March 5, 2016
Originally published on March 5, 2011, this article ranks in my all time top five viewed publications. As insurance and Medicare become more restrictive, medical luxuries become more important. With the recent move to brand many tests and interventions as unnecessary, what was once cutting edge and “necessary” now falls into the realm of luxury. The statisticians look at what is “enough lives saved” in their quest to define necessary. PSA screening is no longer “necessary” as not enough lives were saved for the cost of the test. If your life is saved by a test of intervention, doesn’t that qualify as “enough?” “Medical Luxuries” addresses the word “need.”
The word “need” means different things to different people. In an earlier article, I referred to “need” as the new four letter word. People overuse and abuse the word “need”. In my practice of medicine, I define three levels of need.
A level one need is critical and worth fighting over. I see level one needs two to three times a week. Level one needs are exemplified by the 60 year old hypertensive male who has chest pain. He needs to be in the hospital now! He needs to go by ambulance now! His life depends on it. When he refuses to follow my advice, I dial 911. When he is at home and refuses to heed my advice, I call 911 and his wife. Level one needs are absolute!
Level two is where I spend the majority of my time. My job is to inform you why you need whatever it is you need, what the benefits and risks are, what the expense is and how soon I think you should get it done. I then leave it up to you to decide if and when you are going to do it. I may disagree with your decision but I will respect it. A routine colonoscopy is the standard of care at the age of 50. It is a level two need. (If you have a family history of colon cancer, it is a level one need.)
Level three needs are luxuries and the topic of tonight’s article. Luxuries are needs you can do without but can do better with! In medicine, a luxury is anything that is either unproven (but promising), not standard of care, or not covered by insurance. We live in a peculiar world. I have patients who won’t get a chest x-ray ($200) because their insurance won’t cover it. They drive to the office in a BMW but won’t spend $200 on their own health. I have patients who eat at expensive restaurants every weekend ($50 per person) yet want an inferior generic because the branded cost is $100 per month. The insurance world has convinced us that if, they won’t pay for it, either you don’t need it or it is too expensive to afford.
Luxuries can save you money and your life. Several years ago, I was called in to the hospital to see a very sick patient at 5 a.m. I dressed quickly, jumped into my car, backed out of the garage and slammed into my daughter’s car. I had not spent the extra money to buy back up sensors when I purchased my car. My decision had consequences. I had to tell my daughter I smashed her car. I had to pay for her repairs, as well as mine. What seemed like a luxury item at the time turned out to be more of a necessity than I had anticipated and a costly error in judgment as well. Luckily, the patient did fine.
So what are luxury medical items? The Heart Check America (Cardiac Scoring) is a good example. It measures the calcium load in your coronary arteries and predicts coronary artery disease. A healthy 50 year old male with no family history of heart disease is buying a luxury when he gets one. Insurance won’t pay for it and technically he doesn’t need it. So why get it? Most of us are healthy until we are not. If his results are normal, he gets peace of mind. If his test is strongly positive (it happens to the healthiest of us), he may well have saved his life.
Every year there are unexpected deaths in our community. Could the purchase of a healthcare luxury, an annual physical, an EKG, blood test or x-ray, have saved their lives? I would like to think so. The next time your doc asks you to get a test or buy a medication that is not a covered benefit, think twice before you dismiss the idea. Times are tough and money is tight; but, if your roof was leaking, you would find a way to get it repaired. I often use analogies to make a point and my favorite has to do with your house. Your house is very important; and, when it needs repairs, we find the means to do so. Your house shelters your body; your body houses your soul. Do everything you can to protect your body and keep it fit for many years to come.