Tuesday, 20 October 2009

I Don't Have TB

Like most Europeans of my generation, I have had the BCG, the very effective vaccine against Tuberculosis. So imagine my surprise at being ordered to take a TB test in order to register for class. Just to go into that a bit further, it’s not an immunity test to check that the BCG worked, it’s a test to check that I have TB antibodies. For those of you unfamiliar with theories of vaccines and immunology, the way they work, more or less, is that they give you antibodies to enable you to fight a particular disease. So if you have had a TB vaccine, you’re pretty likely to have TB antibodies. So a positive result to the ‘TB test’ to test if you have TB in fact means that you EITHER have TB OR you’re immune. Perhaps I’ve been spending too much time on my DME project, but this doesn’t seem like a very effective indicator to me.

So, under extreme duress, I got the test done. Within two days it hurt like hell and was red and swollen – I didn’t need a doctor to tell that it was a positive result. Getting to health services today, they took one look at my arm and escorted me into a private room to break the news that I had TB. My response – don’t you think it might be because I’ve had the BCG – elicited an admission that false positives were very common with people who’d had the BCG. Well, duh! Next exchange went something like this:

Doctor: you now have to get a chest x-ray to show that you don’t have TB. This will cost you at least $40 (20% of the total) and you have to go to a hospital that’s 40 minutes away on a bus.
Me: why? That’s silly – I don’t have any symptoms and I’ve had the BCG so I clearly don’t have TB. Why can’t you do an immunity test?
Doctor: That’s not our policy; we require a chest x-ray
Me: aren’t chest x-rays bad for you and expensive. Isn’t there an easier and cheaper way of doing this that won’t give me cancer later in life?
Doctor: There is a blood test option but it’s more expensive as it isn’t covered by insurance
[aside: why on earth not? Surely getting someone to look in a microscope is cheaper than an x-ray? And why would my insurance cover x-rays but not lab fees?]
Me: what about the immunity test
Doctor: we don’t consider the BCG in our policy
Me: why on earth not? Surely that just makes it a crap policy that needs to be reviewed]

This ping-pong went on for some time until they let me speak to a different doctor. She asked me what my issue with it was:
- Unnecessary expenditure of money and more importantly time
- X-rays aren’t good for you and I want to avoid an unnecessary one
- The whole policy is stupid and almost all the international students have been affected by this – don’t you think you should consider adapting the policy to allow immunity tests?
- I’m an exchange student anyway so by the time I get all this done I’ll only have about 2 weeks left at the school so it seems like a waste of time.

The new doctor was awesome and gave me some advice: go and see a particular doctor involved with the policy-making process in 10 days time and explain my concerns. In the mean time – play it long and if we get into December they’ll leave me alone.

So I now have a strategy to evade having to haul to the hospital and get the pointless x-ray, but this is still driving me crazy and at the risk of overblowing it, it does highlight what is rubbish about American healthcare: I’m paying for it so they have no conscience about making me get unnecessary procedures. In the NHS, there is an incentive for doctors to consider whether treatment is actually useful, since it’s the government paying for it there is therefore a limit on resources.

No comments:

Post a Comment