Wednesday, November 5, 2014

John Tharp, Coincidentalist

After closing my Pinehurst, Idaho, office medical practice in 1993, I spent the next eleven years as a part-time locum tenens ("rent-a-doc"), traveling to fill temporary vacancies in doctors' offices or hospital emergency rooms. In 1999, I worked several weeks in St. Francis, Kansas, a small town far in the northwest corner of the state.
It's a pleasant little town in semi-desert; the hospital took good care of me, providing free lodging in a home whose owner was on vacation. But the house badly needed cleaning and I later moved to a motel out on highway 36. I was up early next morning, and searching for some place to eat. I could see a gas station a quarter-mile down the highway, and figured I could at least find coffee there, so I started walking toward it. 
Midway, I met a man of about 50 coming toward me with a cup of coffee. He stopped and said in amazement, "I know you! We were at board meetings together in Philadelphia!" He was staying at the motel, traveling by bicycle from Utah to Illinois. We had served together on the American Baptist Foreign Mission board several years before, but had not met since then.

I know that New Yorkers boast that if you stand at Times Square long enough, you will see someone from back home. But in a town of 1,300 on a two-lane road where Kansas, Nebraska and Colorado meet? What are the chances that one day two acquaintances, one from Idaho and one from Illinois, will walk into each other along the shoulder of the highway?

John Tharp and I had breakfast together, and later that morning he rode his bicycle into town to see the hospital where I was working, before continuing his journey eastward.
I have occasionally wondered, in the ensuing fifteen years, whether God had had a purpose in that meeting. I have not perceived any reason in my own life, and finally, I wrote John to see if he was aware of any in his.

In his reply, he said he, too, remembered the incident and also wondered about a reason. He had not detected any, but said that, after a number of such coincidences in his life, it has often entered his mind that "God loves to show off." [I myself prefer to think of it as God's sense of humor, but anyway . . .] he went on to say that this may be a way that God alerts us to what He can do, to keep us ready for the occasional time when He does indeed want action from us.

John's observation brought to mind an incident in Mae Sariang, Thailand in 1965, when the new hospital was ready to open except that we lacked nurses. The following report is from my journal of that year:

"We had a bit of drama in the three mission families’ weekly get-together two weeks ago. We were praying that the hospital would soon have some nurses, only to be interrupted by a man at the door asking where he should put some girls' luggage. One of the girls, our friend Orawan who spent some time with us last month, was only visiting, but the other, Yawalak, is now our first full-time graduate nurse-midwife. This afternoon (nearly two weeks after that prayer, for the scientifically minded) a motorcycle pulled up with another nurse riding on the back. Gaysala is just looking the place over today, but will be back permanently on Saturday. Later in the afternoon, two others appeared entirely unexpectedly. They said they were graduate nurses working in Mae Hongson [the provincial capital, about a hundred miles north] and were interested in transferring to MaeSariang where their homes are. The upshot is, one will probably come and work; perhaps the other will come later. With one or two others we expect in the next several months, we will soon have a full nursing staff (and an empty hospital bank account.) As for unskilled workers, two or three new ones apply every day and we can afford to be a little choosy for that group."

My dad sometimes would remark, "When people pray, coincidences happen more often." I'm inclined to agree.

Monday, November 3, 2014

The Medicine She Never Took

"My doctor gave me a new medicine for my stomach pain," a friend answered when I expressed hope that she was feeling well. "It works fine, but I can't take it." 

"I'm sorry to hear that," I said. "Too many side effects?" 

"No, the samples he gave me helped a lot. But when I took his prescription to the pharmacy, a month's supply was four hundred dollars. That's almost half my Social Security check! How am I going to pay my utility bills and buy my groceries? So I'll just keep on with the antacids."

"Did you tell your doctor you couldn't pay that kind of price?"

"I phoned him, and he said he had no idea it was that high."

"Did you ask him about any of the over-the-counter medicines? Some of them are about one-tenth that price, or less."

"No, I didn't know anything about that. He had his nurse make me an appointment for two weeks from now for follow-up. But I never had the prescription filled when I found out the cost."

If you think that's an isolated example, a
nother patient had had at least six back surgeries over the years (laminectomy) and no surgeon would now touch his scarred back. His local doctor was trying to manage the pain with various pills and patches, some of which eased his steady pain, but not the "lightning spasms" that struck when he moved wrong. Additonally, over the years, he had developed unacceptable reactions to some of the medicines, and the doctor was trying a new one. His medical insurance refused to pay for it. The doctor's office clerk said she would try and straighten the matter out, and would call him back. She never did, nor even to let him know the problem. He finally called his pharmacist to see if he could afford to pay for it himself, and found to his horror that a month's supply was $525.00, half his entire monthy income. Presumably, the doctor's clerk could have found that out, but if she did, she never let him know. 

These illustrate a basic flaw in the American way of marketing medicines. The manufacturers have well-paid "detail persons" who make regular calls at each and every doctor's office to inform him/her about their company's latest and most advanced product. They sometimes used to appear around noon, with enough pizza for the whole office staff. Friendly people, well trained and informed in their field, they are a principle source of information for busy doctors who don't spend as much time as they might with medical journals and Internet search. The pharmaceutical rep has free samples to leave with the doctor, along with note pads or pens bearing the product's name.

Sometimes they really do have valuable updates for the doctor, but they rarely mention the price of their product, or that the older remedies still work as well as they always did. And the doctor will try the samples on his patients because (a) he doesn't want them to buy a whole month's supply of any medicine unless he knows it works for them, and/or (b) he may want to help a patient he knows is having difficulty affording care. 

Most doctors don't keep up with the present-day price of what they prescribe. But they could. Every doctor gets an annual free update of Physician's Desk Reference listing all prescription medicines with their uses, side effects, and precautions (about 4,000+ pagesold copies make good doorstops), and a supplement with all the non-prescription medicines is available as well. Plus an annual update of Redbook (not the women's fashions one, but current drug retail prices) with the option of subscribing to monthly updates.

So -
here's what a patient can do. Don't be afraid to ask what a new prescription will cost, and if necessary, ask if there is a less expensive generic that will be adequate. Sometimes there will be, sometimes not. 

Doctors, here's what you can do. Be aware that the latest drug is pushed by the drug rep because that's what he/she is hired to do. It's good to keep that product in mind, but ask yourself, "Is this what this patient sitting here in front of me really needs, or will an older, less expensive drug be effective?" And stay away from reps who want to buy you meals or pay for a vacation trip. Your patients have to pay for that in the cost of their medicine.

And all you readers in the general public, pressure your reps in Congress to reasonably regulate the charges for medicines. Why should a drug that has been on the market eleven years now cost fifteen dollars per pill when the company was raking in high profits at the original price of ten dollars per pill? Why should an injection aimed at mass use be selling for thirty-five dollars, when it originally wholesaled forty years ago at one dollar? Or why should a drug, manufactured in USA, sell for less in Canada or Europe than it does here where it was made?

Even in a free market economy, the customer should get as much consideration as the company's stock holders get.