Of the path to an operation that turned out to be unnecessary
Since it is my thought that one way to collect data about health care is for patients to report it, in December 2008 I began keeping this journal of my own medical odyssey. I didn’t think to start it until the odyssey already was underway. That requires me to play catch up with summations of the first ten months that got me to where the current event by event log starts.
Winter 2008
Pain in right shoulder causes me to ask others about shoulder problems they have had. From time to time during the coming months, getting functional again requires having wife dig her elbow into the back of my shoulder blade to loosen it up.
July 2008
Finally went to orthopedic surgeon. He x-rayed it and told me it wasn’t bone and so was soft tissue and so all I needed was physical therapy and wrote a prescription for it.
October 2008
I finally started physical therapy. The therapist remarked that things that should make me feel better hurt me and the things that should hurt me make me feel better. I’m not supposed to do anything that hurts it since the point is to get it to stop hurting.
December 2008
When the therapist asked how I’m doing I remarked again that it is quite discouraging to keep doing physical therapy everyday for this long with no improvement. The therapist did some tests on me and decided to send me back to the orthopedic surgeon for an evaluation.
December 15, 2008
I almost was late for the appointment with the orthopedic surgeon. I rushed across the parking lot and the lobby and got there just in time. The women behind the counter were smiling and half laughing as they told me they watched me rushing but there really wasn’t a hurry. One of them copied my insurance card and I sat down in the waiting room. This orthopedic surgeon had good magazines. I found a recent edition of The Economist and became absorbed enough in it that I lost track of time, but I think I waited about 20 minutes before being taken to an examination room where I waited another ten or so.
Orthopedic surgeon asks if I’m there about my knee. I remind him that it is the shoulder. He looks through records and asks questions. I say that the physical therapist had said he was going to call the doctor with his thoughts about what the problem might be. Doc looks through records some more and says that the therapist did call and they are on the same page and explains something about soft tissue in that part of the shoulder. This is one of those times that I should have a recorder running because the terminology flies by too quickly. He tells me that the operation to fix it is a twenty minute thing with only a couple of puncture wounds and there is nothing to it. He wants Magnetic Resonance Imaging with contrast to get a look at the problem. As we leave the examination room I thank him for having such good magazines in his lobby. He says he hopes they are current. I say that at least they aren’t Hightlights.
Monique (named changed) in his office schedules it while I stand at the counter. First she dials the number of a hospital geographically closest to me and I ask if I could not go somewhere else. She hangs up the phone and suggests Christ Hospital. I say that will be fine. Another woman behind the counter asks if I had a problem at the first hospital. I nod yes. She asks what happened. I told her they wouldn’t even let me file a complaint. I ended up with the person in charge of complaints there and when I told what happened the woman said “He wouldn’t do that” and refused to let me file the complaint. I commented that it was no wonder they keep getting awards. They don’t collect any negative information. The woman behind the counter asked again about the problem and I said that if I was having a heart attack in their parking lot I would refuse to let anyone take me inside there. I would rather die. And I was completely serious.
Monique got Christ Hospital on the line and asked me about dates and times I was available. The procedure was scheduled for December 18, 2008 at 4:45 PM.
December 18, 2008
Other than Senior Guide there was only one magazine in the waiting room, a fashion magazine. I sat reading it until someone in registration called my name and I set it back on the end table. The woman behind the computer wanted to see identification and then asked me personal information that would help determine if I really was the person whose insurance card this was. When we finished she sent me to another waiting room where I was given a pager and a clipboard and asked to fill out answers to questions. When I finished and looked for a place to sit, there were no magazines other than Senior Guide. I walked back to the first waiting room but some older man had found the fashion magazine and was reading it. I usually carry reading material with me, usually a couple of New Yorker magazines. I wander further afield in the hospital but find nothing other than Senior Guide. When I returned to the first waiting room, that man still was holding the fashion magazine, but he wasn’t reading it. He was looking at his wife who was registering. Thinking he might be leaving, I loitered around waiting to see. Eventually he went and sat next to his wife, but he took the magazine with him. When she finished registering, they walked to the same waiting room I was supposed to be in, got a pager, filled out a form, with him standing next to her the whole time holding the magazine. When they finally sat down, they talked while he continued to hold the magazine.
