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Monitor Board of Contributors: To the health system, I’m just a jumble of parts. Bring on Obamacare!

The Affordable Care Act proposes to make American medicine outcome-based, not volume-based. That means employers, health-care providers and insurance carriers will have an incentive to increase the positive health results for patients. Current incentives are based on the volume of patients that can move through the system in a specified period of time. This change, if nothing else, is a goal worth striving for.

I am currently moving through “the system” as a patient trying to resolve an issue of hip pain that has been plaguing me for five years. The initial diagnosis was hip bursitis.

Every six months, beginning in 2008, I received cortisone injections in my hips and the pain would ease up. Then, for whatever reason, the injections no longer worked. Last winter, the pain and the symptoms began increasing.

My primary care physician referred me to an orthopedic specialist for further testing and diagnosing. This is where the fun began.

It took four calls to set up an appointment with Dr. A. After the initial exam, an X-ray was ordered, and Dr. A exclaimed, “Ah, here’s the problem, an impingement (pinched nerve) on the left hip!”

Dr. A suggested an MRI on the left hip.

“But I have a problem with both hips,” I said.

“Okay, let’s do an MRI on both hips.”

The MRI confirmed that I have an impingement (on my left hip). From there I was scheduled for a consultation with Dr. B and then sent to Dr. C to have an intra-articular corticosteroid injection in my left hip.

Injection done. No relief. That didn’t surprise me. Since I have pain on both hips and an impingement on only my left hip, logic told me this was not an impingement issue.

Dr. B acknowledged that maybe it wasn’t the hip and sent me to Dr. D, the spine specialist. Dr. D ordered lower-back X-rays and MRI tests.

“I see the problem” said Dr. D. “You have a neuroforaminal narrowing in your spine.” He said he would schedule me for a lumbar epidural steroid injection with Dr. E – but not before a consultation.

During my exam, Dr. E was not convinced that the narrowing in my spine was the cause of my symptoms; it looked to him like bursitis.

“How about if we give you a cortisone injection in your left hip and see how it goes?” said Dr. E.

I really liked Dr. E, and I really wanted him to be right, even if we had come full circle with the bursitis diagnosis.

Day 1 after the injection I felt a little better and also on Days 2, 3 and 4. On Day 6 I was supposed to confirm or cancel the lumbar epidural steroid injection appointment that we had kept on the books in case the hip injection didn’t work.

Day 5 was not good. The pain was back – just as bad as ever. So now I had to decide whether to go ahead with the spine injection. At this point I was discouraged and confused.

Dr. E did not think that the small amount of narrowing in my lower back would cause the symptoms I was exhibiting, but that was the next level of testing; actually not just one spine injection, but a series of three. If that didn’t work, spine surgery was the next course of action.

Several points were niggling at me during this process.

First, two doctors said something to the effect of “So, you are having back pain?”

“No,” I said, “hip pain.”

So then the doctors said, “I’m so sorry, yes, yes, your left hip.”

“No, both hips.”

“But your left one is worse.”

“Well, yes, a little.”

“Okay, let’s see if we can get rid of that left hip pain for you.”

Hello . . . are you listening to me?

Second, one doctor strangely asked, “When you are hiking, does it ease the pain to sit on a rock?”

What? Who said I have been hiking?

Bewildered, I answered, “If I had been hiking, I suppose, yes, sitting on a rock would help.”

“Good, good,” said the doctor.

Third, the neuroforaminal narrowing in my spine means that one of the places where the nerves branch out from my back and go toward my lower extremities is tighter than it should be; basically the nerves are pinched at this spot. When I bend forward, this narrowing is opened up and the nerves are no longer pinched. The way I sleep, the nerves are not pinched, so why is my pain greater when sleeping? That doesn’t make sense to me.

So I have to make a decision: Should I get the spine injections? If I go ahead, this may or may not be the problem – and I have a really strong feeling that it is not. If I say no, and the pain escalates as time goes on, then most probably I would have to start the process all over again, including MRIs, as the doctors would want the freshest tests possible to base any further procedures on.

I am lucky that this pain is endurable, albeit some nights I don’t get enough sleep. At this point I can live with it. And I have insurance; otherwise none of it would even be an option.

But through it all, I have felt like a jumble of pieces, not a whole person. This doctor looks at this, that doctor looks at that. Oh, and did I mention that the spine MRI shows other unexpected issues that doctors A through E cannot interpret, as that is out of their scope of practice? I will have to call my PCP to get her opinion and possibly referrals to more doctors. Seriously?

