Cheryl’s lips suddenly seemed fatter, and her ears and face were stinging. She put down her fork and put her hand to her mouth.  Swollen. And her tongue was taking up more space than usual.  It suddenly hit her that she was having an allergic reaction.  Was her throat also swelling?

She looked at her husband.  It was the first big vacation they’d taken in the five years they’d been married, and he was enjoying the gourmet meal he’d been looking forward to for weeks, in a well-regarded little restaurant in a tiny town in a remote part of France.

She hurriedly reviewed her limited French in her mind.  How could she get across the concept of “anaphylactic shock” to the waiter, who spoke no English?

She excused herself and hurried to their room and gulped down a couple antihistamines.  She had allergies and usually put some medicine in her suitcase when she traveled. Fortunately, she had remembered to do so this time.

Also fortunately, the pills did the trick and the swelling started to go down.

She didn’t eat any of the rest of the meal, and sat quietly at the table as her husband proceeded through three more courses, extolling the virtues of the chef.

When she got back to the United States, Cheryl made an appointment to see her doctor.  She was still having flashbacks.  Supposing she hadn’t had any antihistamines with her?  If she hadn’t, what if she had tried to explain the problem to the restaurant staff and they didn’t understand her?  How did you get a doctor quickly in a French village?  Was there a hospital anywhere nearby?  Would she have been able to get an ambulance?

She asked her doctor if she should be carrying an Epi-Pen, last-resort emergency treatment for allergic reactions that threaten breathing.  Her doctor said, “No, not unless you know exactly what ingredient in the meal you had the allergic reaction to.”

Cheryl was still trying to parse this answer when the doctor ended the visit.  Her husband was furious when she told him.  “What kind of an answer is that?  What difference does it make what you reacted to?  If your throat starts closing, who cares what the allergen is? The point is that you have to have a way to reverse the reaction!”

Fast forward a few years.  Cheryl was standing in her kitchen when she suddenly felt that her ears were burning up. Her face felt hot and stinging, and then it started to feel very stiff.  Her arms and legs hurt, too -- she had stinging all over her body.  She pulled up a shirt sleeve and saw that her elbow was bright red and covered with a rash.  The same was true of her knees.  Her torso was only slightly less red.

She said to her husband, “I’m having an allergic reaction.  Take me to the Urgent Care Clinic right now!”  He said, “Or the emergency room?”  She said, “We’ll decide when we get to that intersection.”

As they approached the red light -- left for the clinic, right for the emergency room -- she motioned left.  She was still able to breathe.

The clinic did a great job of separating emergencies from more routine problems.  Within minutes, she and her husband were whisked back to an examining room where Cheryl was given injections and closely monitored for half an hour to ensure that the reaction was dying down.

When the doctor came back to give her some prescriptions and instructions, Cheryl asked about an Epi-Pen.

The doctor said, “We don’t usually give those out, because they’re expensive.  If your insurance doesn’t cover it, it could cost you a hundred dollars.  And it has to be replaced every year, too, whether you use it or not.”

This time, Cheryl was better prepared to discuss this life-saving treatment than she had been the previous time.

“If my choice is to waste $100 a year -- and live if I have an allergic reaction -- or save $100 and die, I choose to spend the $100.”

The doctor laughed.  “Well, when you put it that way . . .”  And he wrote the prescription.

It turned out that Cheryl’s insurance covered the drug, with only a small co-pay. 

Have you ever found that your doctor makes assumptions about the trade-offs you are willing to make that aren’t accurate? 

Once when I was in a restaurant with half a dozen other people, one of the group said, “May I have a salad instead of the potato?”  the waiter said, “No, there are no substitutions.”  It took the customer a minute to regroup and say, “I want a salad.  It’s okay if you have to charge me for it.  But that’s what I want.”

The waiter said, “Oh, okay, I’ll have to charge you another dollar.” The customer was fine with that.

In dealing with your doctor, it can be helpful to say what you understand the trade-offs to be, and to say which you’d prefer.  They’re not always about money.  They can be about benefits and risks of different treatments and about changes you can make yourself so that medical treatment isn’t necessary.