I gave up and took the first contemporaneous notes for this journal, mostly just to kill time, not thinking that I was starting a journal yet, just thinking I was making rough notes that could be of use for local color for something else I am writing. I wrote:
Background hum of air-conditioning. Beeps of elevators arriving. Whir of automatic doors opening and closing. Whir of a computer printer starting up. Footsteps and a cough far down a hallway. Voices arriving through swinging doors. Mature male and female speaking quietly . . .
I was just beginning to write about the guy holding the magazine when my name was called. A nurse came to tell me that Monique had not scheduled the appointment correctly. She had scheduled only one appointment and I needed three. I needed an MRI first and then needed to go to X-ray for an arthrogram and then needed to come back to MRI for another scan. She didn’t know why Monique didn’t know to do that right and said that she should have.
I wondered why people at the hospital did not know to schedule it correctly. Why would they put the responsibility entirely on someone off site to know how things work in their hospital? Was Monique an employee of the hospital set off site at the doctors office in order to steer business to the hospital?
The nurse apologized to me for Monique’s having wasted a couple of hours of my time and wrote out a note for me to fax to Monique to tell her exactly what steps to take to schedule everything correctly next time. There was a brief moment when the nurse appeared to be aware of the fact that I might be wondering if it wouldn’t be better for her to fax this to Monique and be there to receive the call and get things setup correctly while I was present, but then she handed me the note and left.
The Note Handwritten on a large post-it:
Call schedulease @ 585-2668 Must schedule the arthrogram in x-ray department & you need to time slots fo the MRI department. You get an MRI 1st, then go to x-ray for arthrogram, then come back to MRI for another MRI scan.
At least they did not conduct incorrect tests on me as they had at another hospital when there was a similar mix-up when someone at the doctor’s office did not schedule things correctly. Why doesn’t anyone at the hospital feel responsible for checking these things?
December 19, 2008
I faxed the handwritten note to Monique, who apologized, and a new appointment was set up for January 6, 2009. Two days after that I am scheduled to see the surgeon again. I notice that I am not using his name. How much more helpful would it be to the patient community if I felt safe using it.
Getting through the Christmas holidays is not easy with this shoulder. And it interferes with my work. My brother-in-law notices we don’t have the Christmas decorations we usually have. I explain that I couldn’t put them up with this shoulder. He asks me about the problem and then comments about how long and hard the recovery can be from that operation. I wonder if we’re talking about the same operation because the surgeon didn’t say anything about that. But it sure wouldn’t be the first time a surgeon didn’t mention such repercussions.
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2010
The MRI at the hospital cost $5,000. The next time someone tried to send me to that hospital for an MRI (one that probably would have cost about $2500 this time) I shopped around and got it for a little over $300.
The surgeon wanted to schedule a surgery that would be diagnostic as well as therapeutic. He was going to look around inside my shoulder to see what he could find and maybe clean out some things that might be causing the problem. I found a different orthopedic surgeon who said the problem was frozen shoulder and surgery was the wrong thing to do. He stuck a needle in my arm and in ten minutes it was 50% better. He then sent me for physical therapy that took a completely different approach. It took 3 hours a day for 10 months, but healed it. The physical therapy firm to which he sent me arranged the schedule to extract all the money the insurance company will pay. Perhaps he sends patients there because of the free employee they provide to him to assist him in his practice.
I determined that there are other physical therapy firms that do not require as much time or money to heal the problem. In fact, I quickly saw that all the equipment necessary to do the therapy could be purchased for less than the costs of two visits to their office. So I purchased it and stopped going to them until I had gotten all I could out of the schedule they had set up for me. Then I went back for one more session to get a new schedule. I did that every couple of months to get their expertise, but then did the therapy on my own and saved thousands of dollars.
I also discovered that there are physical therapists who take a different approach and can heal the problem in less time. I also discovered a physician who has an entirely different approach – no drugs, no surgery, no physical therapy. He immobilizes the shoulder and claims a high success rate. It’s too bad no one in medicine cares as much about the well being of patients they do about how to earn money on them. If they did they might collect the data on these outcomes that would enable us to know which courses of action worked best and saved the most time and money for the patients who have tried them.
Patients should pool their data so they can find these things out for themselves. It is maddness for your well being blindly to be left in the hands of people whose interests are in conflict with yours.