Saturday, February 18, 2012

The Other Side of the Exam Table

This week I found my self on the "other side" of the exam table as a patient confronted with a medical decision. Two weeks ago, one innocent misstep left me with a tender and slightly swollen left foot. Being the watchful waiting type, I iced, elevated, and medicated with ibuprofen. Since the foot still seemed tender and swollen after 10 days, I sought out medical advice (besides my own). An x-ray showed a stress fracture of the 2nd and 3rd metatarsals (bones on the top of my foot). I was referred out to an orthopedic surgeon for follow up. 

Now this is where I think the story gets interesting and how it relates to how health care and the decisions we make each day that impact these costs. Upon consultation with the orthopedist, it was suggested that I also have an MRI to further visualize the foot.  In the past, I would have immediately scheduled an MRI but now with a high-deductible health care insurance policy, I paused and began an initially uncomfortable discussion with my health care provider of the cost/benefit ratio of having an MRI at this time, postponing it or forgoing it completely.  I asked if the information gathered by an MRI would change the proposed treatment of the injury which had been visualized by x-ray.  When I learned that the answer was no -- that the initial treatment would be the same, I respectfully declined having an MRI at this time.  Knowing that an MRI would cost me in the neighborhood of $1000+, and this would come out of my pocket due to my deductible, certainly influenced initiating the conversation I had with my provider. Would I have made this same decision if I did not know the financial cost of an MRI or if I would not be directly impacted by the cost?  I honestly don't know, but it became apparent to me that we need to educate ourselves, providers and patients, as to the cost of health care choices with  transparency and discussion.  We have all been removed from the true costs of health care, advanced diagnostic tools and pharmaceuticals by our current health care model. What else do we "buy" with total disregard to cost? I can't think of any other product or service.  I am a staunch advocate for universal health care; excellent health care should be a right in any civilized society -- but I am also an advocate of transparency of costs so we can have thoughtful, informed discussions regarding appropriate health care choices in terms of risks, benefits and costs with our providers.  If we know the financial costs of certain procedures or diagnostic tools  as well as potential benefits will that change our behavior as health consumers or our recommendations as health care providers?  

I am mulling over these questions in my mind and would love to hear your thoughts. By the way, my decision was to forgo the MRI at this time, to wear an Aircast boot, use crutches for two weeks and then reassess with my orthopedist the need for further diagnostic workup.  This is what participatory medicine is all about.