Monday, November 13, 2017

A Doctor's Oath--Hippocratic or Hypocritic? Dad's Heart Attack Saga

In my prior post, you read about Dad's successful implementation of his engineering design to get a side X side to reside on top of Big Boomer for transport.  As you can tell from the photos that accompanied that post, he was doing quite a bit of strenuous activity.  He showed no signs of distress while climbing, lifting, and performing the tasks to accomplish the feat.  But that changed quickly.  The minute he entered the truck to depart for home, he said he was parched.  He was flushed and breathing heavy, but quite understandable when you spend 30 minutes doing physical labor in hot, humid Texas weather.  We started down the road, and he still couldn't catch his breath, but shrugged it off.  He wasn't having any chest pain, tingling, or numbness, the classic signs of a heart attack.  If it weren't for anal Mom asking him where he put the keys to the new ATV, Dad might not have even acknowledged he was having a problem.  But after he went back up to the roof to get the keys out of the ignition, he started to get lightheaded and feel a tightness in his throat.  Long story short, we entered the ER on Oct. 31 with Dad undergoing what the doctor classified as a major heart attack.  He had 100% blockage in his right coronary artery, which has since been remedied with a stent.  This post is about what happened subsequently.  It is a sad commentary about the deterioration of a revered vocation.

We have always been healthy.  We don't succumb to colds/flu.   We take no medications.  Mom is hard pressed to even take aspirin.   We have no diabetes, no high cholesterol, no hypertension.   We do not eat fried foods, and NEVER partake of fast foods.   In fact, we don't eat out in restaurants very often since we can't control how things are cooked.  We don't eat frozen dinners or prepared foods.  Instead, Mom cooks meals for us regularly that include all food groups, including vegetables.  She never adds salt to her cooking, making her meals a bit bland.  (Our guilty pleasures, however, were eating meat nearly every night of the week and obviously, cheese).  Dad's been poked and prodded repeatedly since arriving at the hospital.  And other than when he was in the midst of his heart attack, his vitals and Labs are excellent.  (Blood pressure is textbook and cholesterol levels quite reasonable.  Ironic, ain't it!)  Mom donates blood regularly, receiving these vital stats each time.  The vampires are always looking for her (coincidently, she donated blood just 3 hours before our saga started.)

We have paid insurance premiums for decades, always representing the healthy sector of the pool.  We always paid into the pot, RARELY took out.   We have always had insurance, even in 2015 when we got caught up in the ACA mandates (see blogs of Feb. 20, 2015 and Feb. 2, 2016).  As fulltime RVers, we tried to catch a moving target, changing domiciles from SD to TX in 2015.  When TX pulled its only PPO from the exchange the following year, we opted instead for Liberty Healthshare (LHS), a faith-based alternative, a pool of like-minded, faith-based folks who care and share in each other's costs.  Like insurance premiums, we contribute a monthly sum for our plan.  Since we have been healthy, our contributions have always gone to pay other members' bills.  Since we had never utilized our plan in the nearly two years we were members, we were now learning the parameters of our coverage.  We have a $1,000 unshared amount (think "deductible".)   Then LHS takes all medical bills, negotiates directly with medical facilities/professionals, and pays an agreed price, usually within 30 days.  They have an excellent reputation and the testimonials from other members we spoke with said they have had no problems or issues.

Since LHS is exempt from ACA compliance, it does have pre-existing condition clauses, which did not present any real problem for us.  LHS does require pre-certifications for non-emergency surgeries and other procedures.

LHS and the hospital have been wonderful, handling everything seamlessly.  The hospital staff, from nurses to case managers, have been pleasant, efficient, and caring.  LHS have bee compassionate and patient, dealing with Mom's many inquiries and providing helpful information. This commentary is about the behavior of a specific doctor and what is becoming a systemic problem when the world loses "vocations" and instead has "jobs".

The cardiologist told Mom after the original ER procedure that Dad came in with a 100% blockage, which was now 100% cleared.  Dad was doing great and he would be discharged the next day.  These statements set Mom's expectations.  Mom later learned the doctor apparently told Dad during the procedure that he had two other "moderate" blockages, but that he would not touch them at that time.  Mind you, the doctor did not mention these additional blockages to Mom at all!  Imagine her shock when the doctor came in mid-day on Nov. 1, which she thought was for discharge, only to learn something quite different.  Those other blockages, in the left arterial descending (LAD), and its branch (that the doctor considered moderate when speaking to Dad) are now being classified at 90% and 80%!  Therefore, more stents/angioplasty were required.  He recommended we do the additional procedure while Dad was already at the hospital rather than wait and do them as outpatient. Mom called LHS about precert, since this is subsequent to the ER visit.  She was surprised to learn that all approvals were already in place.  Apparently the patient and his wife were last to know that an additional procedure was planned! After discussion and a Q&A with the cardiologist, my parents agreed to move forward with the procedure for Dad the next day.

