Published 12:00 am Friday, July 6, 2007

By Dr. Ada M. Fisher
For the Salisbury Post
I was reluctant to write this column because my health is not the public’s business. But I thought my story might help some folks look at the stakes in making medicine affordable and accessible.
On Saturday, June 23, upon returning from the Charlotte Black Political Women’s CaucusóBlackberry Luncheon, I felt donkeys kicking up in my chest, above the sternum, with pain in my teeth on both sides of my mouth. Eight Rolaids didn’t make it go away, and neither did sitting down. I made it out to my car, searching for some NTG pills (nitroglycerine, the same thing used to blow up buildings, just in smaller doses).
Strategically, I appreciated that by the time the EMT people got to me, I could be dead. I drove myself to the hospital (which is usually a no-no). I hurt so bad, I couldn’t get out of the car without assistance. When I got to the receptionist, I said I was having chest pain and needed to see someone immediately. After five minutes, I asked politely if she had heard what I said and requested to be triaged immediately. There were almost a dozen folks sitting around waiting to be seen who didn’t appear to have the pressing emergency that my chest said I did. About 10 minutes later, the nurse took me into the triage room, asked me my name and other questions, all of which, I told her, could wait until they got rid of this pain.
Finally, two of the nicest and most competent doctors, both from Africa, waited on me and had their protocol down pat. When I saw the EKG, I knew I had had a heart attack or myocardial infarction, though they weren’t totally convinced. Even if it was just unstable angina, I was to be admitted and scheduled for angiography (heart catherization). With positive cardiac enzymes, I was transferred to Duke, where I receive most of my care. I had the angiography three days after the attack of chest pain. Two 95-percent clogged arteries later, I have two new coated stents to keep my arteries open while decreasing clotting. Four days later, I was sent home, limited to light activity for a few days before resumption of my life, with lifestyle changes I had already begun. I could now get into cardiac rehab, which insurance would cover, but when I needed this for preventive reasons, given my risk factors, no such luck. New medications such as Plavix ($139.09 for 30 days) to limit platelet formation around the stents and Coreg ($122.39), a new beta blocker, were given to make me as good as new.
My personal story has lessons for all of us, including the need to control our risk factors by watching our weight and controlling our blood sugars (mine are good, thank you). It is not enough to have health insurance; getting access is a major problem, even for those of us who are insured. When I tried previously, I couldn’t get in to see a cardiologist until July 23, even with money, insurance and collegial connections. How do you think John Q. Public will fair?
Mid-level practitioners, though nice, don’t take the place of doctors. The thought that two of Africa’s best and brightest were induced here while thousands in their own nations are without care is sad. We need to re-examine the training of medical practitioners in this country and make sure we have the primary and secondary physicians needed in the right places to decrease the unreasonable demands being placed on emergency rooms for this level of care. Just change the reimbursement rates so more will be paid well-enough to do this kind of medicine. Medicaid payments are inadequate, and Medicare only covers 80 percent of the charges government decides are reasonable, no matter the time, service and actual cost.
EMTs in my county are paid more than firefighters, but the trucks used and equipment funded through stretched county budgets are often not enough to meet our needs. I had to smile, remembering that when my brother in Durham first opened his funeral parlor, it was the undertaker who provided the emergency service. We have come a long way. Without changes, those with no access may have to call undertakers again, but this time for a different reason.
When I was a medical student, the average heart-attack patient had two or more weeks in the hospital on bed rest and weeks of the same at home. The innovations from competition and the free enterprise system have made better-targeted drugs with fewer side effects, leading to less debilitation. Socializing medicine and controlling profits, though in some ways ethically correct, is also wrong in that it will kill research and cutting-edge technologies that make our health care the envy of the world.
Had I not been a physician, my outcomes might have been different. Had I not lived in this nation, I would most likely be dead.
All of those who wish to tie physicians’ hands, stop research and new drug development, and regulate health care more are giving administrators proportionately more of the dollars than those delivering the services or producing the medicines. This is wrong. To allow insurance companies to dictate care in deciding what they will pay for and for whom is also wrong. Allowing folks with no medical training to decide who is eligible for what care and for how long is dead wrong.
It is the free enterprise system which brings us unique and good health care advances. Medicine ain’t cheap, but it’s nice to have it when you need it.
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Dr. Ada M. Fisher is a physician, former member of the Rowan-Salisbury Board of Education and former Republican candidate for Congress.