The Consumer I Am
Recently I had an encounter with the health care system that illustrates how difficult it will be to usher in the consumer revolution and reduce costs in any significant way.
Several months ago, I noticed a lump on my knee. Being the knowledgeable consumer I am, I immediately thought: Cancer. I’m going to die.
As luck would have it, I had an appointment with my family physician for an annual checkup the following week. He looked at the lump and pressed down on it with his finger. It moved around, and was soft and squishy. I felt no pain at all.
“It’s probably a ganglion cyst,” he said nonchalantly. You should have it checked out. “A dermatologist or orthopedist could do it.”
As luck would have it, I happened to have an appointment with my dermatologist the following week for my semi-annual scan for basal cell carcinoma. He, too, concluded it was a ganglion cyst and “no big deal.”
“I’m 99 percent sure it’s nothing,” he said. “You could hit it with a large book, like a Bible. Or you could just ignore it, and it might go away on its own. But if you don’t like looking at it, you could see an orthopedic surgeon and have it removed.”
Being the cost-conscious consumer I am, I went home and whacked it with The Brothers Karamazov, not having a Bible on hand. Sure enough, it reduced in size but swelled up again after a week.
My wife, being the health expert she is, inspected the lump and pronounced it “really gross.” She advised me to see an orthopedic surgeon immediately, lest they have to amputate my leg.
Being the educated consumer I am, I researched ganglion cysts on the web and found tons of information, including The Bible method and the general conclusion that these are no big deal, especially if you’re not in pain. But a voice kept nagging in the back of my brain. “A lump on your knee is not a normal thing,” it intoned ominously. “You’re not the type of guy who can live with uncertainty. Besides, you have health insurance. Get an appointment with that surgeon who operated on the knee six years ago for real pain. He’ll take care of this once and for all.”
Being the paranoid consumer I am, I called up the orthopedic surgeon’s office to schedule an appointment. As luck would have it, he could see me the following week.
Here’s where it gets interesting.
A day before the appointment, someone from the surgeon’s office called me. “You have to get an MRI before you come in,” she said, and told me where to go.
No way, I said to myself after she hung up. An MRI for a ganglion cyst? They’ve got to be joking. I bet the surgeon has a financial interest in the facility. Being the pushy consumer I am, I’ll confront him tomorrow.
The following morning I showed up at the surgeon’s office. The waiting room was packed. The person behind the glass partition gave me a medical history form to fill out.
“I’m on file here,” I said smugly. You already have my medical information.”
“You haven’t been here in six years,” she shot back. “We need to update the information.”
I stalked back to a chair next to an overweight woman with crutches. If we had electronic medical records, I wouldn’t have to put up with the gross inefficiency, I complained to myself. I’m going to ask the surgeon why he doesn’t get with the program.
I filled out the form and went back to the counter. The woman looked at my paperwork. “You didn’t get an MRI,” she said in a distinct tone of disapproval. “Now you have to go to X-Ray.”
“X-Ray?” I replied incredulously. “I don’t need an x-ray. I have an ganglion cyst, for God’s sake. I just want to get it removed.”
She shrank back, like I was going to assault her. “I don’t make the rules,” she said. “That’s the procedure here.”
Someone ushered me to the X-Ray lab. They stretched me out on the table and positioned the machine over me. They took four x-rays of the knee in various positions, then instructed me to put the other knee in place.
“What for?” I asked. “There’s nothing wrong with that knee.”
“For comparison purposes,” the tech said. “The doctor wants to see both knees.”
By now I was seething. All of my lofty research and pontificating about health system reform, and here I was, caught in the bowels of medical insanity. By God, I’m the consumer, I’m in charge here, I told myself. I’m mad as hell, and I’m not going to take it anymore.
Or something like that.
I left X-Ray and was deposited in an examining room. Some 45 minutes later, the surgeon entered and smiled affably. “Sorry for the delay,” he apologized, and pinned the x-rays up on the wall. “It’s crazy around here.”
He looked at the lump and probed it with his finger. “Ganglion cyst,” he pronounced. “You can’t see it on the x-ray, but we would have picked it up with an MRI. You have three choices: leave it alone and see if it goes away on its own, drain it, but maybe it will come back, or we could cut it out with a simple outpatient procedure. Piece of cake.” He looked at me expectantly.
Sure, you’d love to cut on me, I thought to myself. What’s the markup on that, plus what you’re making off the MRI? I was about to launch into a lecture on his total self-serving behavior, but being the perceptive consumer I am, I saw that absolutely no good would come from it. He would be upset, I would be upset, the whole office would be upset, and I would rush out of there and drive too fast on the way back to my office and probably get a ticket, or I would need a stiff drink that evening when I got home because of the stress and constant complaining, and here I was trying to get into wellness and lose weight and start being nice to others, even if they were jerks.
So I just smiled back at him. “Let’s drain it,” I said.
A few days later, the lump disappeared. So far, it hasn’t come back.
I told this story to a good friend of mine who is a neurologist. “Look at it from the surgeon’s perspective,” he said. “He sees hundreds of patients. It’s more efficient for him to get the basic information first, instead of doing an initial exam and then sending the patient for an MRI and having him come back with the results.”
I give up. Why argue? Docs stick together. The system is set up for them, not consumers. What may be inefficient, unnecessary or ineffective care can be a revenue source for them, and with health plans and the government busting their buns with reduced payments, plus the people who sue them and jack up their medical malpractice insurance rates, they’re motivated to keep the numbers up.
Maybe I’ll just get a Bible and call it a day.
Feedback? Send it my way: Roger.Hughes@slhi.org.
*The Drift reflects the views of the author, and does not represent the official view of SLHI’s Board of Trustees and staff.