Bad Medicine: How a Cracked Lip Turned into Cancer
POSTED ON 7/23/2016 IN Research BY Christopher Centeno
You may recall that some time ago I blogged about my wife's respiratory condition and my interactions with our broken medical-care system. While she eventually recovered from that issue, now a new issue has again caused me to see just how far our medical-care system has deteriorated. What I found is scary for the average patient.
My Prior Experiences
I don't often interact with the medical-care system as a patient. Last year, my wife had an unusual presentation of a common respiratory virus. She literally had episodes where she couldn't breathe due to a spasm in her larynx. It was scary, but even scarier was dealing with the high-volume, mill like medical-care system that had sprung up in the last decade. That system couldn't figure out what she had or how to treat it because all the doctors had been trained in what I call "check box" medicine. Basically, all they could do was follow algorithms and make sure all the boxes were checked in their electronic medical records (EMRs). Since my wife's condition didn't fit in those boxes, rather than using their brains and going off script, they were dumbfounded. What I found was an entire generation of doctors who had been trained not to think outside the box; in fact, anything outside the check boxes didn't exist.
The New Problem Shows Just How Bad It Must Be for Patients
My wife's vocal-cord spam issue eventually went away, no thanks to the army of check-box doctors filling out the fields in their EMRs. This time, her issue was more common—badly cracked lips. However, the medical-care system based on check box EMRs was equally incompetent.
Her lips had been causing her severe pain for the last month or so. This started out as badly chapped lips, and this had escalated to swollen and red lips that caused throbbing pain 24/7. I thought they looked a little infected, so I told her to try some Neosporin. Next, she tried an anti-inflammatory cream—no help. When that and countless types of different ChapStick and lipstick mixes didn't help, she went to see a local dermatologist. This is where the insanity began.
The first dermatologist figured that she had a form of pre-cancer known as "Farmer's Lips." Basically, badly damaged skin that's on the verge of becoming cancer due to excessive lifetime sun exposure. She recommended a course of topical chemotherapy—basically, a cream that has a common cancer-killing chemotherapy agent in it that's usually used IV to treat other types of cancer. She warned that her lips would be severely swollen and painful for months as the chemotherapy would kill off a good part of her lip that was normal as well as the cancer cells. This sounded pretty extreme to my wife, so she sought a second opinion.
The next doctor was even more extreme than the first. This dermatologist wanted to biopsy the lips. This is a procedure that can leave the patient with permanently disfigured lips (i.e., a missing chunk). When my wife didn't want to do this, this doctor prescribed a topical steroid cream, because the diagnosis this time was a chronic allergic reaction. She tried the new anti-inflammatory and just like the first one she had tried, it did nothing.
What Was Really Wrong with the Lips?
At this point, my wife's lip pain had reached epic proportions. It was keeping her up every night, and she couldn't exercise due to the constant pain. I thought the area around the lips looked puffy, which could indicate a local infection, so I put her on a $5 script of amoxicillin, a common oral antibiotic. By day two the lip pain was gone, and last night she had her first good night's sleep in a month. So what began as lip cancer ended up being just an infected, cracked lip. Why did this happen?
In medicine, it's always follow the money. The fancy, cancer-fighting chemotherapy cream is expensive. This means that drug reps and the companies that make the cream can afford to find ways that money moves from the company to the doctor-speaking fees, lunches, and dinners. The little problem is, of course, that recent studies have shown that even the cream form of this chemotherapy drug can cause permanent brain damage in animals. A small little detail nobody mentioned...the biopsy can take the reimbursement for an office visit from $70 and add on hundreds in insurance payments!
The upshot? Our insurance system has been deteriorating for years. The rise of managed care and lower reimbursement rates have launched an army of physician assistants and nurse practitioners, none of whom are as qualified as the actual doctor. In addition, lower insurance reimbursements have forced doctors to see as many patients as possible in a clinic day, further reducing the quality of each interaction. Finally, Obamacare has forced physicians to use EMRs, many of which come preloaded with check boxes and algorithms that basically substitute for original thought! So if you're a frustrated patient, take heart that we doctors and our families are equally frustrated with the declining quality of healthcare because it impacts us too!
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