5 Terrifying Things Nobody Tells You About Health Care
If you're reading this, congratulations! You're probably not currently unconscious in an intensive care unit, surrounded by a gaggle of improbably sexy doctors who use your humorously gained pelvic injuries as a metaphor for their relationship issues. However, as a Cracked reader, there's a pretty good chance that someday you will be (we know our audience).
Still, there is no need to go unprepared! Here is a handy manual for the unexpected shocks and nasty surprises you are likely to encounter during your time on the health care carousel.
Doctors Can't Read the Test Results
Ever had an X-ray taken? Or one of those fancy scans or lab tests? Did the process strike you as professional and trustworthy? Sure it did -- it's science.
In reality, though, all those scans and tests and results are basically Rorschach tests for doctors. For instance, a study done on one type of test (coronary angiograms) discovered that if you give two different doctors a copy of the same test, they'll disagree up to half of the time. In fact, if you give the same doctor the same angiogram twice, he will disagree with himself up to one-third of the time.
"Still a better rate than my marriage choices ... "
Yet another study found that a group of physicians simply couldn't agree on whether any given patient was showing physical signs of goddamn heart failure. Man, we're not medical professionals, but we've always assumed that the bare minimum qualification is knowing if the patient's heart is working.
What's Going on Here?
As high tech as hospital equipment is, they have no Star Trek scanners that pop out easy diagnoses when swiped over patients. All scans, tests, and even standard lists of symptoms must be interpreted by humans. That means you're always relying on one part accurate science, one part unpredictable humanity, and the results can be seriously affected by that particular doctor's training, his knowledge, and how hard he is thinking about the taco he's going to have for lunch. Hell, he could have just smoked a bunch of meth, we don't know your doctor.
Like what's with all those weird black light posters all the time?
But new techniques are surely fixing the situation, even if slowly, right? Nope! These days, many hospitals use teleradiology, a fancy term for outsourcing the interpretation of your scans and tests to workers (who may or may not have medical training) outside the hospital, anywhere from the next state over to India. This is especially popular in emergency medicine, because smaller hospitals don't want to keep a radiologist in their payroll just for the times Cousin Ronnie stumbles in with a cow-tipping injury.
This trend chips heavily at the doctors' diagnosis skills; in the old days, resident radiologists and ER doctors could consult each other on the fly about your symptoms and history as they relate to test results. Now, that X-ray of your butt is nothing but a context-free image on a screen in Pakistan, with no crucial patient information included. You don't need to be a doctor to realize that this leaves you wide open for a very unfortunate variation of Broken Phone.
"Based off your X-rays, they'd like us to check you for possible ovarian bleeding."
Hospital Staffs Suck at Hygiene
Every year, about 1.7 million people in America alone wind up with an infection they got at the hospital. That means you have a 5 to 10 percent chance of getting one every goddamn time you stay in one. And, since these are infections that continuously hang around antibiotics and other medications, their resistance is getting stronger, and the situation is only going to get worse.
But how is it possible that a place dedicated to keeping germs at bay has become such a festering disease hole?
Doctors aren't that different from us. They also have a limited capacity for giving a shit.
What's Going on Here?
You know that time you ate at a taco joint and spent the remainder of the night hate-pooping your guts out because the guy behind the counter doesn't wash his hands? Well, it turns out your doctor doesn't, either.
Preventing most of the hospital-induced illnesses would be stupidly easy: Doctors and other staff just need to wash their hands between patients so that germs can't spread from one to another. The bad news is that they rarely bother doing this. It's estimated that only around 40 percent of hospital staff complies with hand-washing standards, despite the obvious, proven risk of transferring disease. Carefully placed disinfectant gel dispensers and washing sinks fill the hallways, and awareness projects in the vein of "January Is Let's Try to Kill Fewer Patients With Our Filth Month" are frequent. Alas, the medical professionals maintain a bullheaded "not gonna" attitude, which is fine for a 5-year-old but rather less amusing when displayed by the doctor who has your life in his dirt-encrusted hands.
