The Happy Little Box

When you reach a certain point in life–like the age of 50–the indignities start to pile up in five year intervals. You get an unsolicited membership card from AARP welcoming you to their ranks.  Wait staff at restaurants insist that you take their senior citizens discount for dinner at 3. And, if you have a sadistic primary care physician, you begin to get scheduled for medical procedures you used to be thankful you were too young to have to endure.

After having spent the previous week on an actual beach, my wife and I spent last week back on the metaphoric beach of retirement undergoing the same medical procedure.  We have different primary care physicians but both apparently follow the same guidelines.

The procedure which both of us have experienced several times before requires that you have a companion willing to drive you home and stay with you for a few hours as you recover.  No Uber drivers allowed which is just as well given how their newly issued stock has performed. Thus, we had the procedure on separate days.

You start by fasting the day before.  You can have popsicles of a certain color and various clear liquids.  You need to keep hydrated for the ordeal to shortly follow. After midnight of the day of the procedure, no liquids are allowed with one terrible exception.

In the afternoon of the day before, you take your first step in the preparation.  You drink a vaguely cherry favored concoction which is washed down with 32 ounces of water over the next hour.  This first step will soon result in many other quick steps to the bathroom.

A few hours later after midnight, you repeat the process.  It is like the rinse cycle from hell.  If you are lucky, things settle down before you depart for the procedure.

Once at the location of the procedure, you sign a variety of consent forms notifying you of all the bad things which could happen to you.  You sign on an iPad although the signature looks nothing like what you would write on a piece of paper.  This high-tech approach gives you confidence.  You can have the consent forms printed out to take with you but having endured so much already, only a confirmed masochist would do so.

Soon you are taken  to your room where a sympathetic nurse sticks an IV needle into your arm and explains “conscious sedation” to you.  After what you have been through so far, conscious sedation sounds pretty good.

The actual procedure is a breeze.  You remember nothing and you have nurses fussing over you as you recover.  If you are lucky, you won’t have to have the procedure again for another five years.

If by now you have not guess what the procedure is, then you will have a big surprise waiting for you along with your AARP card when you turn 50 and every five to ten years thereafter. Enjoy life until then.

Recently I have noticed a commercial on cable news shows featuring a happy little box with arms and legs touting an alternative to what I outlined above,  You take the contents of the box with you into the bathroom, do what the instructions tell you to do and mail the result for testing.  Mind you, you are hearing all of this right after you have had your dinner.

The problem with this approach is that while the happy little box gives you a result, positive or negative, unlike the other procedure it does not intervene to remove possible conditions that may be a precursor to cancer which is the point of the whole exercise. The happy little box comes with significant limitations.

So why have I gone into such detail?  Aside from the fact that the procedure can and does save many lives, I find it a perfect example of the ability of our healthcare system to adjust to rapid change.  It is, in fact, one of many such examples of how agile our healthcare system is, especially in comparison to the sclerotic state of many other segments of our economy.

Colonoscopies–there, I finally have said the word–were made possible by technological innovation rapidly adopted.  At first, the procedure was done within the confines of a hospital.  Then, as I recall, a few doctors started outpatient centers which did only colonoscopies.  This prompted hospitals to include the procedure in their new outpatient surgery centers at a greatly reduced cost as compared to doing it in the hospital. You see this process of adjustment and change occurring all the time in healthcare.

The pace of technological change in healthcare is accelerating.  New developments in individually tailored cancer treatments, continued development of robotics in surgery and new imaging techniques will test the agility of our healthcare system.  Don’t bet against our vibrant healthcare system and its component parts.

As for the happy little box, it represents a further technological refinement for people who needlessly fear colonoscopies.  If the happy little box tells you need to see a doctor, then you best do so. Better yet, go all the way with the scope.





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