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Doctors are stuck in the same system as patients when they get sick

| Patient | June 25, 2010

I’ve had disgusting congestion in my nose/sinuses for the past month or so.

I’ve never had a sinus infection in my life despite having horrible allergies to dust. I take Claritin every day for my allergies. But this time, the issues just wouldn’t go away. I needed to go see a doctor. So last night around 8pm I made an appointment with Dr. Samuel Grubman via ZocDoc for 9am this morning. ZocDoc is like Open Table for doctors … I highly recommend it.

Interestingly enough, Dr. Grubman does not use any computers to power his practice, but absolutely loves ZocDoc. He is entirely paper-based because he’s found that nothing beats the speed and efficiency of paper to power his practice.

Samuel was my attending for my three year pediatric residency. He’s an allergist who sees both adults and kids. He also happens to be, in my opinion, the best doctor I’ve known. So I made an appointment for him to help me. As a doctor, it’s easy for me to know who I need to see. I’m fortunate in that way.

I suspected I developed some nasal polyps due to my chronic allergies that caused this sinus infection. After talking to me for about 45 minutes and going through my medical history, he examined me. Sure enough, he confirmed what I suspected, nasal polyps with a sinus infection.

And then I told him at this point in time, I don’t have health insurance. I’ve had to sacrifice health insurance in between Hello Health and starting my new firm, The Future Well in mid-February. Now that The Future Well is off the ground, I’ll finally be purchasing health insurance next month. Honestly, I couldn’t afford it. I pay $5,000 a month toward my medical school loans that currently total just over $200,000. I’d like to convert it into a 30 year loan but, due to the economy, school loans are not being refinanced. So, I’m stuck with a $5,000 a month bill and your typical monthly rent for a humble Brooklyn apartment.

Dr. Grubman prescribed me Augmentin (an antibiotic with a generic available), a 5 day course of Prednisone, and Flonase (a nasal steroid) to shrink/eliminate the polyps. I know that Target offers prednisone for $4. So I called Target to see how much they charge for generic Augmentin. Here’s what I found:

Target: $126
Duane Reade: $132
King’s Pharmacy (the mom & pop here in Williamsburg): $144.

Drugstore.com: About $50

I’m about ready to drop off the prescription at King’s and get them to price match Duane Reade and Target. Hopefully I’ll soon be feeling better.

Next month, I’ll be purchasing the $10,000 deductible plan through the Freelancers Union at $196 a month. That means I’ll be required to spend the first $10,000 out of my own pocket before insurance kicks in.

So today’s total bill will be:

Office Visit: $150
Augmentin: $140
Prednisone: $5

Most people don’t realize that many doctors are “freelancers” and, when they’re in need of medical care, they’re often placed in the same position as everyone else. We’ve got some inside information, but when we need beyond what our friends can provide for us as a professional courtesy, we’re stuck in the same system you are.

Jay Parkinson is a pediatrician and preventive medicine specialist and founder of The Future Well. He blogs at his self-titled site, Jay Parkinson + MD + MPH.

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  • Max

    Just checked out ZocDoc. Pretty nice actually. Not yet live where I’m at. It’s also interesting to see how many open appointments there are at various doctors’ offices. Seems like a lot of open appointments out there.

  • madoc

    I love Dr Grubman and and Dr Parkinson.

  • ninguem

    Watching the inside view of an aircraft carrier, Discovery Channel or Military Channel, I forget which. The people who control activity on the deck. They still use models of the aircraft and suppoer equipment, and move the little models around.

    I found it of interest, they said they tried computers to do this task, they found nothing worked better than this old-fashioned hands-on model. Is there a lesson for EHR’s?

    • twicker

      ninguem: That depends: if the task is something that involves large, potentially dangerous 3-D objects (e.g., fighter-bombers) moving around in a very limited space (e.g., the flight deck of an aircraft carrier), then you’d need either a 3-D model or a really great virtual setup (think of the virtual setup used in radiation oncology). With the aircraft carrier, almost every person in the C4I would need to have the virtual gear on, because they’re all manipulating objects in the same space and attempting to make decisions based on the positioning of all those objects in real time.

