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What good is a specialist if you can’t see one? — 51 Comments

1. I’ve encountered delays almost that bad. And when you do get to see someone, what is the actual quality of that care? I’ve thought that a very good AI initial screening and diagnosis system could actually be a huge improvement.

   I really dislike the way in which statistics seem to be used in the process that I’ve experienced. OK, you’ve tested or treated me for things that fall within the 90% probability realm, but what if I’m in the 10% realm?

2. Anger seems to be more and more the end result of contact with the medical establishment. I completely understand yours under the circumstances; it is justified. But I wonder if we were not living in a kind of medical wonderworld for the past four or five decades. Prior to the discovery of antibiotics, people died of all kinds of now readily treated infections. Death from “old age” arrived earlier, thus ending many lives while still enjoying good health, whereas now we are living longer, with the resulting development of many more of the diseases that accompany age. Witness Biden, who probably would have died decades ago from his aneurysms but for surgical intervention that merely a few years prior was simply not available. My wife and I are both in our id-seventies and while I am in relatively good shape-fortunate me!- outside of spinal arthritis that affects my lower estremities and some cardiac rhythm issues, my wife has been more adversely impacted as the years have gone by, including development of a meningioma requiring an entire day’s surgery–which ended as well as we could have hoped. She would not have survived her tumor more than perhaps a few years, with increasing impairment as it grew, but the skill of her surgeon and the development of the surgical arts saved her from that fate. So, despite the justifiable complaints over the state of the medical establishment in general, we have been satisfied with the actual care provided. I only hope your friend finds sooner and better treatment. My prayers will include that request–among many other things.

3. Our system of so-called “private” third-party health care, which has never been “private”, delivers the worst of both worlds–the unaffordability that popular perception associates with a private system, and the lack of access that popular perception associates with a public system.

   See the “constant 2023 dollars” line of the “Total National Health Expenditures” graph. You will see an exponential curve starting at $2,151 per capita in 1970, reaching $14,570 per capita in 2023: about 4.5% annual growth over and above inflation.

   You will look in vain for any sign of Obamacare’s effect on that curve, for good or bad. Obamacare didn’t get us here. The way we have decided as a society to have health care paid for–A pays B on behalf of C to pay D to render a service to C, and then D sticks C with another part of the bill that was negotiated with B, and G (state and Federal governments) constantly changing the rules and dictating artificially low prices to D that get made up for by A, B, and C, while all the while sending money to D by other means–got us here.

   I expect that most of us here at one time or another have believed that despite the high price tag, American health care is the best in the world. It’s simply not true. The high price tag is there, but the outcomes are not better, the price keeps getting higher, and for some things we’re approaching Canadian wait times and lack of access.

4. For all of the problems with the system…..and they are going to get worse….how is this fixed? This doesn’t even look fixable. Suggestions are welcome if you want to take a swing.

5. @Steve:I wonder if we were not living in a kind of medical wonderworld for the past four or five decades.

   The entire First World is living in that wonderland too, but most of the rest of it is not having the poor outcomes and high prices we’re having.

   Take Israel for example. The average salaries of MDs in Israel is 20-30K NIS monthly, about $5500 – $8500 USD per month, which is $65K – $100K annually. US MDs average $350K annually. The difference in cost of living is something like 20%. Israel has decent health care (not in Switzerland’s league though) and does not have single payer either.

6. @Richard F Cook:For all of the problems with the system…..and they are going to get worse….how is this fixed?

   It’s not that they can’t be fixed, it’s that they won’t be. It’s that there are too many vested interests in the way things are now; any possible meaningful change is vetoed by some powerful stakeholder. I am pessimistic I guess, being an insider to health insurance, and I think the system will have to collapse in order to reform. Health care expenditures are currently 18% of US GDP. It can’t really get much higher.

