too much, too often, and too expensive.