Mom, who had been at the hospital for more than 24 hours, left to return home to check up on me and take care of our pets.  She was ballistic when she arrived home after the 1.5 hour commute to have Dad and the doctor calling her on the phone, and to learn the doctor was changing the plan of action once again.  More importantly, the REASON behind this revision in plan.

Apparently, the doctor considered LHS a "charity", and he was not willing to accept the risk of not getting paid for my Dad's, and I quote the doctor, "charity case." Ironically, he had no problem with LHS for the ER work he performed.  Now suddenly he says he is not willing to accept this "great risk." What changed in a 1.5 hour timeframe?  Did he speak to LHS?  Was it the policy of the group practice to which he belongs?  (We've learned since then that each and every physician, whether as a sole practitioner or part of a group practice, makes his/her own determination as to what insurances he/she will accept.)  We were not given any specifics as to what facilitated the cardiologist's change of heart.  We do know the hospital spoke to LHS and had no problem whatsoever billing through them like any insurance company.

 The cardiologist was now saying the blockages weren't that bad and Dad could wait to have the procedures done as an outpatient.  Which was it?  Moderate, which by this stuffed rat's definition is 50-60% max, or 80-90%, which I would consider "severe"?  After all the above-mentioned comments were made by all parties, the doctor said we could self pay and he would be happy to deal with us.   We certainly would have done this had it been discussed earlier, since we know he is a skilled interventional cardiologist.  But his lack of tact and professionalism in making this completely about his personal financial outcome left a bad taste in our mouths.   We had lost faith in his credibility.  Were the procedures needed because of the severity of the blockages or because he thought he was going to make some money?  Did the severity of Dad's condition diminish once the doctor decided, quite erroneously, that it was not going to be in his financial best interest to do surgery accepting payment through LHS?

Everyone has a right to earn a living, doctors included. And had he broached the subject initially with some tact, we all could have come to agreement to self pay.  We could have then submitted the bills to LHS for reimbursement.   Or we could have spoken to LHS jointly to appease his concerns.
However, referring to LHS and us as a "charity case" is disingenuous and insulting.  The Hippocratic Oath was to serve the sick and infirmed.  Apparently, this cardiologist took a hypocritic, not hippocratic oath.

Going from no medical issues to major cardiac problems is challenging enough.  But it is an even more disconcerting and scary situation when dealing with a physician, whom you know nothing about going into the ER, formulates diagnoses and opinions based ONLY on financial factors and not patient well being. 

My parents agreed they would discuss things further when Mom returned to the hospital before determining next steps.  Hence, the cardiologist left the procedure on his surgical schedule.  But while Mom started her 1.5 hour drive back to the hospital, Dad took matters into his own hands and summoned his case worker.  He decided he did not want the original cardiologist to touch him, since his own financial well being came before Dad's health and condition. Dad wanted a second cardiologist to be brought in for consultation.  By this time, Mom was back at the hospital.  It was hours later that the second cardiologist came to speak with them.  He deemed the blockages severe (see, this rat may be stuffed, but he ain't stupid).  Mom and Dad asked all the same questions, and Mom continued to take notes, something she did throughout this ordeal. We asked if there were an issues dealing with LHS.  The second cardiologist said he wasn't worried about payment and insurance.  He just wanted to fix Dad's issues.  Thankfully, this physician understands his oath.

Through God's divine intervention and the surgical abilities he bestowed upon Man, and through the many prayers of our friends, family, and RV community, Dad is alive and kicking, two stents and an angioplasty later.  He was discharged from the hospital just hours after the second procedure, and we are all feeling better, physically and emotionally.

We had our follow-up visits at the second cardiologist's office and with our PCP, who attributed 90% of Dad's issues to genetics (Dad's own father died of a heart attack before age 50).

We have learned many things from this crisis.

1)Live each day to its fullest.  The here and now is all we have for certain.

2)There are no longer vocations, only "jobs".

3)Getting second opinions is important, as is dealing with caring, compassionate physicians that you can trust, ask questions, and in whom you can put your faith.

4)Even the healthiest of people are vulnerable to heart attack, with genetics playing a huge role.

5)My Parents have altered their diets to eat more plant-based foods and less meat and dairy.  Yes, I'm the only one eating cheese in our home now!

6)It is important to have a family member available to ask questions, take notes, and act as advocate.  Through Mom's urging, Dad obtained copies of all his medical records.  Mom poured through them, and found downright falsehoods recorded by the first cardiologist regarding why we switched to another provider.  There were also errors in the list of medications they reported Dad was taking.  She is now in the process of trying to get amended reports (Good luck with that, Mom!).

7)Mom, who was always the strong one of our family in crisis, who Grandma called her "Rock of Gibraltar", isn't as tough as everyone thinks.

We don't know yet how much of the medical costs associated with this situation will be covered through LHS. But money matters little if our loved ones are not around to share it.  We are just so grateful that Daddy is alive and kicking and will be able to enjoy our new off road vehicle!

Thanks to all for your hugs, love, words of encouragement, and most importantly, your prayers.

We would like to thank some amazing organizations for all they do for the RVing community:

Escapees RV Club

Escapees RV Club

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