7. Steve (retired/recovering lawyer):

   You make good points about anger at the medical establishment in general, but that’s not what’s operating to spark my anger in this instance. I don’t expect a cure or a fix, but I do expect an appointment to talk about possible treatment that I’m aware exists and that could help the situation. The situation is very very bad and needs intervention soon or it stands a chance of getting even worse without treatment, and in the meantime there’s already much suffering and disruption and terrible quality of life. To pretend that an appointment nine months from now has any relevance is absurd and they might as well not offer one. This is from a neurologist to his own patient, someone he’s been treating for Parkinson’s for many years. A sudden worsening, with very alarming symptoms, in one’s own patient should cause a doctor to see that patient more quickly on some sort of emergency basis, or at least have a phone conversation with that patient. For a doctor not to even give a callback to an established patient having a huge crisis in symptoms that are new, and to offer that patient only an appointment nine months from now, is a charade of medical care.

8. We’ve been seeing a concierge doctor for almost ten years now, which is the only way we’ve been able to get decent care and rapid referrals to specialists. While it’s not cheap, it’s not prohibitive.

9. Mean salary and fee income for physicians and surgeons was about $270,000 per year in 2023, or about 4x the mean for all occupations. (This does not include fringes). In 1997, it stood at $100,000, or 3.5x the mean.
   ==
   There were about 770,000 working physicians and surgeons in the U.S. in 2023. The number in 1997 was 464,000. The number per capita was 170 per 100,000 in 1997 and 225 per 100,000 in 2024.
   ==
   In 1997, the gross output of the medical sector accounted for 4.9% of total gross output; in 2024, it accounted for 6.4%. Value-added in that sector accounted for 5.5% of total value added in 1997, 6.9% in 2024.
   ==
   The ratio of cancer deaths to new diagnoses was 0.47 in 1998. It was 0.30 in 2024.

10. It is very easy to miss the big picture.
    Cancer is 5x more frequent after the age of 65. Most have Medicare. Private insurance reimbursement is based on what Medicare “allows” (That is Medicare’s word), so if Medicare does not approve of procedure X, the privates usually do not either, so the doc does it and patient is charged for it, often not able to pay, so writeoff. Radiation equipment is very expensive (megabucks), and thus so is radiation treatment. In my practice, new technology was paid for by the docs, and was used though Medicare might not “approve” of it for two years. So treatment was given, gratis, because it is immoral to withold a better method for lack of reimbursement.
    Look at the cost of the new immunochemo drugs-enormous. Try $10K per dose.

    Medicine is not inexpensive. You and I are worth it. Advances in care are not developed in Europe to near the extent here. Europe leads the way in assisted suicide.

    The “medical establishment” is so easily condemned, with our government pushing that. Every Medicare EOB (explanation of benefits) has the statement: “call this number if you suspect fraud or abuse”.

    And try on malpractice insurance premiums, approaching a six-figure premium yearly for specialists in high risk specialties. Our trial attorneys with their lawsuits drive the costly performance of unneeded tests to “rule out” unlikely, rare, very rare diseases.

11. I would have posted about 10 min ago, but my Cat demanded a belly rub. We got here in Sept after the sudden loss of another cat. Bela is older (as was the other cat), maybe 11 or so. We got her at the shelter.
    Anyway, here is my comment. Many here know that my Wife has Cancer. Last yr was a long yr of treatment, with a 5 wk stay in Denver at a Residents Hotel. Last day of Dec, she was declared Cancer Free. That lasted until end of Feb, when she found a new tumor. Her treatment is using old school cancer drugs, because the present cancer does not have “markers” that would allow a targeted approach. We don’t know how she is doing, but have a PET Scan in 2 weeks. There might be a chance of her getting a pill, for long term maintenance. However, it is not approved for this kind of Cancer. Our Doc is seeing if there might be a trial she could be included in, but so far it is No. Last yr the Billed to the Insurance was $6.5 Million. We paid about 7k (insurance cap was 4.5K, but I guess some things weren’t covered). No idea about present costs. We get an itemized billing from insurance every month. Feb was 16 pages. Who can understand insurance billings.
    With all this, we believe we are getting the absolute best care. Docs are great, they all communicate among themselves to discuss treatments and prognosis. All the Nurses we have interacted with have been amazing. Getting appointments has been fairly easy to do, just sometimes a scan appointment may be several weeks out (last yr some machines were out and it did take several months). The specialist care last year (end of Nov to end of Dec) was arranged quickly. We have no complaints about any of the medical care or staffs.

