I'm sure that there is a way to buy better healthcare. Surely Satya Nadella doesn't have to go through this. What I would love to do is pay a large amount of money ($50K out of pocket not counting insurance for just the diagnosis) and go through all of the doctors/tests in two weeks. Does anyone know where I can do that? The US would be best, but can travel internationally for this too.
Would appreciate any pointers people might have, I don't even know what to Google. If necessary, the issue is neck-spine related, relevant doctors might be neurologist, rheumatologist, spine surgeon, etc.
Not a doctor, but several family members have had to go through something similar. So here is my advice:
- Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherently obvious and doctors are sending you down obscure test panels, cut bait early - they're out fishing and you shouldn't expect anything worthwhile.
- For back pain, there is almost no medical solution other than surgery. If surgery is optional, don't take it. The recovery from a back surgery is brutal and long and can come with unintended consequences.
- Talk to a fitness instructor. Especially one with a formal education. This is the most underrated option - these are the true experts on kinesthesiology and recovery. You'll be surprised how much good advice they can give you in a single session - identifying which sets of muscles can be developed to take strain off your back, giving you targeted workouts to try, pain management techniques, etc.
- Patience. My father-in-law spent a year recovering from back problems. Despite trying every medical intervention under the sun, his recovery ended up taking exactly as long as his original doctor said it would. But the important thing was lifestyle interventions to prevent reaggravating the problem.
In my (limited) experience, physical therapists tend to have much broader recommendations. Like a PT might tell you to walk an hour a day, but a trainer might recommend a specific kind of crunch that targets the actual muscles in question.
And to OP's point, PTs are very much ingrained in the US medical system and consuming their services can be a pain in itself.
But the guys who get professional athletes back on the field every week are for the most part just personal trainers with a master's level education in sports science. THOSE are the guys you want to help your back recover.
Personally, I had a debilitating shoulder injury, couldn't put any weight on my right arm at all, and one of my yoga teachers put me on the path of fixing it up. Same with a low back injury, I couldn't even sit at one point and she helped fix me.
I'd 100% recommend someone with back pain visit a highly trained yoga or Pilates teacher. Some Pilates studios even take health insurance, since some are considered PT.
But yeah, they can be literally anyone. A good one understands simple (bio)machines and pays close attention to how a body moves AND is a good teacher.
Edit: "A PT will get you to functional, a fitness instructor will get you to capable"
All one has to do is ask. I've even had scheduling assistants ask me what power of machine the doctor wanted.
I strongly agree out of personal experience. FIs have fixed all and every sedentary-job-induced ailment I've had so far. I highly recommend watching the athlean-x YT channel. Adding to that: also ask older, fit people you meet in the gym. They are full of good advice how to avoid injuries and, once you have one, getting over it.
I have two friends who had almost identical spinal & neck issues: both got no relief until they had surgeries. Both say "Why prolong the suffering? Do the surgery!" One of them did have to wear a neck brace for months, but that was because his surgeon found the old neck vertebra was too delicate to keep, and so cut a chunk of bone out of his patient's hip, hand-carved it to the shape of a healthy vertebra and inserted it into his patient's neck. When the patient awoke he complained about the pain in his hip (his neck was fine).
Now that's the kind of surgeon I want!
Seems like you should expect to pay five digit amounts per year for the privilige though, in addition to fees per visit/service?
This is the kind of thing where I feel that if you are making FAANG tier salary in the US, you can bulldoze your way into getting better quality of life benefits privately, than someone living in say, Europe who would be making a fraction of your earnings but with better publically provided benefits.
In my experience, that's generally a primary care doctor that has on the order of 1/4th or fewer as many patients, but they all pay a membership fee in order to make that sustainable. That means they can spend significantly more time - like hours every week - with you.
That doctor is then well connected in the community, and can call up a friend at the local specialist/hospital/etc and cut the line for some treatments, as well get recommendations for the "best" folks in whatever speciality is needed. They'll be persistent on your behalf, and listen to you instead of dismissing.
It's unfortunate that this is necessary, but it can be had for a few hundred dollars a month, which is a pittance if you're a high earner.
The turnaround from me being told by a med school friend that I should "go get something checked out" to having an appointment with a dermatologist was ~1.5 days, and the total effort I spent was a few minutes filling out a form and responding to someone calling me.
In Spain I was very happy with Sanitas (http://sanitas.es/).
My wife just went through a serious spine/back problem. Our experience was that the turnaround between visits is so slow because the specialists are in such high demand. She is in recovery now but the time from first onset of symptoms to recovery was six months.