      EHRs don’t tend to have nearly the same task requirements, nor the same requirements of having the connections to all the other same-state objects floating around. That said, there may be something to be gained from looking at it in a different way.

      For this article, note that we’re talking about a very small practice, where the practitioner doesn’t need to coordinate (much) with people outside the practice. For a hospital, EHRs make much more sense since you have asynchronous and distal coordination issues (note that, for the C4I room, by having everything in the same space, with people having to see the real-time models to act, you remove both the problems of asynchronicity and of distance).

  • ninguem

    Jay, did you look into Health Savings Accounts? They are made for people like you……and me, in a solo independent practice.

    Because it sounds like you didn’t, if you have a plan with a ten grand deductible, that’s larger than what the IRS allows for HSA’s.

    I’m staying with my HSA until Obama kills it. So far, they’ve been held off, but they keep trying. The last thing the left wants to see is the health care dollar under the control of the individual.

    • twicker

      ninguem: I don’t believe the “left” have anything against HSAs per se; the concern is that insurance companies would funnel people who couldn’t afford the $5k or $10k or whatnot into these policies (because they’re cheaper), and then throw up their hands any time someone spends what may be, to them, an economically-crushing amount.

      Personally, I think HSAs are great, and that we should have a system whereby those HSAs can be funded much higher than they currently are. Further, I would add a provision so that insurance companies could offer (possibly in concert with the insured’s bank or other institution) a system where, for example, Jay could pay, say, $300/month, with the extra $104 automatically going into an HSA. Also allow people to put funds into their HSAs on their own schedule. Then allow people to expand their deductible, based on the amount that’s in the HSA (e.g., if Jay started w/$10k in the account, and added $106/month for 10 months, his new deductible would be set at $11k [what's now in the account] and his premium adjusted accordingly).

      The “left,” of which I’m definitely a member, doesn’t have any specific problem with the health care dollar being under the control of the individual; the “left” has a major problem with the system as it currently exists, which lacks a great deal of accountability for current spending, since insurance companies pass on rate increases with abandon whether or not doctors raise rates (gotta keep the profits rising, you know), and also pass on rate increases brought about by drug companies coming along with the latest me-too drug or $100k/year “wonder drug,” by the perversions in the current fee-for-service model, and by other systemic problems (e.g., ineffective and illegitimate malpractice suits). We have a lack of accountability throughout the system, and that’s not just a problem from the “left” (c.f. the completely unfunded implementation of Medicare Part D with the active prohibition on the payer – i.e., our government – negotiating prices with the drug companies).

      • ninguem

        The left has plenty against HSA’s. The last thing they want to see is the individual in charge of their own money.

        In the run-up to the Obama Health Plan, whatever that is. Nancy Pelosi said we had to pass it to find out what’s in it , so the speculation is legitimate. Whatever it is. there were several efforts to eliminate HSA’s, Jay Rockefeller as just one. Same with the Massachusetts plan.

        Nice to hear your ideas on “improving” HSA’s. How about leaving it the heck alone? Now there’s a suggestion. HSA’s are growing by leaps and bounds without your help, thank you. I offer them in my own practice, my employees love them. I was one of the first adopters, as soon as the HSA law took effect. It was under the Bush administration, I think everyone was so involved with Medicare Part D, the HSA law flew under the radar. No one tried to screw it up. Now they’re trying like crazy. And through business organizations, year in and year out, we have to watch out for the do-gooders who want to add the mandates and squeeze the deductibles, and add one rule after another.

        Thanks for your help, but please go fix something else.

        • http://www.talktoyourunconscious.wordpress.com BobBapaso

          It’s the insurance companies that are against HSAs. If everyone had one insurance would fade away. And you can have one even if the government doesn’t authorize it. That kind you can spend for other unexpected expenses too, and sometimes it is deductible when you spend it. If everyone had one pressure would grow to make them better. Talk it up.

  • Kim

    I have seen many a comment on this blog about skipping primary care and going straight to a specialist.

    You could have gone to a retail clinic for a lot less than seeing a specialist. Of course, if you care about the small business, you should buy your prednisone at the mom and pop pharmacy. Sometimes money is more important, isn’t it?

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