July 09, 2019
One Happy Island
Recently, my wife and I took our kids to Aruba. It was our first time there and we found it to be a wonderful place for vacation if you are into the beach. The weather is uncannily stuck at 85 degrees and mostly sunny. The ocean was incredibly calm and clear. It’s ideal for relaxation; just what the doctor ordered. For me, however, the doctor ordered a bit more.
I suffer from gout. Gout is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. When the crystals collect in a joint, your body’s immune system is called in from the bull pen and envelops the crystals to protect the joint. This results in swelling, excruciating pain and hyper-sensitivity in the affected joint. The most common site for a flare up is the ball joint of the big toe. The weight of a bed sheet on the big toe can have you climbing the walls in agony.
On the evening of day three while at dinner, I felt the twinge in the toe of my right foot. And of course, I did not have my medication with me. I took a double dose of Aleve when we got back to our room and prayed. Either my praying or the Aleve was not strong enough because at 4 am, I awoke in agonizing pain. I took more Aleve and watched every minute on the clock go by until I knew a clinic would be open. At 7 am, I hobbled to the front desk and explained my situation through clenched teeth, as sweat poured down my head. An employee helped me to the driveway and instructed a bellman to take me to an urgent care center. The bellman asked me if I knew what medication I needed. I knew exactly what I needed as I have been living with this for years. He told me that we would go straight to the pharmacy. I told him it was not over-the-counter, that I needed a prescription from a doctor. He said OK and reiterated the pharmacy was the place to go. A bit confused, but with little energy to discuss, I acquiesced. I dragged myself into the pharmacy and talked to the pharmacist. He called a doctor and put me on the phone with him. I told the doctor what was going on and what medication I needed. The doctor asked me to put the pharmacist on the phone. Within thirty seconds, the pharmacist disappeared into the back and returned to the counter with my medication. Five dollars for six pills and a whopping thirty dollars for the physician consult. I was stupefied. Before 8 am, I was back in my hotel room and had already taken the medication.
Could you imagine this kind of efficiency in the US? When the flare up happens at home, I need my wife to drive me to urgent care where I wait up to an hour to see a doctor. I am billed 300 dollars for the urgent care visit. Furthermore, despite my electronic records being available to the attending surgeon at the same urgent care center I always go to, I’m treated like a new patient that has a condition no one has ever seen before. With the prescription called in, I then have to go to the pharmacy and wait for them to fill it. The medication, which has been around for decades, is now 8 dollars a pill and is no longer covered by most insurance companies (something I learned during a previous flare up earlier this year). I typically need up to six pills.
So, there you have it. In the “most advanced” nation in the world, this routine and rather commonplace episode costs $350 dollars and chews up about 3 hours of time. In a country running on island time, it takes under an hour and costs $35 dollars to treat. In the US, protocol for “urgent care” is the same for a broken ankle as it is for running out of meds for an arthritic condition. It’s high time we start giving people some responsibility and accountability for their own care. Collectively, millions of hours and dollars can be saved if we stopped treating every ailment like a rare disease in this country.