My suggestion is find a good doctor that specializes in managing pain to make the waiting more bearable. In my mind, a pain doctor was someone who hands out opioids and gets people addicted to drugs. Nothing could be farther from the truth. There are tons of effective treatments for pain that don't involve opioids. These range from cortisone shots to drugs that target specific nerves.
US is just not an option if you cannot deal with Insurance or don't have enough money. Unfortunately.
Some employers have their own health concierge in their benefits package that often goes mostly unused. I've heard positive feedback about the Stanford Health Navigation Service.
I gave it a try last fall, and the difference is night and day: my current Dr actually works for me, whereas the last one very obviously worked for my insurance company.
Rereading your post, this is exactly what you want. He had me do a whole bunch of tests right off the bat and set about optimizing different things. His job is to keep my body working well, and he takes it seriously. In-network docs are, in my experience, mainly about hitting arbitrary metrics imposed by insurance companies.
To anyone who has gone this route, other then needing to fall back on traditional care when its out of the scope of a DPC provider, somewhat limited options in terms of providers compared to the traditional system, and of course additional cost in addition to still wanting to have insurance when you might not need their services often, any downsides to be aware of? Just making sure its not 'too good to be true'.
My favorite feature though is it seems like if you find a qualified provider I might finally get a "Dr House" who actually listens to what I say and does something rather then just following the standard flow chart.
Looking at the website I've found two providers near me, so I'm definitely going to check it out.
I pay my dr like $80/mo and it’s a bargain. Having a dr whose interests are genuinely aligned with mine has been life-changing.
This is the part that stinks as then you'll be bundled in waiting for the specialist to contact you, run their tests, and normally in a larger hospital group. So you'll be treated as a number again.
I'd second the medical tourism, but I've never done it myself.
I'm a patient at the Mayo.
Also, just because they run all the tests and are great at what they do does not mean they will have all the answers for every patient. They have a fast-paced machine to crank you through which will help many people, but not all. Set your expectations accordingly, and be prepared for any result including more of, "The specialist you need is booked, come back in a few weeks."
I 100% agree to go there and get all you can from it. Just don't walk in expecting a quick easy miracle.
https://www.amazon.com/Back-Mechanic-Stuart-McGill-2015-09-3...
It gives you a lot of information so you can a) intelligently talk about your pain to your providers and b) build up strength and flexibility in your back to hopefully address the issue on your own.
I have been very impressed with private facilities and doctors. Out of pocket costs are very affordable including lab and imaging (ultrasound, CT, and MRI). No insurance needed as long as you have proof of payment. They may request this for intensive surgical operations etc.
Another benefit is results are immediately given to you, for example say you got a CT as hospital/provider A and want to see a specialist in B, no problem just bring the findings/imaging with you. No filing petitions to get your own medical records which you may or may not get in 2-3 weeks....if they honor it, then have to file HIPPA requests etc. All this wastes time, normally in weeks in the US.
A thing that completely surprises me is the doctors provide their cell phone number, so if you have issues after hours or weekends, or they receive lab results and want to provide a recommendation, after hours, just a message away. I wish we did this in the US.
One of the better things since you are self pay is to not deal with insurance. Want to try a different medicine, don't need approval for that. Want a second opinion, don't need to run it by insurance.Is this facility/doc in my network?, no worry there. You control the entire experience.
My recommendation is to look for cities that are expat hot spots as they have medical tourism facilities, normally all speak English including the local people to cater to expats. Yucatan, Quintana Roo (cancun) and I think Jalisco.
If you are interested in more info please email me, email in my profile. My SO has problem and we have played the bounce around game along with a few ER visits mixed in. Few things are more frustrating then experiencing the US medical system first hand with no results and being helpless. Best of luck!
I think a lot of the big medical universities offer something like this:
https://www.emoryhealthcare.org/centers-programs/executive-h...
They have the connections and services available to do it all in-house and thus can make diagnosis' quicker.
Two pieces of advice:
- Find a pain specialist who treats you like a real human and not just a science experiment or revenue source. there are some but not many
- My company produces implants for Spinal Cord Stimulation. The main indication is chronic pain that can't be treated with other means. My ex has one of our implants and it got her from seriously contemplating suicide to a good quality of life. A lot of doctors don't recommend the devices based on experiences a long time ago but the tech is way better now. The implant process is fully reversible unlike most surgeries. The main players in this area are Nevro, Boston scientific, Medtronic and Abbott (I work for one of them). Please look into it. I know several people who got their lives back with SCS.
Hope this makes sense.
