When Should You Stop Being a “Patient” and Start Becoming a “Customer.”


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If you think you can fall into the arms of the U.S. healthcare system and rely on providers to provide excellent and appropriate care, think again. Hey, I’ve met many a practiced and ethical doc in the healthcare jungle, folks who went into healthcare for all the right reasons and continue practicing according their original impulse. But money corrupts. And lots of money corrupts like hell. That’s why 50+% of tests and procedures are medically unnecessary. Yes, a portion of that occurs as defense against malpractice suits–but only a portion.

Lot of doctors, not just some, “bite the apple” and base recommendations on the condition of their wallets, not their patients.

For example:

• My internist in a clinic that owns a physical therapy unit (but doesn’t do orthopedics) referred me to the PT unit for pain in both shoulders. No x-ray. What did the clinic recommend? Lots of PT, of course.

• After ongoing pain for over a year, the internist finally okayed me seeing an orthopod (orthopedic surgeon), which is a “black mark” against the clinic for referring me to a specialist, at least in our system. After an MRI, the orthopod, without showing me the film, recommended surgery in both shoulders for rotator cuff tears, with the left one first because the injury was “older.” That’s only about 6 months mostly off the job. When I told him I was self-employed, he just shrugged. “Just book the earliest available appoint with scheduling on your way out, then schedule the other side for 90 days later.”

• Something didn’t smell right, so I managed to wrangle an appointment with the shoulder and elbow specialist for our major league baseball team (which takes “knowing someone”). Insurance wouldn’t authorize a new MRI, so he went with the old one to avoid me paying a couple of thousand out-of-pocket. Who could blow an MRI, eh? This doc trotted out the film and had a long talk with me. My left shoulder will likely never need surgery, unless I resume pitching baseball, which is how I did the initial damage. But the right one, which doc #1 was going to delay, needed immediate surgery because I was in danger of not having enough tissue left to repair it.

• When doc #2 cut, he discovered that doc #1’s MRI didn’t cover the whole injury area. It was way worse than he realized. But he’s a near magician by reputation, and he was able to repair 90% of it. Would have been 100% if I’d got to him in time. Probably would have been 50% if I waited until having my left side unnecessarily done.

• Here’s another beaut. We had a work overload
spell lasting over a year due to unanticipated project scope expansion. Towards the end, I started wearing down, until I wound up on the bench. Just simple fatigue, my then doc told me. I’d asked several times for a sleep apnea test, but he wouldn’t approve it. Didn’t want that “black mark.” I just needed to lose some weight (all those restaurant meals on the road) and the problem would go away. I did, and it didn’t. I finally bitched enough to get him off the dime. Went in for a sleep test, where I was supposed to sleep naturally for half the night, then aided by this C-Pap air pump the second half. In less than an hour they came rushing in and told me I needed the C-Pap immediately. My blood oxygen level was in the red zone – heart attack/stroke territory. They couldn’t accept the liability of me going without it. So they outfitted me with a machine, and I was fine the rest of the night. And I was back to 100% in a few days.

• Postscript to the above, when I visited the lung clinic to get my machine, a PA looked in my throat with one of those little flashlight deals. I’d already told her about why the delay arriving there. First time I ever heard one practitioner call another a f*****. She asked if past-GP had ever done the flashlight test. He hadn’t. She said “it’s so damn obvious,” or something like that.

• Good friend and colleague of mine had some stomach pains he didn’t like, so his doctor sent him to a gastro specialist. Guess his system doesn’t do “black marks.” Gastro-guy told him he needed some very invasive and debilitating type surgery. When he went in to get cut and plumbed, the check-in PA looked at his chart and asked him, “You’re here for what?” My friend told him. The PA’s response? “Boy, they must be awfully slow up there.” My friend got up and walked out. Turns out there was nothing wrong with him that over-the-counter medicine wouldn’t fix.

• And women might be interested in knowing that a research study (and I wish I’d saved the source) showed that ObGyns are twice as like to perform a C-section if they have a daughter soon to be married.

• And do you know the most expensive market in the U.S. for Medicaid reimbursement? McAllen, Texas. Must have phenomenal overhead in this sleepy little border town. Oh, and all the docs show similar test/procedure patterns.

I could go on forever. But that’s why you have to be a customer whenever you walk through any clinic or hospital door. Healthy consumer skepticism will keep you much healthier than playing the expected “patient” role. Besides, I love the look on receptionist faces when I say “I’m a customer of Dr. ______________.”


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