White Coat Effect

I'm not sure about my memory but I think I read in last Sunday's NYTimes that Massachusetts has the highest healthcare cost of anywhere -- not just in the US, but in the world. This sounds outlandish but it seems to me, today, that it could be true. I had a simple appointment with my cardiologist, the purpose of which was to tell me the outcome of a carotid ultrasound since I'd complained of dizziness and he wondered if my brain was getting it's necessary blood supply. He also changed my diuretic and my dizziness ceased. So I almost called to cancel the ultrasound but having never had the test and being officially diagnosed as a person with congestive heart disease -- and those congested arteries could be carotids as well as heart arteries and lead to much feared strokes, I wanted some reassurance that the blood was flowing properly to the good old brain.

The technician did an EKG ["it's routine" said she]. and after a five minute wait in walked the august M.D. who said, "Hi how are you?" with the intonation of a grocery store check out person. He wasn't asking "how are you?" as my doctor. He gave me a limp hand shake, glanced at the EKG read out and the slightly high blood pressure reading [it's always high in the doctor's office, I have what's known as white coat syndrome"]. He listened to my heart and I breathed as he told me to do. He told me the carotid ultrasound was normal with some "lumps and bumps", talked about prescriptions briefly and said goodbye. All this transpired in less than five very impersonal minutes.

He will be paid by Medicare and I will receive a bill in a couple of weeks for an additional $50 for my "encounter..." This means that I will be paying, on top of the Medicare, $10 a minute for a bit of information that could have been delivered by phone or email. Yes, perhaps it is good to have BP and EKG at regular intervals; when one is almost 73 it's assuring to know that the ticker is tick-tocking as it should be. Back in NYC I did not receive an extra bill on top of Medicare -- why does it cost that much more in Massachusetts? I am a "healthy" patient; I wonder what people with problems have to pay. Oh, joy. I now have six months before we repeat the same routine again. Ia Big Brother looking after me or am I just muddling along, mostly doing the healthy things and deteriorating at a comfortably slow rate.