Friday, July 1, 2011

Take Charge of Your Medical Care

"Take Charge of Your Medical Care" is a post by guest writer Laird Malamed.

Recently, my wife underwent back surgery. After years of lower back pain and leg pain that impacted her quality of life, she chose this elective operation. Sitting through a movie or driving across town brought intolerable pain. Flying across the country to visit our son required purchasing three seats and schlepping a foam pad to construct a makeshift bed on board. Undertaking long distance travel, something she loves, left her recovering for days or weeks. Now a few weeks post-op, initial results on the surgery promise a successful outcome.

During the pre-6 AM check in, the admission and nurse staff asked my wife multiple times to describe the planned treatment, and they went so far as to use a permanent marker to mark which vertebrae was to be operated on. Why? Because back surgery comes with inherent risks, but can you imagine what would happen if the doctor replaced the wrong vertebral disc? Or he took out her gall bladder or a kidney by accident? These horrible mistakes happen from time-to-time (they often make local news broadcasts), and hospitals requesting that patients describe and confirm the planned operation, as well as a good permanent marker, help prevent these types of critical errors. And of course, at any time that morning, my wife could have backed out. Upon waking from the operation, she knew the right surgery had been performed given the complete absence of right leg pain after four long years.

Now, you might wonder how mistaken procedures happen if a patient must confirm their operation or test. However, I nearly had this happen to me with a lab test. While the test that was almost undertaken would not have reduced my total organs by one or demanded weeks of recovery versus none at all, I am a firm believer of only doing what is medically necessary.

This year, despite being a marathon runner with a fairly healthy diet, my total cholesterol rose to nearly 260. I will not get into the debate of how important that number is or isn't but the count did represent a significant change from prior tests. I wish to avoid statins (Vytorin for example) to control my blood chemistry if possible. Yet, my father had open heart surgery at 49 (I'm about to be 44), and my grandfathers both had bypasses in their 60's. My grandmother suffered late in life from angina. I might have the genes to run miles on end, but I certainly must carry some propensity for laying down plaque in my arteries. The question: What deposits have already formed?

My doctor recommended I receive a coronary CT scan to find out the answer. This simple procedure takes under 30 minutes and produces a very readable image of the major cardiac arteries supplying blood to our life pump. According to the doctor, insurance companies consider this a preventative test and, since I had no symptoms of blockage or narrow arteries (thank goodness), my plastic credit card would be swiped for about $500. I decided to schedule the test.

Multiple facilities offer the exam in Santa Monica near where I work. I picked one that had done the images for my wife's back surgery and which is in the building housing a number of the doctors we see. The lab is wired into St. John's Medical Center (our local hospital), and they have been easy to deal with for other procedures. I am not sure they are the cheapest in the area, but I opted for convenience and experience versus shopping around. The lab also specializes in heart testing.

When making the appointment, I was told to not eat starting 4 hours before the test. That seemed odd to me, but I let it pass. (Clue 1). Exercising before was deemed ok, so I did my normal CrossFit workout and arrived about 5 minutes ahead of time.

The receptionist handed me a clipboard of questionnaires. She told me to fill out pages 1 and 2, and then she seemed startled that I had two more sheets to answer too. (Clue 2.) I duly sat down to plop down my relevant medical history. Then, I was struck by the last pages that asked if I had ever had "contrast" injected. Contrast in this context refers to having radioactive fluid pumped into your blood which then can be imaged by the scans as it courses around your circulatory system. No one told me about this when I made the appointment, but I didn't know much about the test, so I guessed it required contrast. (Clue 3.)

If I had been dense up-to-now and already missing the three clues that something was amiss, the next one did not escape my attention.

When I returned my paperwork, the receptionist told me that insurance would not pay for the exam. This I knew, and I handed her my credit card. With a flick of her wrist, she swiped me for $1,500. What? (Clue 4.) $1,500? "I was told $500," I told her. She responded that the test was $1,500. Maybe over the phone, I heard five-hundred instead of fifteen-hundred? I accepted that was possible, but I still asked her to confirm the test was the correct one. She looked at the prescription form I had brought and said it was correct. At this point, the conflicting information really confused me. Having signed away $1,000 more than planned, I followed a nurse to the test area. I could not figure out why the mismatch of information had occurred, and I felt stupid for not price comparing after all. Seemingly, I was somehow ok with radioactive bits floating in my blood but not $1,000 bucks floating out of my wallet.

The technician conducting the test came out of the test chamber and asked me about my experience with contrast, etc. Then the key moment occurred. The woman asked me to tell her what test I was having. "A coronary artery scan," I said. She said "you mean a coronary artery flow analysis." (Clue 5!) At this point, the whole image (so to speak) came clear. My assumption while (over) paying was correct - they had gotten the test incorrect! I told the technician that my doctor had only ordered the scan; this was the first I heard about a flow analysis. (The need for contrast now made sense too.)

The technician looked at her chart and then the prescription. Indeed, the prescription was correct. Somewhere upfront in making the appointment, the wrong test had been keyed in. Why the receptionist who looked up the test still said it was right is beyond me. The technician confirmed that the exam as written did not need contrast or even the four hour abstinence of food (at least it had not been 12 hours of no eating!).

This next part still grates on me, and all I can advise is that you are the only one who really cares about your health and wallet.

The technician continued by saying that since I had fasted, didn't I want the more in depth test? I said "No, I have zero symptoms; I just ran three marathons or longer in 6 weeks. We're just trying to get a baseline." "Are you sure?" I assured her I knew what I wanted and what I did not want.

The technician scurried off to correct the paperwork, and after the short 10 minute CT scan, I received a $1000 refund, as the correct test was indeed $500 as promised.

In the end, the scan revealed only one small and not dangerous area of build up. Still, that spot is something to watch and is a good reason to drop my cholesterol count, at least a bit.

What would have happened if any of the five clues had not awakened me to the pending error? Well, nothing really all that bad, but all medical procedures have risks. Why ask for trouble unnecessarily?

My advice:

  1. Get a clear description from your doctor about any procedures or medications she prescribes
  2. If possible, bring along a family member of friend. Medical tests can be stressful; having someone with a level head can be invaluable.
  3. Never take a test or do an exam that does not seem right to you. Get in touch with your physician if something appears amiss. Do not feel pressured just because you may be sitting at a lab facility.
  4. Take your time and ask questions; no one cares more about your health than you. You have a right to be comfortable and have your questions answered at every step of the way.

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