A Country Doctor Writes:

This time of year the snowbirds return from their winter retreats in condominiums, trailer parks, relatives’ homes and motels far south of here – in Florida, Arizona, the Carolinas and other, warmer locales.

I have had many serious requests from patients to relocate with them to Florida for the winter months, so I could continue to provide medical care for them year-round.

Today I saw a patient, whose updated medical history made me seriously wonder what kind of cultural chasm exists between medicine in the two opposite corners of this country, or perhaps this is more about money than medical care.

My patient, a woman approaching seventy, had a colonoscopy done at Cityside Hospital last July for recurrent precancerous polyps. Our local gastroenterologist recommended another colonoscopy in three years. She has a history of heartburn that is quite well controlled on omeprazole, 20 mg daily. She had a small heart attack a few years ago, and takes cholesterol medication and blood pressure pills. She is physically active, quit smoking two years ago, and has no chest pain or shortness of breath whatsoever with even vigorous exercise. She has mild, chronic low back pain without any sciatica, and doesn’t ever take anything for pain.

During her time away she had no new symptoms, yet her winter physician put her through another colonoscopy only six months after her previous one, an upper endoscopy, a nuclear stress test, lumbar nerve conduction studies, an exhaustive battery of esoteric blood tests and even a comprehensive urine test for drugs of abuse. Medicare, her health insurance, must have paid well over $10,000 for these tests.

“So, how did you end up with all those tests?” I asked.

“I don’t know, Dr. Z. said I needed them. Actually, he didn’t tell me much,” she shrugged.

“And what did the tests show?” I had the upper and lower endoscopy report, the stress test and the urine drug screen. They were all normal, but I didn’t have anything on the nerve conduction studies. I also couldn’t find any diabetes-related tests.

“Well, the other tests were fine, I guess, but he said my back was a mess. All the nerves there are shot.”

“But you don’t have any new symptoms?”

“No, but he still prescribed this new medication, gabapentin….”

“Does it do anything for you?”

“I haven’t tried it yet.” She added: “Do you think I should?”

“Not if you don’t have pain going down the nerves in your legs.”

I leafed through the pages of printouts again.

“I don’t see any recent blood sugar results or cholesterol tests, did you have any done?”

“I must have,” she shrugged again.

In my mind, I weighed the cost of all the esoteric testing she had had over the winter and the cost of what she needed right now. Trying to retrieve more information from her winter physician in a timely fashion might or might not be possible.

I took out my fountain pen and ordered an inexpensive new set of routine blood tests to monitor her blood sugar, cholesterol, thyroid function, a complete blood count and a comprehensive metabolic profile. Perhaps this was a small duplication of effort, I wasn’t completely sure, but I needed to take care of the basics.