"That's not dirt."
The problem is so bad that there are special doctor wristbands that'll let people know whether the wearers have washed their hands sufficiently. Seriously. We're assuming the next step will be making non-complying doctors wear "I have poop on my hands!" badges.
It turns brown.
Lots of Doctors Are Shockingly Behind the Times
The medical profession is one of those rare paths of employment where the word "old" isn't immediately followed with "fart." A lot of us prefer our authority figures with a little mileage -- just summon the mental image of an accomplished, white-haired senior doctor and one of a pimply, overworked intern and see which one you'd prefer as an emergency appendectomist.
You chose the old guy, didn't you? Bad move.
Sorry, but the correct choice was "Contact-High Condoleezza Rice" in the back.
While the interns may sometimes mess up because they're inexperienced and overworked, the older doctors can be at least as dangerous because they don't keep their skills up to date. They've been on the job for a long time and know how it's done -- no young whippersnapper of a groundbreaking medical discovery is going to tell them otherwise, goshdarnit. As a result, the amount of time your doctor has been practicing medicine tends to correlate with lower quality care, and people getting complex surgery are more likely to die if older doctors are operating on them.
"I'm sorry about your son. The leeches simply weren't strong enough."
Hey, did we mention that 20 percent of America's doctors today are over 65, and that percentage keeps rising?
What's Going on Here?
Unlike pilots and various other "people's lives are in my hands" occupations, doctors have no federally mandated retirement age. Not even surgeons. This allows many older doctors to keep going well past their mental prime, to the point where it's estimated that thousands of practicing doctors in America have full-blown dementia.
"President Obama? It's a honor, sir."
That's not the real problem, though -- it's a telltale sign of trouble when your cardiologist tackles you to the ground and starts screaming that you're a Soviet spy. The real problem is that many older doctors are simply repeating what they learned in medical school back in the day, and obviously medicine, particularly surgery, has improved massively since then. Today, it involves modern humbug such as robots and lasers and decent odds for survival. Still, there's no standardized retraining system in place that makes doctors keep up with it. And while some older surgeons are diving scalpel-first into robot surgery, there are others who are sticking with the tried-and-true method they learned in 1971 from Hacksaw Harrison.
How Much Attention You Get Depends on a Randomly Compiled List
Hospitals are well-honed institutions, smoothly functioning machines custom designed to cure your ass. But they're also workplaces, with all the usual ass-grabbery, office pranks, and bored waiting-for-the-shift-to-end wackiness found in any work environment. Although medical professionals are fairly good at keeping their shenanigans in check and barely ever graft boar tusks into their patients' mouths for shits and giggles, this still means that you can get royally shafted because of simple office routines.
We're talking about the shift change, that all-too-frequent moment when a doctor "hands off" her shift -- and patients --to the next one. According to one study, a whopping 25 percent of these handoffs result in an error in the patient's care.
No time for this bullshit when you've got Kanye tickets.
What's Going on Here?
Imagine a busy meeting. The first item on the agenda gets a lot of time and attention, but by the sixth one, everyone is tired and wants to get out of there, so they just sort of lazily leaf through the rest of the list. Well, in a hospital, the items are patients. At shift change, doctors prep the next guy using a list of the patients they're looking after. The further down the list they go, the less attention a patient is going to get.
"OK, so the chart says you're here for a pregnancy test ... oh."
What's more, there's absolutely no way of telling how they will place you on the list. Many hospitals don't bother organizing according to the severity of the patient's condition (that is, by how much explaining it requires), but just slap 'em on the spreadsheet according to their bed number, room number, or just the alphabetical order of their name. This means Mr. Adams, cruising the ER for Vicodin, has a decent chance of ending up with more attention than Mr. Zerkowitz and his never-before-seen Tanzanian supervirus.
