Vocabulary

Every profession has it's own vocabulary. The vocabulary of medicine is notorious for it's complexity. "Inspection of the malar area revealed a patch of vitaligo next to a maculopapular rash that the patient states is puritic." Translation: "This patient has an area on her cheek that has both lost it's pigment and a rash that is visiable, palpable and itches." Dysuria means it hurts when you pee, excuse me urinate. A cholecystectomy is the removal of a patients gall bladder as opposed to a cystotomy which is making an incision in a cyst, even that big cyst that all of us have, the urinary bladder.

Today puzzling over what it is that physicians do, I realized that I went to school for four years to learn all these words. Then I spent another four years learning how to use them with other physicians while also learning to translate them back into a language patients can understand. Now that I am in practice, to get paid I have to use an entirely new language: Current Procedural Terminology or CPT for short.

CPT codes are numbers that insurance companies use to determine payment. The reimbursement I receive for a patient visit is based on the number of questions I ask, the number of body parts I examine and the time I spend explaining the diagnosis and treatment to the patient. All of this must be properly matched with a numerical code that is put into the computer and sent to the insurance company in order to receive payment. No one is ever told in medical school that the system is run this way. Why would anyone spend all that time learning a complicated language only to then learn some sort of Morse Code system so that the insurance company will pay you?

As I write this, I realize that in the practice of medicine I now use three languages. There is the language I speak to the patients. It is much the same that I use with friends and family. This language is English, hopefully as plain and simple as I can make it so that the patient I am caring for will understand what I believe is happening to them and what my plans are for treating this condition.

My second language is the one I use with other physicians and the health care team. I love this language. I have spent years learning it. I enjoy reading medical journals, talking with colleagues and attending conferences where it is used. The preciseness of this language is helpful in the diagnosis and treatment of patients.

This third language I consider a necessary evil. Without it I will not get paid. I am not proud of the fact that I know a 99213 is a specific level of office service or that V25.1 is the code for contraception counseling. These are facts that seem to clutter my brain. They do not make me a better physician or even a nicer person. Knowing this language only allows me to succeed at billing for my services.

Inside out

The political cartoon of the day features a patient lying in a hospital bed labeled "US Heath Care System." Equipment packs the room preventing the nurse and the masked and gloved surgeon, labeled "Obama," from touching the patient. The nurse questions, "Where do we start?"

The letters section contains comments from a physician decrying the criticism of a retired multimillionaire hospital administrator and a taxpayer who points out all pay the price of the uninsured using hospital emergency rooms as their sole access.

So where do we begin? With the only avenue open to each of us. Ourselves. The physician must take the time to get the results of the test done last week rather than simply ordering another one from the laboratory she owns. The health care administrator must stop ordering supplies exclusively from the company on whose board he sits. The politician must look at the big picture of affordable health care not the plan that will garner the most votes in the next elections.

And the patient? The patient wants everything done and wants it, well, yesterday! We are all patients. If we do not require health care at this moment we will in the future. You can bet on that. Where do we begin? Start eating better. Increase physical activity. Drink more water. Reduce stimulants (caffeine, sugar, electronic media) and depressants (alcohol). Get more fresh air. Don't smoke tobacco. Go to bed at a reasonable hour to get enough rest. These simple measure will not only reduce health care costs. Lifestyle changes such as these will decrease illness as well reducing the need for many of the costly advances now available.

A new norm

As I closed my eyes after the last twenty-four hour shift as an OB hospitalist the realization hit me concerning my new patient population. My final delivery of the night was one of a 16 year old having her first baby with her mother and her older sister in attendance. If she had delivered yesterday she would have been 15 when her first baby was born.

The baby weighed 4 pounds and 11 ounces. Small in size due to the fact that she was six weeks early, the early arrival was due to the fact that her mother and her aunt, her mother's older sister were smoking pot and doing lines of cocaine last night just before the bag of waters broke. The patient unabashedly told me this story which was confirmed by the urine drug screen.

This is the new norm for me. Teenage moms, positive drug screens, no fathers in the picture. No one employed, no insurance, the government attempting to pick up the tab.

Today social services have been notified. The patient and I have discussed and she has agreed to injectable contraception that will last for three months following discharge. Still I have the feeling that this entire screen will repeat itself in her life all too soon.

And what will happen to this baby. Born six weeks early, withdrawing from drugs to a single teenage mother living with her single grandmother. How will she ever have a chance?