It’s actually a bit… unexpected… that I would marry a doctor. Especially a (for now) family practice doctor. I never had “a doctor” growing up. We had a clinic. First come, first serve. I had a dentist and an eye-doctor. The former I remember well, the latter made an absolute mint in Lasik and so he became harder and harder to see and so I would usually see an associate. But no guy I could call “my doctor.” And it was just as well because I never went to the doctor enough to have formed that relationship anyway. The truth is, I avoid the doctor. I try to take medication are rarely as possible. I am the prototypical critic of modern medicine, but married to a doctor. And the latter has, as one might expect, changed my outlook on the medical profession.
Dr. Saunders counters a piece by Virginia Postrel about contraception prescription requirements and they they exist. As it turns out, it involves questions I recently asked him over at Blinded Trials: Namely, what’s the rationale for allowing Plan-B over the counter but not contraception, and could we go more than a year between prescription re-ups? As I asked the question, though, the thought of “extortion” never crossed my mind. But there was a time when it did (well, maybe not “extortion” but “policy based around self-interest”).
I am a clumsy and forgetful sort of guy. I misplace, and break, glasses with regularity. I also wear contacts. Because I lose and break glasses with such regularity, I have to replace them with regularity as well. Generally, you can’t refill a prescription that’s more than a year old. The only reason for this that I could figure was that the eye-doctors wanted the business. They’d talk about how it was for safety and blah-blah-blah, but it was really about their pocketbook! It’s a tempting, and seductive, thing to believe. It provides a bad guy (the Eye Care Establishment!) and provides a cheap soapbox moment.
None of this is to say that I have come around to agreeing with the law. It is unnecessary hassle. Not just because of the required visit, but because I am terrible at those eye-tests and half the time my new prescription is worse than my old. And, for contacts, even a slightly different contact can have all sorts of glare problems or just not turn out as well. The other thing is that the eye tests always send off all sorts of warning bells for glaucoma, which I suppose isn’t their fault but it opens up a can of inconvenience each time when they refer me to somewhere else for visits every three to six months to “monitor the situation” until insurance coverage runs out.
When it comes to the medical profession, they want things “just so” because that is their job. Just like it’s a safety inspector’s job to be obsessed with safety. So of course convenience is going to take a back-seat to the best health care when it’s even moderately close. They know all of the things that can go wrong and to worry about, so they are going to be more attuned to all of the things that can go wrong and need to be worried about. Getting someone in to the eye doctor once a year to run some tests is thus valuable. They might have glaucoma! And if they didn’t, the inconvenience of testing does not compare to catching glaucoma early! Don’t talk to me about inconvenience – glaucoma is awful! And you don’t even have to pay for the testing (until you do, then the balance does start to change).
I still oppose the eye care requirements for a plethora of reasons. On the prescription contraception subject, I simply don’t know. Russell and Clancy are both pretty adamant on the subject, and I am relatively disinclined to suggest that I know better. I am still not entirely sure about the yearly requirements. As Russell points out (and Clancy said when I talked to her about it a while back) it’s pretty standard for any medication. I’m not sure the extent to which it should be, especially when you’ve been taking a medication for a while. But even so, it’s mostly a question of how you balance this with that. And it doesn’t take conspiracy theories to answer why physicians are particularly cautionary and might put a little more weight on making sure things don’t go wrong. That’s their job.
I’m relieved to know that Clancy and I are on the same side.
I think this issue really varies from prescription to prescription. For example, I’m pretty liberal with refilling allergy medications like Flonase, since presumably the patient would be back if it didn’t work and there’s almost no major ill effects to monitor. As I said in my own post, with contraception there is the concern about monitoring blood pressure, at least. But I could see an argument for extended refills.
Can’t speak to your eye complaint, though think of your poor eye doctors! Of course they want you to keep coming back. As far as they can tell, your prescription keeps changing, and they’re going to feel compelled to stay on top of it!
Every other year is the standard for good eyes. I think it’s diabetes that causes blindness…
From my experience, most eye doctors want to see you every year for an exam. Insurance covers glasses every two years, in most cases.
that’s only if you have glasses.
If I didn’t have glasses (or have an apparent need for them), I would probably have a standing eye appointment on the Fifth of Never.
I regret to inform you that the Fifth of Never is overbooked. We’ve moved your appointment to the Seventh.
Fortunately, I think I can rearrange my schedule for that.
When I’m at the optometrist’s, it’s like being at a Marrakesh souk. They tell me how much the contacts are, I say I’ll order them online, and they’ll halve the price. Or if I’m toying with getting in expensive glasses, they’ll start throwing in sunglasses or whatever.
One of the differences between an optometrist and a doctor is that doctors don’t usually sell their own prescriptions.
It is kind of funny to see how the price for lenses seems to vary widely until you realize that it’s “whatever the customer’s insurance pays for glass, plus a fixed amount.”
The entire notion of eye care insurance is ridiculous. It shouldn’t exist. If it’s important (like glaucoma or blindness or whatever), health insurance will pick it up (and besides which, it will take you outside your maximum payout). When it’s routine, like new glasses or whatever, it’s a relatively stable expense (as opposed to health care and dentistry) and the hassle of coordinating with an insurance company isn’t worth it.
But since VSP keeps changing the list of PPOs, it is a nice way to meet new people.
Perhaps this is true, but since it’s a benefit The Wife brings home, I’m going to use it anyway.
I’ve gotten it free of charge with a couple of jobs. I even tried to use it once. Once. Even when I have it, I will still just get my glasses from Walmart.
If you were saying this about contraception, I’d have to conclude that you’re a misogynist. What sort of bigotry should I attribute to you on the basis of what you actually did say?
Do they yell at you for exposing your arms there, too?
If I put the wrong tires on my car then it will fail to operate properly. In fact, it can fail so badly that it endangers my life and the lives of other drivers.
And yet I can buy tires with nobody even asking whether I own a car, let alone one appropriate for those tires.
Until I read Will’s comments on yearly requirements for oral contraception, I hadn’t thought about drug to drug interaction. I’m thinking this would be an additional benefit of seeing a patient at least one time a year before renewing the prescription. I’m not a physician, but I imagine a patient’s current meds could be difficult to keep up with if the patient changes their medications, sees multiple doctors, and/or uses multiple pharmacies.
Even if we rule out straight-up rent-seeking, doctors don’t have the right incentives to balance the costs and benefits. The question isn’t whether regular check-ups are a good thing. The question whether regular check-ups are important enough to justify the extra expenditures and hassle they entail. When someone actually benefits from those extra expenditures, and doesn’t have to deal with the hassle, I think it’s going to be hard for him to answer those questions without bias, even if he has the best of intentions.
And of course, doctors aren’t economists. Many of them don’t understand the concept of opportunity cost anyway.
Brandon, I don’t disagree with this. What takes 20 minutes of the doctors time can cause a half day off work for the patient. We shouldn’t always do what they want us to do, but we can’t hardly blame them for seeing things from their perspective (just as we see things from ours).
So, while I disagree with the eyedocs, I no longer believe it’s a conspiracy. Healthy eyes are their professional life*. Your scheduling hassles… aren’t.
* – Which, of course, brings us to those who think that doctors want people to be sick so that they can drum up business. It just doesn’t work like that. Regardless of their self-interest, a doctor who has seen patient after patient die too young of cancer with heartbreak all around them wants a cure for cancer. Even if they are an oncologist.