America's most popular doctor doesn't have terrible handwriting and doesn't make you cool your heels reading tattered copies of last fall's golf magazines. He doesn't abandon you and your bare ass, wrapped only in an absurd paper smock, in some cramped chamber with lurid charts of diseased organs festooned on the walls.
Dr. Google is his name, and you can always read his handwriting and he doesn't fine you if you can't make it to an appointment. Hell, Dr. Google still makes house calls, and he is available 24/7.
And a lot of us today — particularly if we're in our twenties — have a damn-near unshakable faith in His Holy Writ.
To say he is literally everybody's first-call doctor exaggerates the matter only a little. A 2008 Microsoft study found that one of every 50 total Web queries was health-related, and one-quarter of the million people in the study had embarked on at least one health-related search over the course of the study.
Even other doctors confer with Dr. Google, and what's more, with pretty good results. A 2006 Australian study presented a team of doctors with 26 batches of symptoms which they then took to the Net, and Dr. Google accurately diagnosed 15 of them, even though they had been selected for their difficulty.
Dr. Hangwi Tang, the leader of the Australian research team, stressed that the results of the Google searches needed to be interpreted by a "human expert." Laypeople, Dr. Tang stressed, would have less success.
In a Harris County Hospital District press release on this very subject, Casa de Amigos medical director Dr. Yasmeen Quadri said that people don't do themselves any favors by looking on the Internet. "Their symptoms might match a particular illness, but there are several diagnoses that have similar symptoms."
Problems with this mind-set cut both ways. Sometimes, people misdiagnose downward by convincing themselves that the early signs of a serious illness are instead symptoms of something less dangerous. On the other hand, Ryen White and Eric Horvitz, the authors of the 2008 Microsoft study, found that many Web searches cause people to mistake benign ailments like headaches for devastating ones like brain tumors. They call these people "cyberchondriacs," and say that the condition is growing.
Local record store owner Kurt Brennan has seen Dr. Google — or, in this case, an even less-qualified Internet medical "expert" — misused in just the manner doctors Tang and Quadri feared. About a year ago, Brennan was trolling through the daily messages at local indie rock message board Hands Up Houston when he came upon a highly sophisticated spin on a visit to Dr. Google's office.
"Some kid had a spider bite and was concerned that it might have been a brown recluse," Brennan remembers. "So he posted a photo he got on-line asking for people's opinions."
Brennan says he couldn't stop laughing when he ran through the thought process. "First, research spiders on the Internet. Then download photo of possible perpetrator. Post spider picture on message board...wait, he's gotta go to Photobucket first. Then have your possibly dangerous spider bite diagnosed over the Internet by a 22-year-old who works at Buffalo Exchange."
For ten years, and even today now that he has a good job with a subcontractor for the VA, a local musician we'll call Sam (for reasons that will become apparent later) has depended on Dr. Google for his medical care. Sam spent about ten years — roughly between 1998 and last year — uninsured, though he occasionally rose to the ranks of the woefully underinsured.
"I had some stomach problems for years, but I never went to see anybody," he says. Based on what he could glean from the Internet, and from old-fashioned books, Sam learned to get a handle on those, at least for a time. "I just kinda changed eating habits, and looked for other ways to address my symptoms."
In addition to consulting with Dr. Google, Sam had enough snap to talk to real-live experts. "I asked friends who were in med school, and I have a cousin who is a surgeon in an emergency room in a different state. I would call him and ask, 'Hey man, is there something I can do other than going to the doctor?' So definitely the Internet, but also social network and just whoever was around, before I would actually go somewhere."
Such meandering troubles doctors. "That is a concern as a physician — patients waiting too long to be seen," says Dr. Chris Benton, a former resident at Ben Taub Hospital. "That is something I've seen quite a bit of at Ben Taub. Young patients don't often have regular physicians. They don't have a primary-care doctor. By the time they present to us, it's out of necessity. They have to be seen, they have to go to the hospital. And that's when they show up."
Josie Gardner is only 28, and outwardly healthy-looking, but two months ago she was diagnosed with sky-high blood pressure.
