msg:

zachklein’s problem with healthcare:

Two months ago, overnight, I began to experience sharp pain along one particular rib line. I went to a general practitioner who briefly examined me, who heard me explain that I suspected I had broken a rib a year before in a snowboarding accident and this was probably a derivative injury (he had examined me back then, right after the accident, and cleared me of any injury). All I wanted was some meds to help me sleep.

He dismissed the correlation and feared there was something worse given that no recent trauma had occurred. In the following three weeks, I visited him 3 more times to be prescribed 6 blood tests for pathological diseases (cancer) although it is ‘extremely rare’ for my profile he stated. Thankfully, a batch of cookies from my mom and a week later, these tests came back negative. Subsequently, I was prescribed a chest x-ray, which showed nothing, and then an entire day at NYU hospital for a full-body bone scan, which finally revealed that I had indeed a broken rib #7. Still, it wouldn’t explain the pain as I felt it as it wasn’t a dislocated fracture.

Finally, at a loss for an explanation, the GP sends me to a pulmonary specialist. This grandfatherly man sat me down in his office to interview me for 30 minutes — the longest any physician had talked to that point, about my lifestyle, athletic interests, and previous injuries — and then takes me into an examination room to one of those old-fashioned ‘shirt off’ tests where he pounded one hand with the hammer of his other fist into several parts of my back in chest. He grunted and told me to put my shirt back on, and meet him back in the office.

I sat down and he declared without doubt, “You have Costochondritis.”

My mouth open, he reassured me, “It’s harmless. Take motrin and stop throwing your body all around. Take it easy, man.”

I went home and read from bed for hours symptoms and testimony from people who share this pain involving “the inflammation of the cartilage that attaches the ribs to the breastbone.” It seems like a fit.

So, look, I don’t know that this old man is right — there could be still be an undectected ailment affecting me — however, I generally agree with Occam’s Razor, the principle that given competing explanations, the simplest is better.

What I do know is that this scavenger hunt for an answer cost me about $500 and 20 hours of missed work, and my health insurer nearly $4,000.

But you know what the real punch line is? If you simply Google ‘pain sternum rib’, guess the first result?

Costochondritis

So, against this backdrop of a national meltdown over healthcare, I wonder how any solution could work on top of our culture of hypochondria and the bureaucratic and almost lawyerly process of diagnosis and treatment.

Zach…sorry to hear about all that. My expert advice is that it was probably an old bowling league injury due to an overbearing coach. We still kicked ass man, despite the adversity.

There is a lovely movement called “e-patients” who are spearheading this notion that Google and the individual knowledge gained from this endless supply of health-related information on the internet is an extremely powerful partner in conjunction with doctors who believe that patients aren’t dumb and Google can actually be a good thing. And like you discovered, having health insurance sure doesn’t guarantee you access to doctors who know and appreciate you. And, again, like you discovered, specialists have all the time in the world to spend with you because they aren’t primary care doctor “gatekeepers” who have been forced by the insurance industry and Medicare to see 40 patients a day to make a third of a specialist salary. Less than 5% of graduating residents are going into primary care every year. This is only going to get markedly worse. Britain and Canada have a system composed of 75% GPs. Ours is a quickly dwindling 25%. Essentially, GPs will be no longer in just a few years.

But take your example of a mild pain and turn it into a person with Grade 4, Stage 4 kidney cancer with a 5 month prognosis. Dave had a kidney tumor erupt from his tongue. It was that bad. And he is currently one of my favorite people I’ve ever met in this journey. I’m glad he’s alive. And I’m glad he’s working his ass off to get the medical world and the consumer world to pay attention to the power of this thing we call the internet. And these patients have been gathered together so they can share information gleaned from their readings and they can work together with doctors who are willing to work as partners with their patients and with Google.

It will be a whole new world for you in the very near future. We’re working our asses off to serve as a magnet for doctors who want to work with you using the internet for information and communication.

The shame is this…look at those websites I linked to above. Now look at this one and this one. Shouldn’t the ridiculously smart, creative people who can create stunningly beautifully designed websites work together with the medical world to make this very rare and annoying situation almost pleasant and that much easier to understand and find a doctor who can help you once Google has told you what’s wrong? I know healthcare is so unsexy and boring, but, as we all know, it’s actually something people occasionally need and honestly appreciate.