12. @Cicero: Private insurance reimbursement is based on what Medicare “allows” (That is Medicare’s word), so if Medicare does not approve of procedure X, the privates usually do not either

    1) “Allow” doesn’t refer to whether the procedure is permitted, it refers to what the provider may be compensated for the procedure. “Allowed amount” = “Insurance paid amount” + “member paid amount”.

    2) Private insurance can and does cover things not “approved” by Medicare. It would have to as Medicare is rated around an entirely different population from private insurance, most obviously children and women of child-bearing age.

    Advances in care are not developed in Europe to near the extent here. Europe leads the way in assisted suicide.

    Assisted suicides, though ideally should never happen, are a tiny fraction of deaths in Europe and do not account for the huge differences in costs and outcomes between systems such as Switzerland’s or Israel’s and that of the US.

    European costs are generally lower and outcomes are generally better for most people, and they do not generally do it through single payer, but through a combination of public and private insurance.

    It cannot be papered over anymore with handwaving. We are doing it wrong.

    Health care expenditures in real dollars in the US are doubling every 15 years but we’re not getting twice as healthy every fifteen years. Even if health care in Europe is not as good as the United States, they are getting far more value for the expenditure. The numbers are going to collapse the system. There’s not much more to go from 18% of GDP, something is going to catastrophically fail.

13. What percentage of the money spent on health care in this country goes for insurance overhead? By that I mean the profits, salaries and other costs of the insurance companies, the budgets of the government agencies involved, the costs to providers of processing insurance claims, and whatever else I haven’t thought of.

    Somebody please do my homework for me; I’m too ignorant to know how to look it up, not good enough at math, and don’t believe in AI. Thanks in advance!

14. @bof:What percentage of the money spent on health care in this country goes for insurance overhead? By that I mean the profits, salaries and other costs of the insurance companies, the budgets of the government agencies involved, the costs to providers of processing insurance claims, and whatever else I haven’t thought of.

    The answers to most of these questions are sourced from here though not everything is easy to find.

    Hospital services, physician services, and prescription drugs are the vast majority of health care spending, about 60% of the total. Government administration and net cost of insurance is about 7% of national health expenditure.

    Insurance companies have what’s called MLR, “medical loss ratio”, the percentage of premiums spent on medical services. MLRs range from 80% – 95%, depending on just what kind of insurance it is. Every state has rules about what MLRs can be and what insurance companies must do if MLR is too low. For the “Obamacare” plans, if the MLR is too low the insurance company has to give members a refund. For Medicare Advantage, if MLR is too low for too many years in a row, an insurance company gets the “death penalty” and loses their Medicare contract.

    The 5% – 20% that’s left over, that is all the insurance overhead: the people doing medical necessity review and prior authorization, processing claims, negotiating contracts, salaries and bonus and profits.

    But that’s only part of the story. Hospitals are paid about two to three times as much, for the same services, by private insurance as for Medicare. So someone with private insurance is mostly paying far more for the services themselves, before you ever get into what the insurance company’s overhead is.

15. Value added in the insurance business accounts for 2.6% of value added in the sum of all industries. IIRC, it’s been between 2% and 3% throughout the post-war period. The share of value-added accounted for by the gross operating surplus is in the insurance industry (42.5%) about the mean of the sum of all industries.

16. I’m going to offer a hypothesis that Neo’s friend is enrolled in a neurology practice where they do not have a sensible triage system in place for allocating the doctor’s clinic time. Alternatively, they may have a system, but they’ve hired people who do not understand how it is supposed to work.
    ==
    I remember hearing a close relation complain he’d been put on a waiting list eleven months long. It was for an ophthalmology appointment. The year was 1974 and the city was Honolulu.

