Friday, January 18, 2013

Stubbornness? Have you considered other reasons?

I see this billboard when I drive north on 99 to work. After months of being annoyed, I decided to deconstruct why.

Men : Yes, we know that men 24% less likely than women to have visited a doctor in the past year. However, to suggest that only men neglect doctor's visits and women never do is offensive.

Money:  The role of money can't be ignored in a person's decision to abstain from medical tests. If someone has a job, paid sick time that can be used for preventative care, medical insurance, and the ability to pay any co-pays that may arise, it's much easier to decide to get recommended testing. If a person has no sick pay, no insurance, or has insurance, or their co-pay would be high enough to be a burden, it's much less likely they can afford to test for an illness they may have no symptoms for. In a country where many people can't afford diagnosis or treatment for diagnosed conditions, it might be better to spend money on subsidizing tests than on billboards.

Comfort Level  Say you don't have the limitations described above. Say you have a great employer and health insurance that pays all the costs of all your tests at 100%. Will you still get them all "on schedule?" You might, or you might still abstain from some based on comfort level. Think about some of the tests people avoid; prostrate exam, colonoscopy. I was scheduled for a colonoscopy last year,due to digestive symptoms. Despite those symptoms and a few family members who had colon cancer, I chose not to go through with it. Why? The thought of the procedure damaged my calm in such a way that within days I knew that *for me*, there were things worse than not knowing. Really, if you think about it, it's not surprising so many people choose not to sign up NOT EAT for at least a day, take medicine that makes you poop until it's clear, and get drugged so someone can shove a camera up your anus. It's a shock to me that so many DO, especially in the total absence of symptoms! Let's get some research on non-invasive tests, mmmkay?

Risk level: The recommended timeline for medical tests is at best based on averages. There's no doubt that makes things easier for the medical community, and for patients who just want to be told where to be when.  But for some, especially with the more invasive stuff and/or when money or time are at issue, we want to know it's REALLY worth going in for. I've been in a monogamous relationship for 20 years, had normal Pap smears, and do not smoke? Am I at the same risk as the "average" woman for cervical cancer? Do I get a Pap smear every year? No, and no. In fact, I stopped doing so at a point of my life where having small children to care for intersected with my insurance, at the time, requiring co-pays even on yearly check up (and those co=pays kept rising, right up to $30). This would be a terribly irresponsible decision for some women, but I in no way feel I've endangered my health. By the same token, I breastfed for 8 years, am not obese, and have no family history of breast cancer. I haven't gone for a baseline mammogram, even though it would be covered at 100%.

Fear of overdiagnosis or medical complications: Briefly put, some people choose not to know. They may know in advance that there are treatments they are unwilling to go through, or not want to risk going through treatment (with it's attendant risk of complications) for something that may not have been terminal, or may not have killed them for years. Is that not their choice?


At 8:21 AM, Blogger Cameron VSJ said...

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