Deductive Reasoning for Prevention

As an allied health care professional- a physical therapist to be exact- it amazes me how passive so many people are when they go see a practitioner in any of the vast medical fields- from RN's to MD's to DC's to PT's. A system has been created, from as far back as ancient tribal shamans to the father of modern medicine, Galen, where a patient tells the practitioner what is wrong and expects the practitioner to heal them. In fact, this model is thoroughly utilized every time you go see your family physician- you have some symptoms and he/she prescribes an antidote, typically pharmaceutical, and you're told to call if you do not improve. It works most of the time, even with the expectation that there may not be a response to what has been prescribed, especially if the patient follows as he or she has been advised.

So here's my scenario- a patient walks in last week with a prescription for rehabilitation for spinal pain from an orthopedic specialist. He has private commercial insurance, and as a favor my company always researches his medical benefits prior to his appointment just so he will know what his costs will be for utilizing my services. While we do this he chooses to wait to see what they are before he schedules his initial evaluation.

We get through to his insurance company fairly quickly (and by this I mean in under 20 minutes) and find that he will have a $250 deductible that must be met before his insurance company will pick up 80% of the bill. He declines to schedule.

So this is a man who probably started out at his primary care physician for complaints of back pain. He was then most likely prescribed pain medications, either steroidal or non-steroidal anti-inflammatory medications, and possibly muscle relaxants to relieve his symptoms because 80% of spinal complaints resolve in less than 1-2 weeks (thus the use of medication- it gets you through those two weeks). But for this guy, we can only guess it did not work, because he was sent on to a specialist, maybe even after his primary care doctor ordered a series of imaging (X-ray, MRI) to better assess what he or she was treating.

So he now arrives at his second physician appointment, a specialist in the care of back pain we would imagine. This physician most certainly would order imaging of some sort if it had not been done before, might also again try some medications, and in this case determined that he should try rehabilitation in the form of physical therapy as well.

Let's recap: 2 physician appointments, great chance for the use of medications, probably some imaging of the spine involved, and our patient still has complaints of pain in his back. A specialist, who he chose to visit after being referred by his primary care physician, tells him to go to therapy.

BUT...when he finds out that he will have to pay for at least a few visits out of his own pocket- and I know that $250 can be a lot of money for some people, which is why we have a payment assistance program for those who need it- HE DECLINES TO BE SEEN!

I want to ask him, "Why did you take the time to go through the hassle above when you were not going to follow the physician's advice anyway?" Obviously what he has tried himself has not been working, else why would he have sought out care?

The sad thing is that in someone who has gone this far through the system, he likely will not return to the specialist until his case becomes so involved that he would require surgery. And this surgery will cost him the deductible plus a whole lot more, especially when you think about the time off work required and the fact that his deductible probably will go up in the coming years, for something he may have been able to prevent if he had not worried so much about that $250 right now.