Reflection #6

How to get the highest quality medical care

Don’t let this happen to you! If you can afford it financially, take charge of your own medical care. NEVER assume your medical condition is "normal."

Former Infoseek COO, Les Wright, felt his back "go out" while digging a ditch. The doctors ordered some drugs to relax his muscles, but delayed an MRI until he had symptoms of losing feeling in one of his legs, since an MRI isn’t normally warranted based on the symptoms. As a result of this delay to find out what was really going on, he now can walk only on one leg.

The word "normally" is key here. Doctors aren’t going to order "unnecessary" medical procedures unless there is evidence that the procedure is warranted. There are a couple of reasons for this: 1) your insurance company won't pay 2) it reduces strain on the facilities (e.g., even after Les exhibited loss of feeling, it still took a day before he could be booked on the MRI because of the demand).

But it’s even worse than that! When the surgeon read the MRI, he wanted to operate immediately (but again, the soonest they could schedule a surgery was the next day). When the doctor called the insurance company for approval to operate, the insurance company said they would not cover the surgery until he had gone through a seven-day evaluation to see if he got better. The surgeon operated anyway and told Les to argue with the insurance company later.

Moral of the story: If you aren’t destitute, don’t screw around trying to save money on medical care. Get several opinions, always assume you are the 1% case where the external symptoms don’t show the full nature of an injury, explain to the doctors that you’d rather be safe than sorry, and that cost is no object. If your situation warrants an immediate MRI to be safe, don’t wait. Call around. Offer to pay overtime to the MRI operator. An ounce of prevention is worth a pound of cure here.

In this case, if Les had the MRI right after experiencing a tingling sensation in his thigh, it might have been caught early enough that no significant nerve damage would have occurred.

Les is in his mid 40s and very smart, and he got good medical advice. But it wasn’t good enough. Don’t let this happen to you.

Here’s what a doctor at Stanford had to say about Les’s case: "Les wasn't followed closely (which is really only possible if the patients are admitted to the hospital). He never had a careful muscle power exam until he was almost paralyzed; by then it was too late. Interestingly, when surgeons have back pain and a herniated disk, in my experience, they always get an MRI and have themselves operated on immediately, even when there is only back pain and/or numbness and no weakness."

Bottom line is that if you can afford it, take charge. Get the best treatment and the best doctors. There is effectively a two-tier medical system in this country. Many people cannot afford to get premium care. But if you can afford it, it’s up to you to get it for yourself. Don’t expect it to be handed to you.