"My doctor told me it was at stroke level for my age, and it is not going down," she says. The brunette bartender at Heights-area bar Big Star was referred by her GP to a cardiologist, but since she has no insurance, she has been delaying and dreading that visit ever since. "I've been putting it off and putting it off, because of the money," she says. "What are they gonna do? All these tests? That will be thousands of dollars."
Now she's working extra shifts to save money for the expenses to come. "I'm just trying to save X amount of money. I'm just gonna bartend, and hopefully I can come up with the amount of money I will need." Worse still, she has no idea how much that will be. "My doctor can't even tell me," she says. "I don't know what tests they are gonna be doing or anything. My doctor told me to tell the cardiologist that I didn't have insurance from the beginning so he can pick and choose what tests to do."
The very efforts Gardner is making to pay her medical bills — all that time on her feet in those extra bartending shifts — might even be exacerbating her condition. A Scandinavian study from 2005 found that "prolonged time in an upright posture at work constitutes a risk factor for the development of hypertension comparable to 20 years of aging."
In the jargon of the health-care and health-insurance industry, people like Gardner and Sam are known as "Young Invincibles": late teenagers or twentysomethings who spurn health insurance for any number of reasons.
Some opt out because of simple ignorance of the process by which health care is delivered in this country. "They really don't understand health insurance — co-pays, deductibles, in-network or out-of-network, PPOs, HMOs — they have no clue how to navigate through that," says Christine Hassler, a life coach, author and public speaker on matters concerning twentysomethings. "Even when they do go get a job, oftentimes they pick the plan that is the least expensive, where a PPO might better serve them. They don't know that they can write off some of their health-care expenses and things like that."
Hassler says pondering health-care insurance and its alphabet soup of programs simply bewilders many twentysomethings into inaction. "Something like health care — it causes such overwhelming anxiety they just avoid it altogether," she says.
Others, because of their age, simply feel invulnerable, and so they throw the dice. Against relatively bad odds, as it turns out, as many twentysomethings view their personal safety with the same blasé disregard they view buying a health-care plan. According to statistics from the Centers for Disease Control and Prevention, young adults binge-drink, do drugs and have sex with more partners (and take fewer precautions when they do) than any other age group. The same sense of invulnerability that leads them to forgo buying health insurance causes them to do the very things that could cause them to need it.
"Especially with respect to accidents, trauma, that's a concern," says Benton. And not only do they make errors of commission — living dangerously — but Benton believes it to be something of an error of omission in not seeing a doctor for a period of years. He says that it's hard to quantify, but he wonders how many of these young invincibles are setting themselves up for avoidable cases of middle-age ailments such as hypertension and diabetes.
"A chronic problem doesn't just appear," he says. "There's a pathway, there's a course to getting there. If you release a balloon at the bottom of a pool, it doesn't just appear at the top — it has to travel through the water. The same is true of chronic illnesses — high blood pressure, obesity, diabetes — those are things that occur over time. That's why sometimes having a regular physician or primary-care doctor that you know and have a good relationship with is so important. When you do go and have a problem, you can have more of a regular conversation with them, and those sorts of things can be better prevented."
Tody Castillo, a singer-songwriter and clerk at Cactus Music, has been uninsured since leaving college. In that span he and his wife have had one baby on Medicaid and another with a midwife at home, which cost them about $4,000. "We paid cash," Castillo remembers. "By 'we,' I mean our parents helped us."
Castillo doesn't let the stress of being uninsured get him down, and one of the reasons he is so relaxed is that years ago, he became a believer in Eastern medicine. He also happens to be married to a woman who just finished a master's degree in that discipline. "Now I don't feel as panicked," he says.
He insists that Eastern remedies are just as effective as Western ones. "Chinese medicine addresses anything that the body does to itself," he says. "There are no medical mysteries in Chinese medicine." Better still, they cost a fraction of the price — $35 for an hour's visit to a clinic, he says. He adds that he now treats his anxiety and depression with an herbal remedy — one that costs much less than his old Western meds. "I got off of Lexapro and got on a Chinese, herbal Lexapro," he says. "If I forget to take it for two days in a row, I feel like I am gonna die."
