The High Cost of Bargains

This past week the local paper ran an article about dental tourism. I’m not sure why it popped up just now as both medical and dental tourism have been around for quite a few years.

On the one hand it should come as no surprise to anyone living in the United States that, owing to the high cost of health care, people look for bargains. For those with the necessary resources, courage, and an underlying sense for adventure, medical/dental tourism makes sense. The cost of care in Mexico, Central and South America, India, China, and many other overseas destinations is a fraction of what one would pay in the U.S.

On the other hand it disappoints the hell out of me. In a region of the U.S. where complaints of job loss and outsourcing to foreign competition is always front and center, it is odd that anyone would look to medical/dental tourism as a clever option in controlling healthcare costs. It’s like plumbing: If you need a new fixture you can buy it online with free shipping for X dollars. You can purchase the same item for half again as much at a local bigbox store—one that employees the people you know and one that pays local taxes (maybe). Or, you can buy the same item at a locally owned store for 2 to 3 times the Internet price and know that you are not just buying hardware, you’re supporting a business that keeps its revenue—all of it—right here in your city and state. The price you pay at a locally owned store goes toward way more than the cost of a simple fixture.

Like Internet hardware, when one travels abroad for a medical or dental procedure you are likely to get quality work. After all, many of those practitioners may have come to the U.S. to receive their specialty training and often with the benefit of your tax supported facilities.  But it’s not just the local dentist who suffers when a patient goes abroad for treatment. Every member of that dentist’s staff, every patient that remains behind, and every member of the community supported by that practice’s revenue pays for the loss of that overseas patient. And, ultimately, we may find ourselves waxing nostalgic about the day when we had a local dentist, doctor, or other caregiver.

I guess if one truly supports the fiction of a “free market system,” than we can all agree the best deal is the lowest price. Just be prepared, though, to live with the consequences of your bargain shopping as you find your choices dwindle and convenience disappears at just about the same rate as local jobs: Nobody can find a good job but, man, what bargains!

Not Treated Like a Dog

I saw an old patient of mine in the emergency room a few weeks back. He had broken his hip and was happy to see me because I had replaced his knees quite a few years earlier. In his mid eighties, he was living at home with his meticulously groomed and well-coiffed attractive wife of 60+ years.

There were options for this gentleman. I could do a quick and easy repair that would necessitate his not walking on the hip for a couple of months, or I could replace it, give him a new hip and get him going. He was a busy man, he assured me, with a garden to tend and a yard to maintain-- he wanted to get home and get back to business. So, a hip replacement it was.

One of the problems with taking care of an elderly person is that you don't always know when what they want to do is no longer what they can do. Needless to say, my patient needed to go to a nursing home for rehab for a few weeks after surgery.

Three weeks later he was back in the hospital with pneumonia (a "readmission within 30 days," an event for which Medicare no longer reimburses hospitals). And that's when the nurse noticed his wound was a little red.

My patient went on to require 2 more surgeries to wash out his infected wound. He had pneumonia, miserable pain, hated going back to the nursing home, and pleaded with his doctors, including me, to just let him die-- the latter something he managed to do on his own about 8 weeks after the whole miserable episode started.

I feel confident there was nothing technically wrong with the care he received. We followed all the "best practices," we met all the "core quality measures" set by the Centers for Medicare and Medicaid Services. But, in the end, I think our system failed to take care of a frightened old man who was in pain and dying. He had hospice care but not until the bitter end.

I've been thinking a lot about this man and his wife the last few days since I learned of his passing. And it leads me to think about this: If we euthanize our dogs when they are suffering and dying as an act of human kindness, why do our elderly have to suffer and beg?

Public Service Pam

Every girl under the age of 25 should have been watching Dancing With the Stars the last couple of nights. Every dad in America should have been watching as well. In an "All Star" reprise season of the show, Pamela Andersen was among the celebrities invited to make an encore appearance on the show. Her appearance really served as a public service announcement for every young woman in America.

What I know about Pamela Andersen has come from copies of People magazine left laying around the office and hearing other peoples comments about her, her celebrity marriages, and her criminally augmented boobs. So, I'll go out on a limb here with my observation but feel fairly safe at this height: Pamela Andersen is a poster child for a failure of parenting. For an absence of self-esteem. For what becomes of a person who chooses a life lived in pursuit of fame and esteem by association. A life that lives or dies by the arm you hang on.

When a child, any child, regardless of gender, is raised without a well formed sense of self then they accumulate nothing in the drawer marked "self-worth." They become puppets and dolls, errand boys and accessories, in the lives of others-- and almost always others who share a similar disease. They are condemned to a life trying to gain approval, constantly at the bidding of others. (As a friend of mine in the ER likes to say, when your daughter grows up to be a pole dancer you know you've pretty much flunked fatherhood.)

I felt there was a desperate sadness to Pamela Anderson last night as she failed her dance routine and became the first to get booted off the show. It was a "Sunset Boulevard" moment. It just seemed that, there she was, not flunking at dance but at the only thing she knew how to do: be popular.

Flunking popularity on a primetime national TV stage has got to be a miserable feeling. For someone with her credentials, a monumental personal failure, a zero balance in the self-worth vault. And that's why father's and daughters should have been watching. This is a woman who seems to have started out in self-esteem bankruptcy, created a fortune-- a self-worth Ponzi scheme, if you will-- only to get caught on primetime television with nothing. Nothing to provide and nothing to be given.

