Physician, hear thyself

The other day I received an e-mail that was a little upsetting. It came from an e-Alert reader who had taken my frequent references to homocysteine to heart and asked her doctor to check her homocysteine level — which is a good idea for anyone concerned about reducing the risk of heart disease, heart attack and stroke. As I’ve often mentioned, your homocysteine level more accurately reveals the risk of heart related disorders than a cholesterol test.

So what could be the problem with a homocysteine test? You draw blood, send it off to the lab, and wait for results. Simple enough. But sometimes the simplest things can become unnecessarily complicated when outside pressures come into play.

Getting tagged

To ensure this reader’s privacy, I’m not going to give her real name. We’ll call her Tracy. And here’s part of her e-mail:

“I was at my doctor’s office the other day for my annual exam and asked if I could have my homocysteine level checked. She said she would highly recommend against this because, since I have no other “risk factors” for heart disease, my health insurance premiums would rise when they see a test for homocysteine. She also said what good would it do since I already take B vitamins, I exercise six days a week, I’m thin and lean, and I’m premenopausal.

“Normally, my response would have been that since I am on my husband’s group plan at work my premiums won’t go up. But then I thought that since my husband is going to retire in a few years and I’ll have to get my own, non-group insurance, that maybe I would be tagged for higher insurance premiums because of this test. Have you ever heard of this? Do you have any comments on this?”

Comments? You know I do!

Something fishy

I rarely discuss the insurance industry in the e-Alert. Insurance is an important tangent to health care, but it’s outside the scope of our primary mission at HSI. And besides, I have my hands full with two other hot buttons: the pharmaceutical industry and the FDA.

That said, I’ll push this uncustomary button, and make a couple of observations.

Like the pharmaceutical companies, insurance companies are in business for one reason: to make money. So while we’d like to think that they care about our health as much as we do, it simply isn’t true. To them our health is a business and our doctors are de facto employees. When you look at it that way, it makes sense that health insurance providers offer incentives to doctors who call for a low number of surgeries and special screenings for their patients. (That probably includes homocysteine screening.) They simply found a way to make their “employees” focus on their bottom line.

Now I don’t know Tracy’s doctor, she may be a wonderful physician who genuinely had Tracy’s best interests in mind. But there is a chance that she was motivated by a concern that was in the insurance company’s best interests, not Tracy’s. Which, to my mind, violates the doctor-patient relationship plain and simple. When you walk into that office, you have a right to think the doctor is working for YOU while you’re there, not Acme Insurance.

Granted, Tracy does not appear to be in a high-risk group for heart disorders. But people outside the normal risk groups suffer from ailments of every kind every day. Is it possible that by getting the test, Tracy’s insurance coverage would be “tagged” for higher premiums? I don’t know enough about the inner workings of the insurance companies but it certainly sounds like a common practice. But this is a simple blood test. If the test involved an elaborate procedure or a hospital stay, I might buy the tagging story. But raising premiums in response to a simple blood test – and not even considering the results? Frankly, that sounds fishy.

Getting all histrionic about it

Doctors are revered in our society. And they should be. They have a tremendously difficult job to do. And without a doubt, the good ones are worth their weight in gold. But anytime you feel a doctor is not adequately serving your health needs, you have to stand up for yourself and insist on being well served. Of course, this is often easier said than done.

Tracy’s story reminded me of an experience of my own. A few months ago I had some vision problems – headaches and trouble focusing. I hadn’t had an eye exam in years, so I went to my primary care physician and asked him to refer me to an ophthalmologist. Which he did. And fortunately my problem turned out to be a simple case of eyestrain.

Then, a couple of months later, I developed a severe sore throat. I found it difficult to swallow and my throat was closing up at night. When it became unbearable, I called my doctor. He was out of town, but his receiving nurse scheduled me to see another doctor. When I went in for my appointment, the substitute physician looked over my medical history file and asked about my recent complaint about declining vision. Then he floored me with this casual statement: “That was a bit histrionic, wasn’t it?”

No. It was not even remotely histrionic. I was having eye problems and I sought help. But with this comment he revealed his attitude toward his patients’ health needs. In effect he was saying: “You exaggerate. You’re fine. Don’t trust yourself. And don’t bother me with your problems.”

Thinking about this experience later, I wondered about his other patients and what sort of treatment they regularly receive. Then I imagined someone like my grandmother – someone who had a mild personality and a trusting nature – and how someone like that would be intimidated and, as a result, poorly served by this insensitive doctor.

As many of us do, I let my health problem go on too long before I called for an appointment. I can only imagine that the regular patients of that substitute doctor wait even longer than most people – not wanting to be thought of as hypochondriacs or be labeled as histrionic.

I hope that the next time Tracy gets a check up she’ll insist on the homocysteine test. If anyone else has had an experience similar to Tracy’s, or if their insurance policies have been tagged for increased premiums in response to a homocysteine test, I’d very much like to hear about it. Because you have every right to expect a “can do” attitude from your doctor when it comes to something as important and the health of your heart.
To Your Good Health,

Jenny Thompson
Health Sciences Institute