17. outcomes are generally better for most people,
    ==
    https://marketplace.secondlife.com/p/Citation-Needed/1589506

18. AD @ 1232am may have hit the real issue. It seems there is no longer any physician that is not part of a group. That sea change, at least to me, is a consequence of Obamacare. I know, correlation is not causation, but show me I’m wrong. If the neurology practice is not set up so that a true need case is handled quickly, then one is left with trying to get through layers of scheduling administrators who have strict guidelines in allocating appointments. Case in point: my PCP was located in a leased facility with just her and her staff while a new larger office was being built. She was still part of Baptist Health, but just physically separate. I could call, and get an appointment either that day, or within one to two days. Her staff knew her patients and reacted accordingly. Last fall they moved to the new facility which also now houses 4 other PCPs, and along with that came a new office manager who decided all patient calls would go to the Baptist Health central call center rather than to the actual office and its staff. Suddenly, no one could get an appointment sooner than 3-4 weeks. Fortunately, my doc, and her colleagues, took control of the situation and the new office manager was read the riot act, and things returned to normal with calls being routed directly to the facility and the appropriate staff for the MD. If a large practice, like I assume the neurology practice is, and, the MDs don’t take interest in the triage aspect of a patient calling, then you get what Neo is experiencing.

19. My wife’s recent experience with cancer treatment is similar to the experience described by Shirehome. We are on Medicare with a large discount in the cost of chemotherapy drugs, which include shots and pills. My wife went over the Part D $2,000 maximum for this year in April. The cancer doctors and nurses have been terrific and very compassionate. We are part of a large university health care system in Southern California. On a side note, I read this blog every day and learn so much from the posts and the comments. This post and comments were very informative.

20. We are now in the “suddenly” part of the destruction of the practice of medicine by government.
    The “gradually” part started in the 1960s with the passage of Medicare and Medicaid. There were warnings about trying to maintain a system that had infinite demand and limited supply, but these were not heeded- too much “feel good” when taking care of granny. Costs were projected to be minimal as most people died within a few years of getting access to Medicare, and there was a stigma attached to being on welfare/Medicaid.
    When Medicare was passed, there was a required 25 year budget projection. The 1965 estimate was 9% of the actual cost in 1990- it was off by a factor of 11.
    The reason that the “gradual” part of the destruction took a half century to progress to the “sudden” phase is that a generation of doctors had to be replaced. Old-timers were trained to put the patient first, to do everything possible for the patient, putting patient before self, before family, even before money. Today, residents are taught that limiting their work hours is paramount, less their residency program lose its accreditation (that is literally true). When they finish their training, they do not go into private practice, they become employees of huge corporations that monitor their productivity and their compliance with guidelines and standards. These corporations grow and thrive because they are staffed by MBAs who understand how to make money within the bounds of the 80,000 pages of government regulations related to health care. A new doctor who wants to practice independently under this burden does not stand a chance.
    The docs trained under the old system are now phased out- retired, dead, or burned out if they still are physically present in their offices.

    There is a solution, but politically difficult/impossible. Allow doctors to practice outside government control The concierge movement is a small step in this direction, but still they are subject to many requirements and regulations, and it’s an uphill battle for them. Let a doc set up a practice, charge patients directly, be free of HIPAA, EMTALA, ADA, Stark, and the myriad other pettifogging policies that afflict our society. It would be analogous to homeschooling, and just a welcome by the established order.

21. There is a solution,
    ==
    That’s not a solution.

22. Just prior to my dad’s passing, he spent 5 days in the hospital prior to being discharged. He was given a few tests – no surgery, nothing major – and the cost was $15,000 PER DAY.
    He had insurance , so it picked up whatever Medicare did not.

