Yak Attack

A place to unwind and spend some time yakking.

Tuesday, May 16, 2006

Mandatory Screening

The CDC is pushing for routine AIDS testing with physicals. The recommendations are projected to be released by the CDC this summer, and would effect Americans age 13-64. I can understand the concern-- if you look at the most recent statistics(from 2003) for the top ten causes of death for Americans, HIV is listed as 10th for 15-24 y.o.; 6th for 25-34 y.o.; 5th for 35-45 y.o.; and 8th for 45-55 y.o. I'm not quite sure why the projected recommendations are spread out to cover such a wide range of ages, since HIV doesn't appear on the spectrum for the under 15 and over 55 crowd.

What concerns me is that once recommendations are in place, then people aren't well informed that they don't have to submit to the testing. Standard consent forms don't spell out well that you don't have to comply with any testing. We've all been there at the doctor's, with a form shoved in your general direction, so you can sign it--the nurse or receptionist gets impatient if you actually start to read the form. Or worse, they'll discourage you from reading it before you sign it.

Offering AIDS testing more routinely, and including it in insurance coverage, should be encouraged by the medical field. However, running everyone through the exact same battery of tests, just because, subjects people to unnecessary procedures and further inflates the cost of medical care.

The medical field has been a for-profit, factory mentality industry for years. It's rare for patients and doctors to have a personable relationship, where the doctor knows you by name. Profit demands pit-stop exams and 30 second Q&A time during the alloted visit perimeter. A fortress of office workers, nurse's aids, nurses and lab workers further buffer patients from their physicians. And then you add in the dreaded paperwork and HIPPA red tape, and you have system failure. Patients who should seek testing fall through the cracks sometimes, so then sweeping measures to catch them, foisted on the general public, are called for.

In another medical field newstory, Group Health conducted a study on domestic violence. They surveyed 3500 women patients who've been Group Health patients for over three years and found that approximately 44% of them admitted to being in an abusive at some point in their lifetime. Based on this study, the authors of the research report are urging that doctors look for signs of domestic abuse during routine patient visits. The studies are published in the May edition of American Journal of Preventative Medicine.

Again, I have trouble with mandatory screening. Note that the 44% of the surveyed women stated they had been in an abusive relationship at some point in their lives. Not necessarily at that moment, at that visit. Having information readily available in the office, and a doctor/patient relationship foundation built on trust and actually knowing each other would benefit anyone in an abusive relationship. Putting each woman who crosses the threshold in the "abused" category and cross-examining each as such, makes me not want to go to the doctor. It's difficult enough to make yourself go and be poked and prodded. The thought of an underqualified stranger crawling through my potentially bruised psyche creeps me out.

Also, it bothers me that the prevalent opinion is that women are the only people in abusive relationships. Men can be victims of an abusive relationship as well. They're probably even more reluctant to seek out help in such circumstances. Why would they discuss their problems with their flavor of the week doctor in the allotted 30 seconds of banter?

Does anyone out there have a personal relationship with their doctor? Does the physican know your name without consulting your chart? Do they remember one major ailment you sought care for? I'm wondering if such a relationship is just rare, or extinct. In my opinion, this is the missing ingredient of competent medical care. Doctors can't make a decent wage by conducting their practices on the foundations of trust, friendliness and knowledge. They're drummed out of business by double pronged intrusion--the insurance monopoly and federal rules, recommendations and red tape.


At 11:44 AM, Blogger Mark said...

1. The government not only wants to screen everyone for HIV, it also wants to subject every woman who has a baby to a mental health screening. The justification is post-partum depression. This is as terrifying as the HIV screen.

2. As for abusive relationships, who defines them and in what sense are they abusive? Does such a relationship automatically exist just because someone complains?

3. The practice of medicine has always been "for profit". How else can a doctor survive unless it is in a socialist economy? The government essentially ran individual docs out of business by its legislation: promoting health insurance through your job, regulating the types of health insurance it will pay for, Medicare and Medicaid. Of course, the blame for bureaucratic, industrialized, one-size-fits-all medical care is placed on the "greedy" doctors and insurance companies. It is remarkable that people buy this BS and think the government is the solution to the problem when, in fact, it is the cause.

At 12:29 PM, Blogger lewlew said...

The medical field has been a for-profit, factory mentality industry for years. I changed this sentence, to clarify what I meant. Of course, doctors have gone into business to support themselves and their families. What we have today, is a mass-produced medical system. This is thanks to: They're drummed out of business by double pronged intrusion--the insurance monopoly and federal rules, recommendations and red tape. I also edited this sentence for clarity.

I didn't read anything about universal mental health screening for women after birth. It doesn't surprise me at all. Can you provide me a link to an article you've read? I'd like to read it.

As for point number two, you are correct-- what defines an abusive relationship, per this study and thus what is being urged by the study conclusions? I haven't read the study, so I can't answer that. This is one of the reasons why mandatory screening is so scary, along with your other comment, Does such a relationship automatically exist just because someone complains?

As someone who's been in an abusive relationship, often you wonder if you're just making too big of a deal out of the crazy stuff going on around. That's part of the problem with getting out of the relationship, or even talking about it-- it's got to be your fault, something you're doing. Since these women reported being in such a relationship at some point in their lives, I'm assuming they're referring to past tense relationships. It takes a long time for the veil to fall way. And that misses the identified target of the recommended screening, if my assumption is correct.

At 12:38 PM, Blogger Mark said...

Here's one link to an article about post-partum screening.

I was a phoneworker on the King County Crisis Line for about 5 years. The biggest problem in dealing with abused people was exactly what you describe -- their difficulty in seeing that they were really in such a relationship.


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