Private care in the UK can be very fast - e.g. I went from an initial consultation with a doctor for "knee pain" to having two sessions with a consultant and an MRI complete and booked in for physiotherapy within 48 hours. Things are often done the same day or within 24-48 hour turnarounds, although sometimes you can only get seen by specific consultants on certain days (e.g. they only see people on wed + Fri etc) . I am not sure what the on-ramp for that is as I go through my work health insurance but presumably you can just pay out of pocket.
www.hcahealthcare.co.uk seems to be what everything my healthcare insurance (from a BigCo) goes through, so could be worth starting there if you fancy a visit to the UK.
Good luck.
And, will NHS really break down? I know it has been considered many times but enough of the population seems to be against the idea that I suspect it may not break down soon. Do you have any reason to believe it may break down?
In general, I've heard they are good at getting multiple tests done and multiple visits with specialists quickly.
2. In the meantime, or if concierge medicine isn't available, you can contact your insurance company and ask them to assign a care coordinator to help you get the maximum benefit from your providers. https://www.webmd.com/health-insurance/terms/care-coordinato...
Of course, getting into such a relationship with such people in the first place isn't exactly easy to begin with unless you are already a member of the club. But if you're a really good networking type, something to keep in mind.
Physiatry is a small specialty which most folks have not heard of. I'd encourage you to research the specialty and what it's about at the very least.
None of this is a perfect solution though. It can take time to find the issue. Going to places with a high reputation for the area of the issue can get faster results.
Just recently I had an xray, blood work, and an ultrasound for unexplained swelling in my chest and armpit. They still don't know what it is and don't care to investigate farther. The only theory I have to go on is that it may be a medium/long term reaction to the Covid vaccine. I didn't even think of that until the ultrasound tech ask which side I got my shots on. Apparently short term swelling like this is normal enough that women are told not to get mammograms for some time (weeks) after receiving it. Additional research found this, which sounds very similar but in a different location.
https://pubmed.ncbi.nlm.nih.gov/35049235/
At least it's not cancer. Although I'm hesitant to truly believe that until a cause is found.
In the USA you'd have no problem walking into most doctor's offices and offering cold cash. They'd fall over each other trying to get you as a patient.
Cash is still king.
This is not medical advice, but just what I would do in a similar situation.
I'd go in knowing I'm going to have to keep at this constantly until I'm on a treatment regimen that handled it well, for starters.
I can usually have mixed results speeding things up saying I'm ready to pay right now with a card for whatever medication/test. If someone's unavailable for scheduling then call around to every other place. Call out of the area if needed. Like you would call around for a dentist if you needed a root canal or crown asap.
Edit-Oh, also, the best time to call providers is 7-8 am on Monday or when ever they first open on their first day of the week. The worst time is anytime else, with within an hour of closing being a far maybe. But be persistent regardless, and especially if start of business Monday is too far away.
For back pain I'll try to outline some options for relief in the meantime:
-Try this shortly (20 minutes) and see whether it feels better/worse: Get something that does "far infrared" heat and try it on your neck/spine. You want to be careful to not overdo it on the heat though so use a towel between you and the heat and look for redness. Redness should be avoided. A low-cost/immediate way to try out far infrared are the instant hot packs sold at corner stores like Walgreens/CVS. Try to get the ones that are made with iron. They're basically a slow exothermic reaction that can last 8 hours+.
-Cold might work if hot doesn't.
-Lidocaine patches ("salonpass"/"icyhot") might help, too. Again, try temporarily (10-20 minutes) and see how you react to it. There are even sprays or gels (think, for sunburn) that can help locally fend off pain a little.
-A TENS unit has helped with muscle spasm pain for me before, too, but I had to leave it on the area for about an hour. Edit-look at some anatomy pictures for what muscles to target.
-A physical therapist might actually be able to help you. Look for good ones that are obviously kept up to date on things. I had one mixing ultra sound and TENS on my back and it helped immensely. The TENS made it so I could feel the ultrasound vibrations. You want to go to them to make sure you're doing stretches with proper form. X-Rays and such will help them know what to target.
Good luck, chronic pain in America is both common and not always treated equally.
Dunno if the private health care would be any better (wait time aside), but if anything I'm surprised you can't just throw money at the problem while in the US. Did something similar to what you described twice recently and for each condition it took less than 2-3 weeks between GP, specialist and results.
I don’t have any advice except to pester the scheduling staff at every turn (which is easier said than done when most places try to divert you with an automated phone tree ending in the option to leave a voicemail). It’s aggravating for sure. I have no doubt that people are dying who wouldn’t have if they had received more timely care.