    Somehow, insurance companies, hospitals and the medical profession in general are allowed to collude and fix prices. This sort of price fixing would normally result in some folks being sent off to jail.
    The entire system in this country is a total disaster.

    As an aside; I recently had a root canal and the dental surgeon gave me a prescription for amoxicillin. This stuff is inexpensive and it cost me under $3.00.
    At the pharmacy they requested to see my drug insurance card.
    A week or so later I get in the mail from my drug insurance company a description of coverage for this insignificant purchase.
    I kid you not, it was 5 PAGES of insurance-speak jibberish.
    What a F’n joke.

    It is the consumer of medical and pharma services that is paying for the REVENUE LESS PAYOUTS of the insurance companies. This amount is greater than the PROFITS the insurance companies earn.

    There has got to be a better way to provide medical services. There needs to be some sort of DOGE analysis of medical costs.

23. @West TX Intermediate Crude: there was a stigma attached to being on welfare/Medicaid.

    78 million people are on now some kind of Medicaid. More than 20% of the population.

24. @Art Deco:citation needed

    Kaiser Family Foundation is one place to start. But there are a number of organizations that do this and they all have their different systems of weights and metrics. Depending on the weights and metrics chosen, you get a different set of countries in the top 5; some put Taiwan at the top, some put Switzerland, etc.

    Nobody has figured out how to jigger metrics and weights to put the US in the top 5, but the US is not at the bottom of every metric either.

    Some metrics are really demographics in disguise: life expectancy at birth, maternal mortality. Some are not: cancer mortality rates, sepsis after hospitalization, same-day or next-day appointments when needing care, physicians per capita.

    The bottom line is that the US spends 2-3 times as much per capita as the other First World nations, but we’re not doing 2-3 times better on everything. We do a little better on some things, a little worse on others.

    There’s really no question that we are not getting value for all that money, that our system is doing something really wrong, and it’s getting wronger. There’s not any one element of that system that you can point to and fix, and it didn’t get this bad in a day, it took fifty years.

25. Approximately 7,000–10,000 additional residency slots annually for specialists will be needed over the next decade to close the specialist gap. There is no plan to meet this need. The situation will just get worse and worse.

26. So-called “managed care” began moving in around 1979. It strong-armed the medical world around 1986. Professional liability insurance went crazy around 1995 or so. ObamaCare — with many “zero premium” policies — made it impossible for independent medical offices to survive. Since 2019, between 24 & 25 US hospitals have gone bankrupt each year. Flooding the county with zillions of folks who had no tradition of paying anything for their medical care has been “the last straw”.

27. Previous comments have hit on some of the likely causes but I skimmed over some comments so I may have missed the rapid population rise of the US due to immigration. ( Not the only reason, as other comments have mentioned, but I suspect it is part of it.)

28. I see RCP typed his comment just before mine.

29. With our concierge practice, most of our medical care is online, often by text, and most often from an excellent nurse practitioner rather than the MD whose name is on the door. We weren’t sure what to think of the NP at first but were quickly converted. A very bright and well-informed woman, she answers texts quickly and reads, interprets, and communicates any test results from bloodwork or imaging about as fast as they get posted to the internet, which is quite fast these days. We make the hour drive to be seen in person only on the rare occasions when it makes sense, but in that case, we can be seen the same day or the next day if it’s urgent. If it’s something like a boil, all she needs is a screenshot; bloodwork can be handled locally in our little town without our driving to her office. It’s clear that part of what enables this practice to see us timely is the severe limitation of the patient pool, made possible by the annual retainer, but the other factor is this extremely efficient electronic communication and avoidance of pointless office visits. Never again do I want to deal with a doctor’s office that can’t answer the most basic questions unless you make an appointment weeks out, waste time waiting, and then struggle to get the doc’s concentrated attention for 2 minutes.

30. PS, we can get attention after hours and on weekends, a privilege we don’t abuse if it’s not urgent. The doc has been known to return my calls when he’s out of town on vacation. It’s like going back in time 60 years.