So I am just a jumble of parts; no holistic approach at all. I don’t blame the doctors for this; I blame the system that is dictated by insurance companies and health care facilities with strict guidelines on how many patients must be seen per day and what doctors can do or say or diagnose or order for tests. It is all scripted. Perhaps it is scripted in a logical way (for those in the medical field), but as a patient, it does not feel comforting.

And lest someone say that I should have looked into alternative medicine. I did that prior to my PCP visit in the spring and had another whole set of unnerving (no pun intended) experiences.

Count me in on the Affordable Care Act. Even with this very limited experience, I can see that something is terribly wrong with the system.

Since we patients really only care about the outcome and the cost, then let’s go for this new approach, where greater value is placed on successful outcomes and where patients are looked at as a whole and not just the sum of their parts.

(Lynn West of Boscawen is a retired state administrator and a former elementary school librarian.)

Legacy Comments12

I am pretty sure like most Americans that turning over health care to this bureaucratic dysfunctional govt is a really bad bad idea. One look at the British model will tell you it is a mistake.

Really? When was the last time you lived in Britain? I've lived in two countries with single payer medical care. It was great.

the British National Institute of Health is the 3rd largest government employer IN THE WORLD up there with the Chineese Army and the Indian Railway. They are 1/5 the size of the USA. I am positive only democrats don't know where this is going to end up - a massively expensive BIG bureaucratic death panel disaster. PS I lived in England for a short while in the 70's working for Lloyds of London - and you?

Try physical therapy. It can be very effective for this type of problem.

Thank you for the suggestion. Unfortunately for me, pt did not work and it was actually my physical therapist that suggested that I go back to my PCP and request referral elsewhere.

Sorry to read about your travails. All I can offer is, "you're not alone." Medical services have become a commodity, with specialists who only look at a tiny piece of the puzzle. If auto mechanics worked this way, you would first have to take your car to the injector guy, if that didn't work you might take it to the transmission guy, if that didn't work, you might take it to the electrical system guy. Fortunately these relatively low tech folks have their world together far better than the high tech doctors. And while I'm at it, you hear complaints about too many people using the emergency room, try calling your physician with an immediate problem at 2PM in the afternoon, most likely you'll be referred to the ER. They don't want to upset their finely-tuned schedule with walk-ins.

That's a great analogy, Mr. K. The docs nowadays are scheduled every fifteen minutes. Unless they work in a practice that sets aside 90 minutes a day for urgent care they simply are not able to see you. And yes, you'll get referred to the ER. Where you'll wait in a plastic chair for hours in a room with parking-garage ambiance, surrounded by people writing in pain while a television blares in your face. There's a special place in the ninth circle for the person who thought it was a good idea to put tvs in public places.

Great analogy about auto mechanics. Wish I had thought of that when writing the article!

Physical Therapists are who many folks need to see in regards to hips, backs, arthritis, etc. I know from experience. They teach you what you are doing wrong in regards to getting out of a chair correctly, bending etc. They give you exercises to build up the muscles around the problem areas. Really works. Also consider the mattress you sleep on, the shoes you wear and your activity level. The old adage, Use It Or Lose it is true. I get more pain from sitting too long than I do from being active. If you work at a desk, take breaks, go for a walk. really helps.

Thank you for your interest and suggestions. Actually pt did not work for me and is what led me to this next step. I did get some good info from my physical therapist, however, including proper footwear. She was so helpful in that area that she had me go out and buy a better pair of sneakers with more support and asked me to bring them in for her to approve. Took me 3 pair before I had it right! The mattress is fairly new (5 yrs) and extra firm, but who knows about that. Exercise, yes, the more the better. Always room for improvement there.

Lynn, Not to add to your misery, but have you considered seeing a physiatrist? They are doctors of rehab medicine and are much more likely to take a holistic view of the patient. They tend to know about the whole toolbox of options where a surgeon is likely to recommend surgery, etc. Also, I believe they're finding out that steroid shots are not as effective as they once thought. You'd need to do some research on that. And yes, doctors simply do NOT listen. Even the best of them seem to be merely nicer about it. It's quite vexing.

Thank you for your interest and suggestions. I had never heard of a physiatrist before. I will definitely keep that option in mind when continuing to try to resolve this problem.

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