I have always told my daughter that it doesn't matter what she chooses in life. She just needs to choose wisely enough that, by the time she's 50, she can look in the mirror, know who's looking back, and have the ability to say, "I choose to be here." It's about ownership. And it's a sad thing watching someone discover that, after all these years, they have been a renter, not an owner. Worse still, to find you can no longer come up with the rent.

McDonalds - Smart: An Oxymoron

The other night my daughter and I were watching U of M throw the ball to Notre Dame in what was supposed to be a football game. An ad came on which has been in the loop now for a month or so: It features a group of youngish adults going out to eat at a McDonalds. One of the guys is asked where he is living and, via flashback, we see he has moved back home. The crux of the matter is his need to gracefully get out of telling his friends he has moved back in with his parents. After a moment he comes up with a clever reply that distorts the truth and the equation is it's smart to eat at Mcdonalds just like our hapless friend was smart in embroidering his reply.

My daughter said, "I will never be in that situation."
Dad, a little disappointed, "What, moving back home?"
Daughter, "No! Going out for a meal with my friends at McDonalds in my 30's!"

I was relieved with her answer but then I was struck by the rest of the story: Lying and distorting the truth has become a standard-- and apparently admirable-- modi operandi in our society. We've just become so clever and smart we can just say whatever we want. Credibility is in the answer, not the truth.

The other really pathetic part of the ad is that is implies there is shame in having to move back home with your parents. In a time when millions of Americans cannot find work it is an all too well known scenario that young people who would like to be independent, working, and living in their own apartment or home are having to move back home. So, rather than admit to the circumstance, rather than demonstrate a sense of gratitude that his mother is happy, able, and willing to have him move back home, our sorry McDonalds customer lies about it. And then comes the tag line that links eating at McDonalds with being smart, something like: McDonalds. Smart.

From a personal perspective I'm not too disappointed. I stopped eating at McDonalds quite a while back because it's just wrong on so many levels. But for the "billions and billions served" it's the wrong message entirely and a disservice. Unfortunately, it's also probably a pretty good barometer of the current state of personal integrity.

Yes. A Good Weekend

Dad time, c. 1992

It drives me crazy when people ask, "J'have a good weekend?" It's not a privacy issue so much as weekends kind of come and go. My life is good. My weekdays are good. My weekends aren't some type of uncorked celebration marking the end of a tedious week. My weekends are just two more days of the week and, happily, tend to be enjoyable as well….providing there aren't too many chores to take care of.

But this weekend was different. I got to spend almost the whole entire day Saturday with Kels. I never get to do that. At least not since she started driving.  Not since she got a boyfriend. Not since she left for college. But she was home for the weekend from school and decided she wanted to kinda hang out with me. Amazing!

We did rounds at two different hospitals-- something she hasn't done much really since she stopped drawing with crayons. We looked at x-rays together; straightened out a broken ankle and a couple of broken wrists; talked about school and exams and medical school and the future of medicine and working. We talked about damn near everything and finished up the day watching U of M lose to Notre Dame which turned out to be the only sour note in the symphony that was a day spent with my daughter.

In the morning Ev and I bundled up in the crisp fall air and sunshine and rode our bikes down to Lance's Bakery and hauled home fresh bread, donuts and maple bars. The breakfast of champions. And the perfect end to a perfect weekend with my daughter, something I never get to do.

Ya, so just if you were wondering, I did have a good weekend. A really good weekend.

Nosey Discount Cards

Where I live it seems like every retailer wants you to have their card. Not a charge card. A discount card. You know: It's that little stubby plastic number you hang on your keyring so that you can read "You saved $4 using your savings card!" at the bottom of your receipt. Makes you feel pretty thrifty and shopper savvy, right? There are even little perks like a free donut or something on your birthday.

Not so much me. I resist these programs as a nuisance and an invasion of privacy. I prefer to shop where the prices just seem reasonable and you don't have to feel bad if you drive your wife's car and forget your little keychain card. That said, I finally got tired of being asked if I have a card and so consented to obtaining one of the little buggers some time ago. It's not a great store but it is close by and I do use their pharmacy.

After yesterday, however, I know why I hate the little discount cards and will never use one again: "Here's your receipt and a coupon" the clerk says handing me my paperwork. The coupon was for Men's One-A-Day Over 50. Whatever. Like I'm even 50.

Not just an invasion of my privacy, it's, like, y'know, totally stupid and inaccurate. Seriously. I'm going full retail if it's gonna be about name calling.

Of Soup and Stew and Chili

Last night summer melted away into the first day of autumn. Enough of a soft, cool, intermittent rain fell to keep our big oaks water soaked-- their leaves dripping larges drops of water on the roof over our bedroom. Water soaked enough to let the occasional small branch give way and hit the roof with a crack. Water soaked enough to break free those last few acorns-- and dear God there were billions this year-- and let them smack our roof as well. Summer melting away.

Michigan never takes her seasons for granted: Each enters and exits with some degree of ceremony and display. The winds in the last couple weeks were enough to make the dog raise his clever nose for long pause and a whiff. Even to the lowly human nose it was simple enough to pick up the smell of a hundred fields, farms, and forests that surround this town. The wind carried it all: crops harvested, crops waiting, leaves preparing to shut down 'til next year. And the memory of 50-some summers past,warm days, late night play, and a thousand things to accomplish before it's over-- all of that carried in the wind.

Like most everything in my life, I look forward to what's ahead and am grateful for most all that's left behind. For now, I'll send the light weight stuff into storage and start taking inventory of the flannels, the rubber mocs, the Portland clogs, and my rain coats. It's time to start thinking of soups, and stews, and chili.