I Just Got Health Insurance, Should I Get An MRI Or Something?
by Adam Baer
Somehow Still-Alive Guy is not a doctor, and he does not provide medical advice. But he has seen all the doctors! And is currently still alive, and here to answer questions from you. Remember, there are no stupid medical questions — only answers that can get you killed.
Dear Somehow Still-Alive Guy,
I’m 34 and I just got health insurance for the first time since being on my parents’ plan after college. I never go to the doctor. I actually don’t even have a doctor. But all kinds of things could be wrong with me. I feel pretty normal but I started noticing some stuff. I think I might be depressed. I gained weight. I don’t sleep but when I do I wake up sweaty like Bruce Springsteen working the arena. I get gnarly headaches and random pains in my stomach. I have these weird skin tags all over. I still keep getting drunk even though I can’t handle my liquor the way I did ten years ago. Now that I have some coverage should I just get a head-to-toe body scan of some kind so we know everything that we’re dealing with here?
Thanks,
No Rage Against the Machine
Dear NRATM:
Before we talk about why you or anyone shouldn’t just get a “head-to-toe body scan” to offer some relief from becoming the anxiety ball that not having health insurance can make one, let’s acknowledge a truism: Despite the perpetual whining in the media about medical overtesting, no doctor in his or her right mind will prescribe a scan — CT, PET, or MRI — of any body part for you without an undeniably good reason.1 And that reason has to be: he or she thinks something nefarious could be growing inside you (not just existential angst, resentment, or fat cells) — or in the more orthopedic sense, that there’s a problem with one of your joints, a sprain-injury, tear of ligaments, etc., perhaps from supporting a flesh-chassis too heavy for its wheels.
Let’s say for the purpose of our argument, however, that you’ve found the equivalent of that doctor who kinda-killed Michael Jackson — or anyone else who would be willing to agree to this fast-food drive-thru interpretation of “preventative medicine.” A scan of this type would certainly cost a healthy four figures, and that’s without factoring in perhaps separate steep bills for analyses by radiologists and neuroradiologists (assuming you want your worried brain scanned, too). What’s more, few insurance companies will cover this kind of on-demand scan unless someone with an M.D. in a specialty related to a specific problem claims — and proves — medical necessity, or, in “Law & Order”-speak, has “probable cause.”
So you’d basically have to be independently wealthy to have a full-body scan done for no specific reason as a relatively healthy person, and even then, you’d probably have a hard time finding a medical team to approve — and independently want you to do — it in our sweet summer of love for American healthcare. I also assume that the insurance plan you just managed to nab, perhaps via a job or luckily employed life partner, is not the same brand of luxurious health coverage currently given to Senators and CEOs. So I’d watch that deductible the way that you presumably watch your count of Twitter followers. Every number matters, and there’s nothing more miserably out-of-body, anxiety-provoking than finding yourself in a year-long, three-way virtual shoot-em-up between a medical provider and insurance company — all because you thought that a procedure was going to cost “n,” and it turns out that now, despite the “promise” in your plan to cover that specific thing, it costs “’n’ x 7.” (Promises in today’s health-insurance policies, as in the course of having sex, are sort of offered for momentary satisfaction only.)
Having had a few of the cancers and their mysterious late effects, I’ve experienced a few too many MRIs, CT-scans, and full-body films done in my time (the latter often being nuclear and PET-CTs, which I’ll define for you in a minute). At any rate, I’m sorry that I’ve had to have so many big-budget films made of my innards (and, to date, none made of my stories).
Why do I regret such highly personal imaging? I’m now one crazy-radioactive mofo (the magnetic part, I still work on), and my chances for even more cancers are exponentially increased because of extra exposure to the radiant power that still perfumes the blustery winds of Chernobyl.
We complain about having to go through security scanners in airports, but I’ve had so much radiation therapy that, while I should avoid more unnecessary scanning like I would a job removing asbestos without a protective spacesuit, I could spend the day in one of those TSA booths, chain-smoking and eating deep-fried Twix bars, and I’d emerge with only a little more damage to my body than the reason radioactive rays of light sometimes seem to burst out of it.
Simply put: You don’t want an ounce of this shit, believe me, and getting a full-body CT or PET scan (the latter being a 3-D nuclear thing that could titillate a Pixar director) will make you glow to more people than your mother. I say stop the radiation Peace Train before it starts (because it’s hard to slam on the brakes once there are real reasons to snap invasive selfies). As for MRIs, well, they use magnets, and it’s a little like baking you in a private, one-person tunnel with lightly heated walls. There’s no ionizing radiation there, but it has its minuses, too, especially if you sneak some bling into it — unlikely but possible, depending on what you may have had pierced after a late night in the bottle — or if your body dislikes being infused with a rare-earth metal in liquid form often used as a “contrast” to light up areas of radiologic intrigue. (Other possible “contrast” infusions for scans include an iodine-based juice, for CT scans, and a radioactive “tracer” for PET scans. You pee these contrasts out like your Jack-and-cokes, but if you try to fly somewhere right after this brand of film debut you may have to tell airport security that you do not have a bomb velcroed to your colon.)