The costs of Western medicine are well known, but fall hardest on the young and uninsured. Milagro Tovar, a 21-year-old restaurant server, found that out the hard way. She says that she "grew up sick" — she was born with a malformed hip. As a child, the daughter of immigrants was treated for free or at greatly reduced cost at Shriners Hospital, where doctors twice operated on her hip. "They helped me out when I was a kid, but after I turned 18 they didn't anymore," she says. Tovar attended college for a time, but didn't sign up for insurance. She was also certified to join the CHIP program, but her application took so long to process that once she was allowed in, she was no longer eligible.
And suddenly, Tovar really needed health insurance. About a year ago, she broke her ankle. "I was hospitalized for a night and then they let me go and I was referred to Methodist, and I had to have surgery at that point," she says. "They let me have the surgery, but after all is said and done I owe them 15 grand." Now collection agencies are harassing her, and though she works at a popular restaurant, tips only go so far. Tovar has no idea how she will pay.
It brings up a vicious irony of modern American health care. People like Tovar are charged much more than people with insurance for the same services. Hospitals, like hotels, set official charges for specific services, but just as virtually nobody pays the ridiculously expensive "rack rate" you see posted on a hotel door, only the uninsured pay the full fee at a hospital.
"The insurance companies have such huge numbers, they can negotiate," says Jay Norris, an insurance shopper and the Webmaster of the site Texasinsurance.org. "They can say, 'We have all these people that can be on your network and we'll negotiate a certain rate as a provider contract.' Whereas a hospital might say to an uninsured patient, 'Well, we'll give you an uninsured rate' or whatever, but they have no incentive to drop it as low as an insurance company might."
Or perhaps it is more accurate to say "are charged the full fee," as a 2007 study found that these uninsured patients were only able to pay 39 percent of what the hospitals demanded. "Of the entire bulk of the people they deal with, a lot of them end up not paying or filing for bankruptcy," says Norris.
One such was Sam, whose stomach problems flared up again while he was touring with a band in Canada. One day, he found he could not stop vomiting. At first he thought he was in luck — at least he was in the Great White North, land of socialized medicine. But such was not to be. "We went to a pharmacy, hoping to just get some antinausea medicine," Sam recalls. "The guy there's literal words were, 'Go back to America.'"
Sam was conveyed across the frontier into Ohio, where he was hospitalized for ten days. Doctors never found out what was wrong with him — they suspected a cloaked form of salmonella — but Sam's vomiting eventually ceased. Then came the bills. Even though he had what he termed a "really, really bad" insurance policy from the little bar in Montrose where he worked, the final out-of-pocket tally from his involuntary stay in Ohio came to $18,000.
"They knocked a bunch of it off," he adds. "I think I ended up paying about $3,000 of it, and I probably still owe about another thousand to somebody somewhere. Every now and then I will see a 1-800 number pop up and I'll just send that straight to voice mail."
Once upon a time, walking away from $15,000 worth of medical debt would have been seen as shameful, but no longer. (If anything, it now seems the greater sin to be charged that much money rather than to walk away from the debt.) Hassler says the twentysomething generation's flexible morality comes into clear focus when viewed through the prism of health care.
"Their sense of right and wrong isn't as stringent as their parents' or the mature generation," she says. "So the bending of the rules isn't really an issue — say taking someone else's prescription, or lying to a doctor, getting free samples, whatever. They see all of that as just what they need to do. I don't blame that on them. It's not about blame. What we see out there is what we can get away with. With what's going on with the bailouts, it seems like anybody can get away with anything. The lines have been blurred. There's a beating-the-system element to this as well."
Nowhere does the beating-the-system element come into play more obviously than in the chase for prescription drugs. One of the simplest ways to hoodwink Big Pharma is simply to help yourself to the remains of a friend's prescription. Occasionally, you'll even see people requesting specific meds via Facebook status updates. Hassler says that she has heard of twentysomethings cozying up to pharmaceutical sales reps in order to get free drugs, and parents sharing prescriptions with their children.
Other methods are even more elaborate. For example, those of (occasional Houston Press contributor) Linda Leseman, a 27-year-old Houston woman now living in New York. She recently decided to administer herself a course of Gardasil, the vaccine against the virus that causes cervical cancer. To do so, she e-mailed a Houston clinic and simply asked for a prescription to be sent to a Walgreens near her northeastern home.
