The Worst Patients
Well, I went to the doctor today for the first time since I started medical school. It was weird seeing things from the other side- the rooms in Ghent Family Practice are almost exactly the same as the ones we use with Standardized Patients. And I discovered another thing-- I really don't much like doctors, when I'm the patient.
Those of you who saw me over the holidays know that I've Done Something to my left knee. It gets stiff and painful if I sit cross-legged for any length of time. It started after a particularly rigorous yoga practice a couple of months ago, and it's been getting worse. Advil helps, but doesn't make it go away. When I drove up to DC, it got stiff and sore just from being bent while I was sitting in the car. So I figured it was time to see somebody. Well, I got a couple of lessons
Lesson 1: never go to the doctor for pain if you're not goign to be in pain when you're in the office. The doctor kept asking "so does it hurt right now?" and I said, "no, I haven't done anything that would make it hurt." He had me sit on the table and he moved it around a little. "Does that hurt?" -- "No, none of that makes it hurt." So it goes down as "vague, intermittent non-reproduceable pain" (that's doctor-speak for "the patient is making this up").
Bullshit. Just because you can't reproduce it in the freaking office doesn't mean it isn't reproduceable or predictable. I'm sitting at the computer with the cat on my lap, and when I get up to go to the kitchen in a minute I'll be limping. By the time I get back to the computer, I'll be fine again. It's perfectly predictable. And it's perfectly precise- it feels like a stiff, pulled muscle. A pulled muscle that hasn't gone away in 9 weeks. Just because it doesn't fit the list of symptoms of anything you know doesn't mean the symptoms aren't well-defined.
He said it sounded like a Baker's Cyst- despite the fact that he couldn't find any significant swelling. There is swelling, he just didn't find it because he measured with the leg bent (Did I mention that the problems all happen when I try to straighten the leg out? I certainly mentioned it to him. Silly doctor.) I checked the straight leg when I got home, and the left knee has about an inch greater circumferance than the right. Anyway, the doctor recommended me for an ultrasound of my knee, so I called the hospital to set it up. Which is when I got my second lesson.
Lesson 2: Don't ask how much it costs. They don't know. I asked the doctor how much the US would cost. "Don't you have insurance?" he said. "It shouldn't cost you anything then." Yes, but how much does it cost? He didn't know.
So, I called my insurance company to double-check coverage. They said that they would pay 80% of whatever it cost, and I would be responsible for 20% of the total, which was still discounted from the hospital's usual cost. What was the hospital's usual cost? They didn't know. I called the hospital and scheduled it. I asked the nice lady on the other end of the phone how much it would cost. "Don't you have insurance? They should pay for it," she told me. Well, they'd pay for most of it, but I still wanted to know what the procedure cost. She didn't know- only the billing department knew that. I thanked her, scheduled the sonogram for noon tomorrow, and got off the phone.
That's right folks, there's no way to find out how much a medical procedure will cost before you have it. The only people who know are the billing department, who have no reason to speak to you until after it's done. The people who order the test don't know. The people who actually will pay for the test, at the insurance company, don't know. The people who arrange and perform the test don't know. And the people who have the test done don't know.
I'm not a big fan of the free-market solution to the health care crisis. I don't think it will work. But, come on! Is there any other business in the world where they tell you "Oh, don't worry about how much it costs- we'll just send the bill to someone else after it's done!" Shouldn't there be some rule that the costs of the procedure or service have to be disclosed before the consumer *receives* the service? I mean, I don't like to spend someone else's money without knowing how much I'm spending. This is totally optional- it's probably worth the $50-$100 I expect it to cost, but it wouldn't be worth, say, $1000. And if the insurance company turns into little bitches and refuses to pay, I'm still responsible for the total amount. Shouldn't there be some clause that says if they refuse to tell me how much it costs, I get to refuse to pay?
Anyway, it was a very bizarre experience. And the fun news, if it is a "Baker's Cyst", most of the treatments involve surgery, which is not something I feel inclined to go through unless it keeps getting worse. The ultrasound won't show anything other than a cyst; I'd need a much-more-expensive MRI to show any damage to the ligaments. So I will go through all this for pretty much no reason.
