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.

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 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!