And if that seems kind of random, just wait until you get the bill ...
Hospitals Are Financial Supervillains
Let's say you go through the American health care system with all the luck in the world. You survived falling into the Australian animal enclosure at the zoo. Emergency medical care managed to remove nearly all of the spiders and persuade the dingo to detach its jaws from your leg. You even avoided picking up any flesh-eating viruses at the hospital. Now all that's left is the bill. You know it'll be on the hefty side -- hospital bills always are, and you don't actually have the best insurance. Still, you're not worried. The only things the doctors in the ER did was scan you a few times and patch you up. How much could it cost?
Two weeks later, you get the bill in the mail for $56,000.
Wait, don't hang yourself before you rule out exotic dancing.
What's Going on Here?
Bullshit pricing, that's what.
Hospital overcharging of uninsured and underinsured patients is so common that an entire middleman industry -- medical billing advocacy -- has grown around haggling with the hospitals and correcting all the wacky extra charges added to people's bills. Notable examples of extra charges have included billing patients for the blankets on their beds and charging a separate fee for closing up an incision after surgery. This is a bit like the cable guy coming to connect your Internet and then charging you an extra $300 fee to leave your house.
We apologize in advance for when they read this and actually start doing it.
And if they can't come up with enough extra fees, they'll just inflate the actual ones. Hospitals have been caught charging people a 10,000 percent markup for ER-administered Tylenol, and over $1,200 for a blood test that actually costs about $39. It's not that these shenanigans are even difficult to track down: Medicare ensures that the hospitals are paid a specially calculated per-patient fee that covers the average price of a procedure, which tends to be several times lower than what they actually attempt to charge. The Medicare-determined reimbursement for the average "So you walked in through the ER door" fee, already an absurd $300, can turn into freaking $1,200 in the unforgiving innards of the hospital's billing machine.
So, why the hell are hospitals being so sneaky? As it turns out, they're not. When asked, hospitals are unreasonably honest about the whole business and freely admit that they overcharge. They're literally just throwing fiscal crap at a wall and seeing what sticks. You can have 10 different patients who all get the same procedure, and they get charged 10 wildly different prices.
Some charge triple if they have alimony payments.
That's because the hospitals fully expect most of their clients (which are mostly insurance companies) to contest the bill to the point where they only pay a fraction of it. It's like the price at a used car lot -- they set it high because they expect you to haggle. The problem is that most uninsured people don't realize this, and hospitals aren't exactly rushing to tell them.
After all, these bills are often received by elderly or recuperating patients still confined to their beds, or by family members coping with a relative's cancer treatment. These people aren't very likely to go through a bill line by line, looking for the part where the ER charged them an $800 "not strangling you to death" fee. Then, a bunch of those patients will simply declare bankruptcy and never pay the bill at all, so the hospital has to make it up by trying to jack up the price on somebody else, like a game of hot potato where the loser is whoever doesn't have good lawyers. Hey, maybe it'll be you!
C. Coville's Twitter is here.
For more breakdowns in the system, check out The 5 Most Popular Safety Laws (That Don't Work) and 5 Popular Safety Measures That Don't Make You Any Safer.
If you're pressed for time and just looking for a quick fix, then check out 5 Ways We're Totally Ruining Kickstarter.
Related reading: Find out why getting a yearly physical makes you more likely to die young, #4 on the 5 Common Medical Procedures That Secretly Aren't Worth It. If you don't know the deadliest day to land in the hospital, its coming up, so read #8 in our 9 Most Statistically Terrifying Days on the Calendar. Of course, ambulances freaking explode all the time #5 of the 5 Terrifying Secrets About Riding in an Ambulance so you should just feel lucky to get there in one piece. And now to make room for all those new fears, we'll make a bunch of your stupidest fears disappear: you have a 96 percent chance of surviving a plane crash and are more likely to be killed by a cow than a shark.