The Conflict of Interest

I am lucky to have wonderful insurance. The stars have truly aligned to provide this self-employed prego with any insurance at all–but amazing, wonderful, ridiculously awesome, free insurance is mine until January 1, 2013. At which point, God knows what I will do.

I’ve been making good use of this insurance. Going to the chiropractor, the dentist, getting up to date on shots, getting a long overdue pap smear (looove that word), and getting muhself pregnant to boot.  But I noticed that with great insurance comes special treatment. Providers will look at my insurance plan and salivate. No where has this been more apparent than at my OB’s office. . .

I have been having weird stabbing pains all throughout this pregnancy. They aren’t terribly painful, but they are odd. So two weeks ago I called my OB and left a message with the nurse who called me back and told me this was a sign of ectopic pregnancy and that ectopic pregnancy is life theratening.  She ordered blood work and an ultrasound and I obediently complied. I was paranoid. And maybe so was she–liability’s a bitch. But so is making decisions for your patients.

I believe that the short story–telling me it could be ectopic and that it is life-threatening–was a violation of trust.  She should have told me what I had to find by lots of research– that in ectopic pregnancies the stabbing pain is severe. She should have told me how much it cost to do bloodwork and an ultrasound (after all, I’m still paying 15%). Then, after getting perfect bloodwork back, she should have told me that I was very low risk and that there was no need to to an ultrasound at that point. She should have let me decide what to do about this situation. And if I had no insurance or bad insurance, she almost certainly would have asked.

I know I could have objected to the doctor’s orders at absolutely any time. But I was ill-informed. I was told what to do and I did it. It’s only looking back on the situation that I see how silly it was and have minor regrets. I see how my best interests (being totally informed) and the doctor’s best interests (covering their ass from liability and raking in money) conflicted. I have no doubt that it is this office’s business practice to capitalize off of every pregnant woman’s minor complaint. This woman has minor pain AND great insurance? Let’s keep our people busy! Bloodtests! Ultrasounds! OB followup appointment! I must have generated thousands of dollars of business for them in the past two weeks. It’s insane.

I got to see my baby. I got to see my levels double. But I also worried and stressed non-stop for two weeks thinking that ectopic pregnancy was a real risk when it just wasn’t. Furthermore, I think the vaginal ultrasound might have been the cause of my bleeding. If I could do it all over again, I wish the nurse had just told me what the actual risk level was, what signs I should surely watch out for, and let me decide. Maybe I would have done this same things, maybe I would have just rolled with it. But at least the choice would have been informed and mine. I know if I had been at a midwife, she would have given me a realistic picture of the risk asked me first.

I want to be clear that I like my OB and the nurses and everyone I’ve met at this clinic. I just worry that my blood and my body and my insecurities were used for profit. I have to wonder how they treat the people without insurance. And I worry that I’ve already given them the power to decide too much for me.

One thought on “The Conflict of Interest

  1. I think profit plays a big part in American medicine, surely. Ordering a million tests that probably won’t do any harm but may or may not provide useful information is a goldmine.

    On the other hand, I think American doctors practice a lot of defensive medicine, in part because of the litigious nature of our society and some less than scrupulous lawyers who are willing to represent anybody with even half a claim. It’s one of the factors that plays in to our dangerously high c-section rate (though certainly not the only one, of course—c-sections are good money in terms of cost and time devoted to an individual woman).

    I’ve spoken with doctors who talk about ordering a panoply of tests for persons who don’t fit the profile of whatever disease or disorder they’re being tested for—simply out of fear that they will miss the one person who doesn’t fit any of the symptoms but is sick anyway. It’s kind of a sorry state of things.

    Anyway, bah. Needing to see the doctor is the pits. I prefer my chiropractor and my midwife who I only see for routine maintenance type stuff. 🙂

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