31. PPS, in watching British detective mysteries on TV lately, I’ve noticed that characters who need a root canal or treatment for a heart attack receive care I can barely recognize, whether the episode is set in the 1960s or the 1990s. The dentists don’t use painkillers when drilling. Heart attack patients appear to be given bed rest while they die. No one’s complaining; they seem to think it’s normal. I’m not sure whether that’s changed in the 21st century.

32. Keep in mind that it is in the federal government’s interest to keep the situation like this, or worse. It’s their form of rationing health care.
    Every interaction between a physician and patient produces costs to the government (or insurer). Not just the fee for the office visit, but tests, imaging, and referrals to other physicians may result. If the next physician is a surgeon of some type, costs can get serious quickly. A small percentage of interactions will result in complications, which can cost tens or hundreds of thousands of dollars.

    Many problems that people would seek medical attention for turn out to be self limiting or transient. If the evaluation is delayed, some will resolve and cost government nothing. The government likes this. Delay also might allow a correctible illness to become one that it is futile to treat, resulting in a quick and relatively inexpensive demise. Either way, the government wins.

    If you don’t think this is an accurate representation of bureaucratic thinking, you are not cynical enough.

33. Assuming your friend’s PCP is on the ball, that might be the optimal route for now. Hopefully the PCP subscribes to a service like UpToDate.* An ARNP friend printed out information on a certain condition I had once, and it was quite comprehensive.

    * https://store.uptodate.com/?&redirect=true

34. Watt:

    About 2 hours ago, “X” was able to obtain an appointment on Thursday with a doctor in the PCP’s group, although not the PCP. That’s at least a start, but treating Parkinson’s hallucinations is a very very tricky proposition and X needs to see a neurologist. It is unconscionable that “X’s” regular neurologist’s office only offered an appointment next year. Hopefully, the doctor tomorrow may be able to improve that situation as well.

35. There may be a positive aspect to this ridiculous delay. It gives your friend a chance to explore alternate therapies like integrative medicine. This approach combines the best of traditional medicine with complementary therapies. It was pioneered by Dr. Andrew Weil at the University of Arizona medical school.

    Weil has written many books, but I particularly like his book Spontaneous Healing. There he explains his basic philosophy, which is to use traditional medicine where it does a good job, such as diagnosing diseases, treating trauma, and infectious diseases with antibiotics, but to use other approaches where it does not.

    I think in any urban area you are going to find clinics with integrative medicine departments. It might be worth it to look around for them and give them a try.

    Here’s a book integrated medicine therapies for neurological diseases.
    https://www.amazon.com/WEIL-INTEGRATIVE-MEDICINE-LIBRARY-21-book-series/dp/B08FZPZ6QW

    Dementia, Parkinson’s Disease, headache, and neuropathy are all conditions for which narrowly focused medical interventions all too often fall short. The first book in its field, Integrative Neurology synthesizes complementary modalities with state-of-the-art medical treatment to offer a new vision for neurological care. The authors begin by looking inward at the crisis of stress and burnout that confronts all of medicine, but neurology in particular. It goes on to provide a selective yet in-depth review of important topics in neurological practice from the perspective of integrative medicine. Taking an evidence based approach throughout, chapters cover chronic diseases such as Multiple Sclerosis, Dementia, and Parkinson’s Disease. The volume also address clinical issues such as headache, traumatic brain injury, navigating the endocannabinoid system and aging, nutrition and stroke, neuropathy, toxins and neurodevelopment, as well as the modalities of Ayurvedic Medicine and acupuncture.

36. I’ve heard of similar frustrating situations to neo’s from people who got a referral from their primary care doctor to see a dermatologist about a questionable mole on the skin. When the dermatologist’s office calls them to schedule an appointment, they are surprised to learn the next available appointment is 13 months in the future. What’s the point of booking this appointment and sitting on a potentially deadly melanoma for over a year? Better to do what the migrants do and show up to the ER.

