Corporate medicine is medicine conducted, primarily, for the profits of shareholders in the corporation. Health insurance, healthcare, pharmaceuticals, death prevention in general, forms the most lucrative sector in the American economy. To be sure, decent medical results are required, usually, for a corporately held medical group to stay in business, but make no mistake: the primary goals of the board of directors and CEO of the corporation are for doctors to see as many patients as possible, do as many expensive tests and surgical procedures as possible, bill for every contact with a patient and make the most money for the corporate “person” that employs the medical staff, invests in the medical technology, conducts public relations and fundraising in the community to be seen as self-less healers.
You will notice fewer hospitals with an ombudsman or patient advocate. These skilled professionals calm down patients who are upset, make them feel heard, resolve conflicts that can complicate healing. They also avoid lawsuits against hospitals and doctors. None of these outcomes are as important as a good security system to remove agitated patients who demand things of doctors or medical staff. I will be writing about death by corporate medicine again soon, but for the moment, here’s one example of corporate medicine that might seem subtle, though it doesn’t feel that way to the patient.
The patient (me) was scheduled for an emergency cystoscopy, the insertion of a miniaturized camera into the penis, down the urethra and into the bladder. I’ve had these before, they sound much more nightmarish than they actually are. The phrase associated with things like cystoscopies is “most patients tolerate” the procedure, often with an initial grunt. I was nervous about this emergency test, since my urethra was still painful from an unnecessary surgery conducted on me two weeks ago by a surgeon who, although charming and a great salesman, never did any test before plunging into my urethra and tearing the tissue therein.
I was told by my new urologist that if I arrived one minute after my appointment time the emergency cystoscopy would not be done. I arrived ten minutes before my appointment time. I then waited ninety minutes for my appointment. During those ninety minutes I urinated five times. I was nervous, and annoyed to be kept waiting this long. I had to go again and again because my bladder doesn’t empty easily, but every one of these pisses was pretty much pain free, especially compared to the relentless pain of the last two weeks. Then I was escorted in for the cystoscopy. I told the attendant that a lab report on my recent urine culture was back and that if I had an infection I probably wouldn’t be having a cystoscopy. He turned us around and took me into a regular consult room.
When the doctor finally arrived, I had one thing to say, a final word to clear up our initial misunderstanding. I told her I needed ninety seconds. I wanted to make it clear that I respected her longtime colleague, and my longtime urologist, and that we’d been having a mutual bad day the last time I saw him, that I was under pressure from recently diagnosed kidney disease, the inability to walk and other medical issues. She cut me off about ten seconds in, I was by now, apparently, her last patient of the day. She was not interested in rehashing any of this, she said. She told me I had a massive urinary tract infection and that was the cause of my pain. Obviously we weren’t going to insert a scope into a painfully inflamed urinary tract.
I could have been told that ninety minutes earlier, by the doctor’s smart, engaging personal receptionist. The knowledge that I wasn’t going to have to tolerate a painful (initially) procedure might have saved me two or three trips to the bathroom. It certainly would have spared me some anxiety. But that kind of thing is strictly the patient’s concern, not anyone else’s, in a corporate setting where your doctor is seeing twenty other patients a day.
Because I had urinated so many times while in her office, because I had a massive infection, the doctor assumed that I was still in as much pain as a few days earlier when I was still recovering from an unnecessary procedure (as the surgeon conceded afterwards, I need a different one) that had torn tissue in my urethra. Based on the lab results of a urine culture and her assumption about urinary urgency and pain, she prescribed the Cipro and told me to take two pills, phenoazopyridine, three times daily, to help with the urgency and pain of urination.
I was unable to convey to her that balancing my water intake (after days of trial and error, 48 ounces seems to be the sweet spot) is the best way to keep the urine flow going throughout the day. I began telling her that my previous experience with phenoazopyridine had left me unable to urinate at all for hours at a time. If the goal was, as she said, to keep urine flowing to help protect my kidneys, and empty my bladder as much as possible, this drug, which had not worked for me pain-wise either, was not one to take. She quickly dismissed my experience and encouraged me to take it three times a day, whatever it said on the box.
Updating this post just now I seem to have deleted my final paragraph. Had the doctor asked me my level of urgency to urinate and pain during urination, instead of making hasty assumptions about what I needed to do, I’d have given her a pain score of two on each of those, as opposed to a solid 7 to 8 several days ago, when my torn urethra was still inflamed. I didn’t need pain medication for the infection, only the antibiotic to cure it. I won’t be taking phenoazopyridine again, and I’ve regained much of my ability to urinate as before after last night’s dose, but … seriously, what do you expect from a doctor who works in the setting of corporate medicine? She doesn’t get paid to schmooze or ask patients about their feelings, there’s absolutely nothing in it for a doctor with a tough quota to meet every day.
Next time, remind me: corporate medicine’s denial of any mind/body, affective/corporeal, emotional pain/physical healing connection.
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