Robert Stein 1924-2014

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If anyone has comments, questions or condolences, please feel free to send a private message to the family at robertstein@optonline.net.

Thursday, December 26, 2013

A Tale of Two Shoulders

During this season of aches and pains, the Obamacare battle resumes in full fury with little direct relevance to millions who are hurting and want relief.

Lost in the political clamor is any sense of how American health care really works in a cockpit of special interests and free-lance greed that permeates a “system” of patient choice but no protection.

As a metaphor and cautionary tale, I offer two ancient shoulders. My story may bore you but it has a point.

In excruciating pain a decade ago, I called several orthopedists recommended by my primary physician and was told I could have an introductory appointment in two or more weeks.

In desperation, I searched on my own and found “a physiatrist,” an orthopedic doctor who specializes in relief rather than surgery. He examined my shoulder and gave me a cortisone injection that stopped the pain.

After several years and injections, he recommended rotator cuff surgery. Reluctantly I agreed and went through a six-hour arthroscopic operation in which I could hear the surgeon and his associate debating their moves and the anesthetist stepping away to call his stock broker.

That night I had to go back to the emergency room for a morphine drip to finally stop the unbearable pain. A year later, after many Medicare dollars and even more of my own for physical therapy, my shoulder still hurt and I was not able to raise the arm above my head.

Flash forward a few more years. When my other shoulder acted up, I went to a new physiatrist who had helped me with back pain. She suggested acupuncture, which Medicare doesn’t cover, and I agreed. To this day, that shoulder has more motion and hurts much less than the other.

What does my story suggest? Not a condemnation of rotator cuff surgery but as my second physiatrist says, “To someone with a hammer, every problem looks like a nail.”

There are 27,700 orthopedic surgeons in the US and 8,000 physiatrists. What are the chances of avoiding inadvisable surgery on the basis of this disproportion?

Beyond that, add all the other “specialists”—-podiatrists who clip toenails and bill for surgery, dermatologists who do more cosmetology than skin care, and so on down the line—-and national health care costs become clearer.

A Boomer generation reared to believe that every problem has a solution and a price is not going to change its attitudes late in life. Before them, people of mine did not expect so much, and those who survive still don’t.

1 comment:

Ron Chusid said...

You are probably right that Orthopedic surgeons are often far too quick to do surgery. However I bet that the Podiatrists who clip nails are not doing anything wrong billing it as surgery. That is probably a consequence of how billing codes are classified. I periodically get phone calls asking about bills for surgery from patients who had no actual surgery. The code for drawing blood is classified as surgery, and I bet this is the case with cutting nails. (Of course if the people who call and question the surgery for veinpuncture were to think about it, they might realize that a $3 payment for "surgery" really isn't for an actual surgery.)