Dont'cha just love modern medicine?
Those of you who saw me over the holidays know that I've Done Something to my left knee. It gets stiff and painful if I sit cross-legged for any length of time. It started after a particularly rigorous yoga practice a couple of months ago, and it's been getting worse. Advil helps, but doesn't make it go away. When I drove up to DC, it got stiff and sore just from being bent while I was sitting in the car. So I figured it was time to see somebody. Well, I got a couple of lessons
Lesson 1: never go to the doctor for pain if you're not goign to be in pain when you're in the office. The doctor kept asking "so does it hurt right now?" and I said, "no, I haven't done anything that would make it hurt." He had me sit on the table and he moved it around a little. "Does that hurt?" -- "No, none of that makes it hurt." So it goes down as "vague, intermittent non-reproduceable pain" (that's doctor-speak for "the patient is making this up").
Bullshit. Just because you can't reproduce it in the freaking office doesn't mean it isn't reproduceable or predictable. I'm sitting at the computer with the cat on my lap, and when I get up to go to the kitchen in a minute I'll be limping. By the time I get back to the computer, I'll be fine again. It's perfectly predictable. And it's perfectly precise- it feels like a stiff, pulled muscle. A pulled muscle that hasn't gone away in 9 weeks. Just because it doesn't fit the list of symptoms of anything you know doesn't mean the symptoms aren't well-defined.
He said it sounded like a Baker's Cyst- despite the fact that he couldn't find any significant swelling. There is swelling, he just didn't find it because he measured with the leg bent (Did I mention that the problems all happen when I try to straighten the leg out? I certainly mentioned it to him. Silly doctor.) I checked the straight leg when I got home, and the left knee has about an inch greater circumferance than the right. Anyway, the doctor recommended me for an ultrasound of my knee, so I called the hospital to set it up. Which is when I got my second lesson.
Lesson 2: Don't ask how much it costs. They don't know. I asked the doctor how much the US would cost. "Don't you have insurance?" he said. "It shouldn't cost you anything then." Yes, but how much does it cost? He didn't know.
So, I called my insurance company to double-check coverage. They said that they would pay 80% of whatever it cost, and I would be responsible for 20% of the total, which was still discounted from the hospital's usual cost. What was the hospital's usual cost? They didn't know. I called the hospital and scheduled it. I asked the nice lady on the other end of the phone how much it would cost. "Don't you have insurance? They should pay for it," she told me. Well, they'd pay for most of it, but I still wanted to know what the procedure cost. She didn't know- only the billing department knew that. I thanked her, scheduled the sonogram for noon tomorrow, and got off the phone.
That's right folks, there's no way to find out how much a medical procedure will cost before you have it. The only people who know are the billing department, who have no reason to speak to you until after it's done. The people who order the test don't know. The people who actually will pay for the test, at the insurance company, don't know. The people who arrange and perform the test don't know. And the people who have the test done don't know.
I'm not a big fan of the free-market solution to the health care crisis. I don't think it will work. But, come on! Is there any other business in the world where they tell you "Oh, don't worry about how much it costs- we'll just send the bill to someone else after it's done!" Shouldn't there be some rule that the costs of the procedure or service have to be disclosed before the consumer *receives* the service? I mean, I don't like to spend someone else's money without knowing how much I'm spending. This is totally optional- it's probably worth the $50-$100 I expect it to cost, but it wouldn't be worth, say, $1000. And if the insurance company turns into little bitches and refuses to pay, I'm still responsible for the total amount. Shouldn't there be some clause that says if they refuse to tell me how much it costs, I get to refuse to pay?
Anyway, it was a very bizarre experience. And the fun news, if it is a "Baker's Cyst", most of the treatments involve surgery, which is not something I feel inclined to go through unless it keeps getting worse. The ultrasound won't show anything other than a cyst; I'd need a much-more-expensive MRI to show any damage to the ligaments. So I will go through all this for pretty much no reason.
Dont'cha just love modern medicine?