Wednesday, January 03, 2007

Unavoidable Delays

My pharmacy called this morning to say that the wrong dosage of Effexor arrived today, so they have to re-order, and I'll have it tomorrow.

I called the Nevada Humane Society's spay/neuter clinic to see if Caprica was scheduled for today: they said they have a backlog, so her surgery will probably happen tomorrow, too.

Meanwhile, our local paper carried this AP story about the hidden cost of cancer: the sheer amount of time patients spend in waiting rooms or in the hospital.
The hours spent sitting in doctors' waiting rooms, in line for the CT scan, watching chemotherapy drip into veins: Battling cancer steals a lot of time -- at least $2.3 billion worth for patients in the first year of treatment alone. [. . . ] Although most of these patients were retired, the researchers assigned a monetary value to their time -- $15.23 an hour, the median U.S. wage rate in 2002. Then they estimated the national toll by including the number of patients diagnosed with cancer in 2005.
I have three comments on this.

First, does it strike anybody else as one of those "duh!" pieces of research? Hey, guys, you had to do a study to figure out that cancer patients spend a lot of time in treatment or waiting for treatment? Most of the rest of us could already have told you that.

Second, I strongly suspect that most people with chronic health conditions also spend their fair share of time in waiting rooms: cancer's not the only condition that takes this kind of toll. I'm talking here just about regular waiting in doctors' offices, not emergency visits. I spend a lot of time explaining the triage system to impatient ED patients -- "If you have to wait to be seen, that means you aren't the sickest person here, and that's a good thing, because you never want to be the center of attention in an emergency room" -- and I don't think it's fair to compare those waiting times to the time people spend waiting for scheduled appointments. Office physicians are rarely forced to put everything else on hold because someone's heart has stopped.

And third: Is it just me, or does measuring the burden of illness by lost work time -- assigned an arbitrary monetary value -- seem a little, well, perverse? To me, this is a symptom of American workaholism, where everything's measured in terms of productivity, real or potential. Somehow I doubt that many cancer patients waiting to see their oncologists after a diagnosis are thinking, "If I'd spent the last hour at work, I'd be $15.23 richer now!" That's especially true of retired patients, who formed the majority of this study group. I know that research is all about numbers and data, but please: can we acknowledge that it's impossible to attach a pricetag to someone's life?


  1. I suspect the research is meant for consumption by people who know the price of everything and the value of nothing.

    An hour of my time has all sorts of values, but any monetary value is a long way down the list of measures that interest me.

  2. Hi, Martyn, and Happy New Year!

    I think there are illnesses where it does make sense to attach a dollar value to lost worktime: I've seen that done for both depression and substance abuse, as a way to convince workplaces to implement Employee Assistance Programs. If the numbers are used to advocate for treatment, I'm all for them. But if they're used to measure the value of lost worktime for a patient population that's a) mostly retired and b) already being treated, the project simply seems bizarre.

  3. Hi Susan,

    I think you're right on target that many of these studies aimed at translating illness into lost productivity are an attempt to motivate business to shoulder some of the costs of prevention, although it doesn't make much sense when you're studying retirees. My company offers lots of screening/preventive care benefits.

    In fact, it's been a while, but I just remembered that a number of years ago some outside consultant outfit my company had hired started calling one of my bosses right after he turned 50, trying to get him to schedule a free colonoscopy. THAT must be a thankless job! "Thanks, but could I take the discounted health club membership instead?")

  4. I think the possible value of the research (pun intended) is to perhaps influence folks to consider health care system change. Since our "system" depends so heavily on employer-provided insurance, lost work time is lost productivity. Better care with, one would hope, better access will cost something, but it may cost less than the lost productivity. In addition, we see often that political officials listen to business voices. So, if they complain enough, perhaps this will get politicians over the hump of actually addressing the problems of access.

    Crass and material? Perhaps. Perhaps also "wise as serpents and innocent as doves."

  5. Claire: Well, a colonoscopy's a LOT less unpleasant than colon cancer (which of course is the point).

    Marshall: Yes, good points. But in that case, can we address problems of access for other patient populations, too?

  6. Consider it a first step... documenting and cost-estimating the time spent for a particular, high-profile illness gives advocates something to use in trying to make public or corporate policy. Or so we'd hope.


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