"She was like, 'Yeah, sure,' Leseman says. "So I go to this Walgreens here and they just hand me these vials of medication and they were like, 'Keep this in your refrigerator.' And I asked, 'Well, how do I get them into my body?' And they were like, 'Good luck with that.'"
Leseman called a hospital in the city she lives in and asked an intern to administer the injections. "I said, 'Look, I've got this stuff, I just need someone to give me a shot,' and they said they don't give medication that they didn't prescribe."
Next, Leseman remembered that she had a friend who worked as a travel nurse. "So I called her and she was like, 'Oh sure, I'll look through my closet for you,' so she goes to her supply closet and gets these syringes and alcohol swabs and brought 'em over to my house when I was having a bunch of people over. As a matter of fact, every time I have received this vaccine I have been under the influence of alcohol, so I hope that doesn't negate the effects."
The next round of injections was administered at a "risotto restaurant." "We went into the bathroom," Leseman remembers. "It was one of those singletons, where it was just a toilet and a sink and you could barely move, and she shot me up with the second round there."
And then Leseman's friend moved away, but Leseman still needed to be injected with a third and final round. "I was like, 'What am I gonna do, I'm stuck with this third dose.' And I was like, 'Oh, my friend Jessica.'" Although Jessica is a physician's assistant, Leseman's third dose could very well have been fatal, thanks to Leseman's sloppiness at self-administering her medicine. "She almost shot me up with a shot of air, because I hadn't realized I had not filled the syringe."
"I really feel like there's some kind of grace extended to people in their late teens and early twenties where if you do something stupid sometimes you can just get away with it or survive it," Leseman says. "I don't know if that happens for your entire life, but, you know, maybe there's some kind of cosmic grace that makes you feel invincible."
Or as writer Hassler puts it:" What I see with Gen Y — and I wrote about this [in 20 Something Manifesto] — is that they live in a bubble of invincibility."
"It's interesting that society sort of protects Gen Y'ers," Hassler adds. "They have their parents, and this isn't as true right now as it once was, but there are so many different kinds of jobs, people are extending their time in college... Some of the pressure to figure out what you want to do by the time you are 22 is removed; you're not looked at as a failure if you are still working at Starbucks when you are 24 and figuring out your passion. So there's almost that permission to have a little bit of a Peter Pan syndrome."
Hassler calls them "adultolescents." "It really is the adolescence of our adulthood — we aren't really grown up. There are two extremes — there are the Gen Y'ers that put tons of pressure on themselves and want to figure it all out and be responsible, but for the most part it's 'Well, this is sort of low on my priority list.'"
Many of them get so far as to actually ponder buying insurance, but once they weigh it in the balance against other priorities, they find it wanting. Why worry about an abstraction like health care when there is tangible fun to be had?
"They are more instant-gratification-oriented," points out Hassler. "So if I'm gonna choose between a night out with my friends, a trip to Europe or a car that I really want versus high health insurance when I'm a 22-year-old guy who doesn't get sick, I'm gonna choose the thing that's more instantly gratifying. Their behavior toward insurance is very similar to their behavior towards investing, 401Ks, IRAs, putting money aside for savings. They are more interested in short-term pleasure than long-term security."
But a lot of them are just making their way as best they can through the Western world's most expensive — some would say ruthless — health-care system. What's more, they are in the very worst situation. While only teenagers make less money at their jobs, twentysomethings are asked to pay the most for their health care.
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Take Sam, for example. Fresh out of college, and long before he got a job with benefits, he suffered from depression. Once he was dropped from his parents' insurance plan, the price of Prozac proved prohibitive. That is, it did until Sam lucked into an underground source, one who dabbled in myriad forms of mood elevators.
"I had a pot dealer at the time who dealt in many other things, and he once told me that he could get any prescription drug that I wanted," he recalls. "So I used him to fill my prescriptions. Prozac doesn't have recreational potential, so they were extraordinarily cheap. I think I was getting 200 pills for like $5 or something. It was basically a service charge and he was throwing them in free when I bought pot. I have no idea where he got them, but they were the real thing and they worked, so it worked for me."
The lagniappe-dispensing dealer ended up moving to New York, which sent Sam trudging back to the doctor. Luckily, there's a happy ending: "That was probably a good thing, though," he says, "because I ended up not needing to take them anymore."