Sounds to me like you really need to accept that the vodka-for-your-thirties is something green that you can grow, or for that matter, pills (not too many), and then get a serious, full physical, including a referral to a psychotherapist, dermatologist and maybe other specialists. My guess is that improving the fuel that you ingest, and that working and partying less hard as well as exercising more — along with getting yourself under the care of an internist passionate about real preventative medicine — will save you worlds of hurt. Of course, this is pretty damn hard in our time of super-specialized medicine, especially when a physician you might get a referral to isn’t on an insurance network, but this is when the game gets fun and you can start meeting doctors — most likely, younger, smart ones — and blog about your adventures like no one else.
Pretend you’re on your own reality show, and cast for the character who will bring your fictionalized self the most relief. I’m not going to lie: night sweats, stomach pains, depression, insomnia, and headaches are symptoms to ask a doctor about, but they’re also non-specific (especially for someone who overeats, worries, breathes, and drinks) and often related to the way you live. Doctors can only help you with what they do. They can’t keep you from leaving an appointment about your auto-immune hypothyroid condition and going to eat at the joint some Power Yelper calls “Nirvana for Fried Chicken Fanatics and Foodies Gunning for Diabetes.” They can’t make you hike or swim or just get the hell up from your chair every 15 minutes, and they certainly can’t make you eat stuff that actually heals you and prevents illness (see whatever doctor-as-personal-brand is currently shilling his or her “eat plants like your grandmother did” or “sugar is the devil” diet book for some general suggestions).
Full body scans are also not recommended if you’re a claustrophobe, although having to sweat my way through one super-long brain scan last year did possibly help me lose a few pounds in water weight and feel happy about the size of my apartment. For a day.
Then of course there’s the delightful False-Positive, especially prevalent with MRIs. Imaging, even in today’s physics-geek paradise, is far from perfect, and scans, especially the kind done wherein they infuse your bloodstream with heart-warming iodinized, radioactive or metal contrasts, are prone to shine a light on all kinds of nondescript (and likely benign) areas of inflammation that you don’t need to know about. (Some restless motion in the circular coffin in which you’re supposed to remain still forever can cause this, too.) Of course that’s where the fun begins for the hypochondriac (cue Woody Allen’s character in Hannah and Her Sisters). So maybe get an MRI. Just make sure that you truly dig extraordinarily loud banging sounds. Because that’s what you’ll hear for an hour while you worry that you may pass out inside your tiny cylindrical hole (p.s. so-called “Open MRIs” with more room are great, but they’re less precise, and we don’t want to miss a possible hint that you may be closer to the relief of death than you thought, so stick with the real thing).
If I had to venture a guess, I’d say that you’re going to be fine, but I’m not in the business of dishing out calm or blindly “thinking positive” (as anyone in my family or group of friends who doesn’t worship the religion of entropy like me will tell you). What I will offer as consolation is the comment that the thing you think is going to save you from lots of doctor appointments and perhaps some painful lifestyle revamps is mildly awful and potentially bad for you, and will also win you a number of more doctor appointments. Honestly, you’re probably better getting very high and just hallucinating so that you can see all of your imagined medical problems in one short spell without even having to drop a co-pay.
That said, if you find a doctor who’s loose with the MRI prescription pad, let me know? I’m already due for my yearly brain scan, according to the Boston radiation oncologist who once expertly shot protons into a tumor in the base of my skull — and a local LA physician that I’ve used just dropped my insurance.
And welcome to the world of the Covered! A land where you cannot, in good faith, complain about: everyday billing problems (which can involve serious coin), medical issues that you now may choose not to address, and the chance to develop a new income stream simply to fund the expert care of your body. Like me, you can also still support the Health Insurance for Everyone plight, but now you can feel guilt about not being one of the needy and join a string of organizations devoted to the cause so that you can sleep at night. Thanks, most likely, to the brand-name snooze drug that only costs you $50 a month.
1. One MRI/CT detail: Imaging techs frequently don’t offer full body MRIs or CTS, done in one shot. They do them in sections — foot/ankle, legs, pelvis, abdomen, chest, neck, head. In theory you could stay in the room and just have them do all of those films. But PETs or PET-CT’s and nuclear-medicine scans (like Gallium Scans) are the true full-body scans done in one shot.
Adam Baer (aka Somehow Still-Alive Guy) is The Awl’s vexing medical questions advice columnist. He’s not a doctor but a functional young survivor of too many potentially fatal and mysterious maladies, as well as cutting-edge treatments and procedures that include classically funny words like “stem cells,” “endoscopic neurosurgery,” “sub-lethal chemo,” and “bone-marrow transplant.” Adam’s written essays and stories for NPR, the New York Times, and Harper’s, among other publications. He lives in Los Angeles, and seems curiously normal. Pictured: a CT scanner, photographed by “Phillip.”