37. Late to this, but I agree that this doesn’t seem to be a well-managed neurology practice. Infuriating.

38. WKL,

    What you have is much like what I have with MD Anderson. I can communicate via text messages on the patient portal and receive a return within a few hours. After hours calls are answered, and then ported to the PA/APRN who is on call for the particular specialty that the patient is in, who calls back within 15minutes. Appointments can be had almost immediately. On top of that, it’s obvious the hiring practices have a high bar for those applying. Everyone I’ve met there are at a different level than the standard medical staff.

    I’m so glad MDA is in Jax. I would recommend it even if one would have to travel to a location.

39. Love to have had the late Dr K (Michael Kennedy) here in the discussion. Was a, I believe, thoracic surgeon before being invalided from it by a bad back, probably resulting from hours pent on the hard operating room floor. Turned to policy, with an MPH. Great insights.

40. One of my brothers endured Parkinson’s related hallucinations last year. He went through hell until his doctor figured out a new mix of medication that brought his disease under control for a while. Treating Parkinson’s is a constant race to keep up with the progress of the disease. He is now on a brand-new treatment that involves an implant into which he injects his medication every day. Our mother had Parkinson’s, and it was a sad thing to watch her deteriorate over time as her disease progressed. I’m lucky that I inherited our father’s cardiac problems as they are easier to deal with

41. We also engaged a Concierge Doctor for my husband following his near-death from Covid in March of 2020. There is no question that he has been helped, including a surgery for a lipoma that became twice infected and thereby needed surgical removal. I cannot imagine what might have happened apart from the immediate care of his doctor who directed us to the surgeon. This was something he had seen a dermatologist for twice who was beyond useless. It is not an exaggeration to consider that it might have gone to sepsis, if we had not had access to prompt care by a competent doctor. We will be retiring and moving within the next 2 years. Not sure what our medical care will look like in the future.

42. “We’ve been seeing a concierge doctor for almost ten years now, which is the only way we’ve been able to get decent care and rapid referrals to specialists. While it’s not cheap, it’s not prohibitive.”

    They are not all the same. My concierge doctor is meh. My wife’s is phenomenal. He’s a GP, but with fabulous diagnostic talents. But more importantly, he can get his patients into see the best specialists almost immediately. He does it by trading favors. Wife had some urgent issues, and caller spine surgeon/good friend. He called back an hour later with an appointment with this concierge doc in Las Vegas, less than a week later. The spine surgeon had apparently done his magic on the back of a close family member of the concierge guy on a Sunday. The spine guy used his chit to get my wife in the door of the concierge guy.

    One of the urgent issues was a skin melanoma. It started at the inside corner of her brow. It was biopsies in MT, and that may have set it off growing. Within 2-3 weeks of the biopsy, it had spread all the way across her brow. The local skin cancer practice was talking a couple months out. The LV concierge doc got her in within a week, with best skin cancer doc in LV. She was the last patient of the day, and we were starting to worry. But she was last because he immediately cut it out (MOH surgery), got it all, and you can’t tell.

    The pattern has continued – top pulmonologist. GI specialist, breast cancer (not yet), and at least one more, all within the last 2 years, and got in to all of them in less than a week. My concierge doc sent me to the same GI practice, but ended up with one of their other docs, it was two months out, and her doc (youngest in the practice) was 6 months out. And my concierge doc costs significantly more than hers does.

43. Y’all are going to really love completely nationalized health care. Even with private insurance…

44. Greg:

    Sorry to hear of your family’s health struggles. If possible, could you let me know what meds helped your brother? You can either respond in a comment here or in an email. Thanks.

45. Medical malpractice is a real thing, and is, apparently, one of the, if not the, biggest medical killers in this country.

