IT started as a trotting Charlie-horse but ended in an unstoppable gallop as I crashed into the gym floor writhing in pain.
A self-diagnosis was “Severely sprained left calf aggravated by daily work-outs and volleyball while failing to properly stretch”. Sport’s injuries become more common-place the closer we come to qualifying for AARP benefits, and I decided that an orthopedic physician was the best choice for care.
Was this mistake number one? Should consumers, even a HIT veteran with access to a wealth of internet health information, make the decisions on the direction of their care? You be the judge as I regale the tale.
The orthopedic physician, selected because of his in-network status with United Healthcare, concurred with my diagnosis. Rest, elevation and warm compresses were the course of treatment. The fact that the physician made his diagnosis and outlined the treatment without the use of x-rays, ultrasounds or MRI’s was a shock to how I believed modern medicine practiced. There was no loading of services meant to avoid litigation or pad reimbursements. He was efficient. He was using his significant experience to diagnose a situation considered common-place. He even mentored a young medical student, showing how to diagnose tendon damage by applying precise pressure.
The system was working! My conclusion was that an informed consumer and an experienced physician kept the services and fees to a minimum. I avoided the $40 co-pay by leapfrogging the primary care physician and the series of tests and inevitable referral to an orthopedic physician. Of course I felt I didn’t even need him, as I knew exactly the course of treatment he would prescribe.
All was progressing well as I followed the course of treatment, took Motrin daily and kept my foot elevated as much as possible. However, the pain diminished much more slowly than anticipated and my swollen leg was a quiet whisper from my subdued paranoia that something more sinister was afoot. The whispering voice that believes heart-attack when it heart-burn was permeating a majority of my thoughts.
My orthopedic physician was also concerned with the leg that wouldn’t stop its daily swelling. Neither of us originally recognized the swelling, tenderness and skin warmth with a blood clot teetering on a turn in a vein behind my knee, but a twenty minute visit to the vascular lab was a quick confirmation.
I became an inpatient for the first time in my life.
But first I had to be an Emergency Room patient, and I sat between a wailing elderly woman with a broken hip and an inconsolable infant suffering with a catheter insertion. I didn’t belong here, and certainly my bed could better serve someone in dire straits for the five hours I spent waiting for a bed.
I always believed those drawn into healthcare did so because of a passion for serving others, but I never appreciated their caring until I saw it firsthand. Despite the fact that it was a busy Friday night, the staff at Montgomery Hospital in Norristown Pa were wonderful, patient and determined to assure the best possible comfort. My bet is that this is the case in most hospitals across this country, and if they are not then it’s probably because they are overworked and underappreciated.
Passing before me were microcosms of the ills of our system and society. The morbidly obese smoker gasping to ask the nurse what he could do to feel better, other than lose weight or put down the smokes. There was the feverish infant screaming as staff collected urine, while the father vomiting into a wastebasket ignored his own health because he couldn’t afford a doctor’s office visit or the time off from work.
My admission was a precautionary measure to assure that the Coumadin meant to thin my blood didn’t dislodge the clot and create a pulmonary or brain embolism. The initial assessment was that I would be in the hospital for three nights so that therapeutic levels of blood thinning could be achieved. This was the normal protocol, unless of course my insurance would pay for home-use of Lovenox. Fortunately this was the case, and I would be released the next day with a thirty five dollar prescription for a drug that saved me two nights in the hospital.
Seems like a no-brainer! My nurse Amanda told me how lucky I was compared to other patients. Medicare patients without a drug plan either pay the shelf price of thirteen hundred dollars or endure another two nights in the hospital. Knowing the hospital bill would exceed the expense of the drug, we both shook our heads at the obvious lack of logic. I wondered how many similar situations occurred each day with other drugs and differences in payer payment practices.
How could it be that the same drug, dosage and quantity in Canada cost three hundred and fifty dollars? If I followed the money, who would I find holding the nine-hundred and fifty dollar difference? Some suggest that America pays more to fund the drug companies R&D. No wonder other countries are concerned about healthcare reform that would put caps on drug costs.
Some of my opinions have been changed and others have been justified.
A primary physician should be used in all situations, regardless of how apparent the diagnosis seems to be. A collaborative environment where primary and specialty physician can easily confer would expedite diagnosis and provide a broader view of potential conditions.
Fee for service should be eliminated in favor of fee for performance. Perhaps my diagnosis was fast-tracked because the apparent symptoms seemed common, or because the physician was behind schedule, or perhaps he diagnosed with specialty eyes.
Quality is the cure. Physicians, nurses and other healthcare professionals want to provide the best care possible, and encouraging this innate quality will increase the quality of care and lower costs. It all starts with tightening that bond between physician and patient, so that physicians know their patients better and can afford the time to provide high-tactile service. Right now the average doctor visit is less than 15 minutes, and I believe this needs to change.
Paper forms are still rampant. During my complete stay I estimated that 40 individual pieces of paper were used, many of the forms were very old and appeared to have been photocopied many times over. Because everything was on paper and the documents always seemed to be moving, the same questions were asked over and over again. Not that I minded the conversation, but describing my situation soon got tiresome.
People must assume personal responsibility and liability for their lifestyle choices. If you smoke or engage in other dangerous health behaviors then you should pay more than those that lead a healthy life. This also seems like a no-brainer and a practice that in life insurance.
Communities need twenty-four hour clinics for non-emergency situations. I am hopeful that outpatient clinic collaborations between hospitals and commercial pharmacies will take un-burden jammed emergency rooms. Patients using the ER as a physician office, boarding home or haven for psychological and physical comfort need different services, services that would cost much less elsewhere.
I am not sure what to say about the sick father avoiding time-off and the cost of a physician office visit, but going to work ill is a disaster for both his workmates and his employers. The fact that he couldn’t afford a doctor’s visit is something that needs to be addressed within the healthcare reform debate. Wouldn’t it be cheaper to pay for this man’s appointment rather than risk further infection? My bet is that his child became ill because of his decisions.
Regardless of how much we pay for healthcare, America can no longer afford to support the R&D efforts of the pharmaceutical industry.
Thank you to the clinical staff at Montgomery Hospital in Norristown, your passion for serving humanity gives me confidence that we can reduce costs while increasing our quality of care.
