WRITER - The Tyee -
A Stent in Time or, How Your Health Dollar is Being Mismanaged
- Did you get the medicated stent?
- Excuse me?
- Or did you get the older, cheaper one?
- How would I know?
- Didn’t the cardiologist tell you?
This was just a highlight from the post-operative discussion I was having with my family doctor the other day.
One Monday morning I went in complaining of a sort of dull tightness in my upper chest, throat and jaw. Especially when I exerted myself. Like taking my bike out and riding to UBC campus and back.
First he thought I might have a kind of “walking” pneumonia or bronchitis. But, when I returned to his office on the following Friday, he said the blood work and x-ray were clear.
- What were those symptoms again?
Within minutes, my doctor had telephoned the resident on duty at UBC Urgent Care.
- You have angina, Mr. Berner, and I want you to go immediately to the hospital. They’re expecting you.
- Hey, it’s not even 10 o’clock. Can I stop for coffee?
This is how you respond to the world when you have a central belief that you are a Prince Among Princes, and you can do just about anything you ever want to.
Four hours later, after heart monitors, beta-blockers, more x-rays and blood work, IV drips, two doctors and several nurses, the cardiologist is on the phone.
- Mr. Berner, this is the cardiologist. I’m down the hall in my office and I’m looking at your stress test results.
- Yes?
- Well, the good news is that there is no heart muscle damage, and except for this problem, you’re a remarkably strong and healthy 62-year-old guy.
- Great. What about “the problem.”
- Yes. You have angina, and I want you in my office Monday morning at 9:30.
- Oh. Well. That sounds O.K., but for several months now, I’ve had a commitment to Grace McCarthy to be at the Bayshore Monday morning at 9:30 to help with her Child Foundation.
- Mr. Berner…[deep sigh]…I’m sure that means you’re a lovely person, but did you hear what I just said?
The Prince Among Princes reported for duty Monday morning at 9:30. A few more pokings and proddings, and then it’s off to VGH by ambulance.
Tuesday afternoon at 1:30, they gave me a little Happy Pill, wheeled me out of Cardiac Care Unit 1 to the operating theatre, poked a little freezing needle into my groin, and began a procedure, an angiogram, that they perform 20 times a day. A sheath is placed in the femoral artery and a tiny wire is woven through to the three main arteries, which surround the heart. Red dye is added and the x-ray machines whirling around you take enough pictures to reveal what blockages, if any, exist. At this point, a lot a truly bad things can happen. Cardiac arrest and death is not so uncommon. Or, so many blockages are discovered that they ship you back to the ward and schedule you for open-heart bypass surgery at the earliest possible convenience.
In my case one artery was found to be 99% blocked. Response – angioplasty, an immediate attempt to open the blockage. Sometimes inserting a tiny balloon, which is inflated at the right moment to clean away the deadly build-up of plaque, can do this. More often these days, a tiny wire mesh, called a “stent” is inserted to hold the artery permanently open, and this, is, in fact, what they did when I was on the table.
Recovery has been slow and steady. There has been considerable bruising from the point of entry, leaving my nether reaches first, black and blue, and then, over a period of weeks, orange, yellow and green. Let’s put it this way: intimacy has not been a priority!
But that brings us back to the original question.
- Did you get the medicated stent?
Turns out there are at least two kinds of wire mesh stents used in this heart procedure these days. The first is the older, simpler, hence cheaper version. The new stents have some kind of medication built into them. The medication apparently helps the stent to a) resist the body’s natural resistance, and b) bind the mesh to the walls of your arteries. In short, the newer, more expensive version is not only more effective, but also it significantly reduces the possibility the entire procedure will have to be repeated a month or a year or three years down the line.
Now, what does that mean to your health care dollars? Only this: Hospitals operate on annual budgets. And hospitals buy things (gloves, swabs, toilet paper, alcohol, light bulbs and tiny wire mesh heart stents) by the gross, by the carload, and often, a year in advance.
So, if the older, cheaper and less effective stent can be bought for an amount of money that is more attractive to this year’s budget, it doesn’t really matter if you’ll need another $40,000 angioplasty next year, because that will be in next year’s budget!
Forget the shock and trauma of invasive surgery. Forget the clear and ever present danger of death during the procedure. Forget the extraordinary cost of this procedure on any given day. Forget the lost time and productivity of the patient.
Hospitals are making medical decisions based, not on medical efficiencies, but on compliance on annual budgets, without consideration of the larger picture.
Similarly, there is a hip procedure – a kind of arthroscopy for the hip, such as already is commonplace for knee cartilage – that can be cheaper, faster and more effective for many people waiting for hip replacements. But our medical system will not pay for these for reasons which only they can explain.
Lurking behind the drivel uttered by lazy and uninformed politicians are these real issues of inefficiencies in our health care system. Until real leadership is found that will step up and honestly examine the patient, the illness in our health care systems will continue to be chronic.