    These incidents have impacted my wife’s life:
    – killed her first husband. Burned 30%-40% of his body. Metered fluid intake, but not output. Kidneys shut down, and retained maybe an extra 50-60 lbs of water before he died. Doctor was out playing golf, and had convinced her not to have his employer fly him, by charter jet, to the top burn unit in Houston.
    – Extensive spine surgery. Comatose for most of 2 days. Orders to leave breathing tube in for 48 hours. Someone Pulled it out after 24 (no one took responsibility). Chart marked as allergic to iodine and sensitive to latex. Someone used one of them. Anaphylactic Shock. Was in IC, where the nurses had turned off breathing monitors due to all the old people with apnea. Stopped breathing, but was undetected until her heart stopped. That woke them up. 5 minutes w/o O2 caused damage to her central vision nerves…Took 10 years to regrow, giving her much of her sight back.
    – Came close to both brain surgery and a leg amputation (different occasions) while in prep for spine surgery. Only a zealous advocate saved her. With the brain surgery, it was detected only when they tried to shave her head.
    – After one surgery, while still in the hospital, the pain meds weren’t working. And there was a woman down the hall who had just had her leg amputated, and just kept screaming from the pain. Turns out that the nurses were stealing their pain meds, substituting Tylenol. Her spine surgeon raised hell, and several of them went to prison.
    – Went into Anaphylactic shock. Ambulance medic diagnosed it as a panic attack. Ignored my wife trying to explain. The ER listened to her, instead of my wife, who knew what was going on. They tried to get her to take an antipsychotic med. My frantic call to her pain management doc (also a psychiatrist), and his frantic call to the ER saved her. He actually knew what drug did, when it should be administered, and, importantly here, when it shouldn’t.
    – Had bad flu (temp~104°). Ended up in the ER. Put her in a shared room with a druggie with pneumonia, since they were both considered contagious. Never mind that she was seeing a pulmonologist for multiple problems, and pneumonia was considered life threatening for her. So, of course, she developed it right after recovering from the flu. Compounding it, the druggie roommate smoked meth in the room with her posse.
    – Another spine surgery. Surgeon left a dongle attached to her spine. Something to do, I think with spinal fluid pressure. Nurse instructed me how to use it. Did it wrong. Following her directions, I squeezed the air out then closed the valve. This put negative air pressure on her spinal fluids. That night, she got severe headaches and was being progressively paralyzed. In the ER, I was separated from her. Contacted the spine surgeon, and he frantically tried to call the ER doc. Nope. Wouldn’t take a call from the top spine surgeon in LV, who had operated on her the day before. Wouldn’t talk to me either. They tried everything. Nothing worked. Then, miraculously, she snapped out of it. And when she was wheeled out, I noticed the missing dongle. They had no idea what had happened to it, what it was for, etc. Spine guy and I figured out the next day that it had fallen off, sometime that night, the negative air pressure on her spinal fluids had disappeared, and presto. Back to normal.
    – I know that there is at least one more over the last decade, just can’t remember it.

46. Medical malpractice is a real thing
    ==
    Best I can tell from reading your account, you’ve had a half-dozen instances of negligence and worse by nurses, EMTs, and clerks.
    ==

47. Bruce Hayden:

    Really shocking stories. So glad your wife made it back from all of that.

48. I am hearing more and more about “medical tourism”, meaning seeing specialists overseas, with a round trip ticket and treatment being cheaper (and often better) than the US. Not for this case with an elderly patient with ongoing care and dialing in medication – but I am hearing it for things ranging from heart surgery to cancer. That I am hearing about it more and more – and not just for plastic surgery – makes me think this will be a growing trend.

49. I am at the age( and many commenters here)
    where someone I know is going to the other side every day.

50. I am at the age( and many commenters here)
    where someone I know is going to the other side every single day.

51. My Sister’s husband was afflicted with Parkinson’s and it is indeed a journey through hell. He had hallucinations, hand shaking, developed a crooked foot, and towards the end, bowel and urinary incontinence. The medication doses were the tricky bit to “control” the hallucinations and hand shaking. Too much of one medication could disrupt one symptom while providing temporary relief of another. I pray that your friend X gets to see the specialist as soon as possible, and God bless you for being there.

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