Medical Tourism (NOT!)
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A few weeks ago, the Baker family did something we’d never done before. We took a two-week vacation, and we went to France. While there are many fun places to visit in the U.S., my wife and I decided a couple of years ago that before our oldest went off to college, we thought the kids should see something, somewhere, in Europe. France is small enough to travel around, they have a great train system, it’s a relatively easy place to get to, etc.
So imagine my dismay when, on our second day there, I stepped off of a bluff on the beach and into water I thought was three inches deep — but turned out to be four feet deep — and jammed my right foot into my right leg. It hurt — a lot — but I figured it would work itself out over the next couple of days. Hah! After walking around and site-seeing for the next three days, and popping a few Advil along the way, the pain was getting worse, not better, my ankle was tightening up, and my foot was starting to swell.
Did I go to a doctor? Nope. I bought a cane and a lightweight, removable ankle brace, and I iced my foot and ankle twice a day. The brace helped a lot — and so did the icing — but the swelling and stiffness — five or six days later — had not gone away. At this point, my foot was reacting badly to any pressure on it, so I rented crutches at a local pharmacy for the rest of our stay (at this point, we were in Paris) and figured I’d turn them in when we came back home. A few days later — as our departure date approached — I decided I didn’t want to give them up, and I bought them — used — from the pharmacy, for about $30.
When we got back home, I went to see my physician, who X-Rayed my foot, and said my ankle and foot were not broken. A quick visit with an ortho specialist the same day was insightful (cartilage injuries — which this surely was — take a few days to manifest, bone bruises — which this surely was — hurt like mad — worse than breaks sometimes). We then had a big debate about whether or not I should have an MRI. He was worried that I might have torn a tendon in my foot, which wouldn’t appear on an X-Ray, and if torn, would need to be surgically repaired. I argued no, for a bunch of reasons, and he argued yes. Eventually, I caved. He also put me in an air cast boot, and kept me on my crutches.
The MRI confirmed the bone bruises and a lot of other bad stuff, but no torn tendons. The boot is still on, and the crutches will stay for a while — like maybe another month or so.
So why didn’t I go see a physician in France? Three reasons — all of which, with the benefit of hindsight, were not very well thought out. First, I was hoping the pain would go away and the swelling would subside in a few days. Dumb. Instead, it got worse over time. Second, my French is not very good, and I was worried about having a confusing conversation — where I would not really understand what was being said to me, and the docs would not understand what I was saying to them. In retrospect, this was silly. I would have muddled through, and they would have, too. At a minimum, I would have ended up in a boot two weeks earlier — a good thing. Third, I was concerned about being told to stay off my feet when the name of the game on vacation is to get up and at ‘em. Again, I could have chosen to move around — with better diagnostics and better solutions — even if the recommendation was to sit down and stay down.
The other, unspoken issue, I suppose, was simple familiarity. I know the people, the language, and the system here. I know where to go and what to expect, and I can follow the conversation. I couldn’t help but wonder how many people in this country don’t seek care they might need because they aren’t familiar with the language or the care delivery system — no matter what their insurance status might be. My guess would be that it’s not a small number.
Noooooooo!!!!! I thought for sure we were going to get firsthand insight into healthcare in France! I’m so disappointed, but I do hope you are feeling better and that you have a speedy recovery.
I would also suggest Charlie, that while it’s true that people who don’t speak English probably share the fears that you did, I think there are many people who DO speak English who feel that they don’t communicate well with their doctors. I know a few weeks back you wrote about how people have more of a say in their healthcare today, but I truly wonder how many are able to find their voice when it comes to speaking with their doctors. I think there are still many people out there who think Doctor knows best.
And for what it’s worth, I have known people who have shown up at their doctor’s office prepared to discuss their condition and/or treatment options with their doctor only to leave the office and get a letter the next week saying they were “released” from their doctor’s care, and to please find someone else to treat them. It wasn’t in Boston, but it was still in the United States.
I think communication is a HUGE hurdle in healthcare that must be overcome, whether you speak the same language or not!
Charlie,
The care you received in the U.S. unfortunately highlights our appetite and tendencies for over consumption.
As a musculoskeletal specialist (given the details you provided) I would seriously question why you received so much care for what is obviously a sprain (with or without the bone bruising).
Were your referred to an “Ortho specialist” because an evidence-based treatment approach or perhaps because of your professional/social station?
I would maintain that an ankle injury that is 1) less than three weeks old, 2) has no fracture demonstrated on x-ray, 3) which was not treated appropriately acutely, 4) which allowed you to bear weight (at least partially), does not require an escalation to specialty care and definitely doesn’t likely need an MRI. A detailed exam can generally rule out a tendon tear of significance.
Please understand I don’t mean this to be a personal issue. I just feel strongly that our consumption and utilization patterns are at the heart of our health care crisis. We will never ‘turn the ship’ if these issues are not addressed and corrected. Just think of the cost of treating even half of all ankle sprains in this manner.
I hope you watch reruns of the “That’70s show” on TV occasionally (or maybe ask one of your kids), since the what immediately came to mind is what the father calls the son about every 5 minutes…”D—-ss.” But I think you already figured that out.
AnneMarie - totally agree. Struggle with the right answer to the issue you raise, but share your view. We can all talk past each other in the same language just as easily as we can in different ones.
cabmd - Where were you when I was trying to win the argument about the MRI? I made virtually the same argument you make here - but in the end, felt compelled to listen to the docs (they needed more than one to close the deal). And the ortho visit wasn’t as over the top as it sounds. You see - I’m a patient at Harvard Vanguard Medical Associates (have been for about thirty years). They’re a big, multi-specialty group practice that’s part of a larger physicians’ practice called “Atrius Health.” Anyway, sending me to ortho basically meant sending me down the hall from Internal Medicine to Orthopedics. The MRI was downstairs, and the X-Ray was in between Internal Medicine and Ortho. And if I’d needed to fill a prescription, I could’ve done that in the same building, too. Not bad - almost everything in one place.
And if you’ve read any of my previous postings, you know I share your view that we over-use the system. Next time I need a consult, I’ll post first! Keep reading.
Thanks Charlie you fought valiantly but obviously you encountered an “expert service problem.” This link will explain: http://www.nytimes.com/2007/11/07/business/07leonhardt.html?scp=22&sq=When%20Expert&st=cse