Hyperaldosteronism, Medicare pay cuts, and a good night’s sleep


A patient depressed will cry

I said I didn’t know why

            But, I will mention,    

            There was hypertension

And the aldosterone level is high!

A good night’s sleep is a gift directly from heaven, and one of those graced last evening, making for a euphoric morning.

A patient, after being shuffled from doc to doc, came in last week on a new patient visit with high blood pressure disproportionate to age.  Non smoker, non drinker, and two hundred pounds overweight, an elective surgery was delayed for a pressure of 158/116. 

I see a lot of obese people and a lot of high blood pressure, but I don’t see hypertension this high in a person this young who doesn’t drink.  There were other problems, with more lab pending.  I already started vitamin D and booked a follow-up appointment for Friday.

But the aldosterone level came up high in this morning’s lab queue, 30 with normal being less than 16. 

Aldosterone comes from the adrenal gland and usually gets ignored because this hormone rarely goes bad.  I have never, not once, seen a case of hyperaldosteronism before.  On the verge of ordering spironolactone (an aldosterone blocker), I stopped and asked for further blood tests.  On her way to the endocrinologist I wanted to present my consultant with a thorough work-up.

Over lunch, one of the transcriptionists says, “Look at that Medicare cut, 21%.  What do you think about that, Dr. Gordon?”

“Like I care,” I say, “It’s not my problem.”

It’s a national problem in that people reaching Medicare age will not be able to find medical care if the rates get cut.  As it stands, the government pay for patients over the age of 65 is an insult and doesn’t cover the overhead.  But I’m not worried about it bringing down my income because I’m going to be doing Something Else.  I’ve also found that worrying about the government is a waste of time.  I will still enjoy taking care of the elderly, but in short order I’ll be on salary. 

It will be a problem for our oldest daughter, Jesse, currently in her Family Practice residency in Chicago.  She’ll inherit a lot of problems, and Medicare is only one of them.  

I inherited a lot of problems from my father’s generation of doctors.

Every generation of doctors fixes some problems and generates others.  I have never seen a case of polio or smallpox, but HMO’s still seemed like a pretty good idea while I was in med school.  I’ve had to deal with the rise of the Resource Based Relative Value Unit and the pharmacy review board.  As Jesse progresses there will be more and more faceless bureaucrats pushing her around.  I don’t see a remedy for it.  Medicine will still be the most honorable way to make a living.  Chances are she’ll never see a case of measles or mumps.

The quality of medical care keeps getting better and better and consequently the cost keeps going up.  As life expectancy increases, the rewards for not dying young spiral up and up, and the demand for health care keeps increasing.

I don’t think I’m going to solve the problem, but I’m having a blast taking care of patients.

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