Our friends Dana and Andrew followed up with Dr. Boneanmussle, to find out if anything could be done for Andrew’s neck and shoulder pain.
Dr. Boneanmussle strode confidently into the room. He was a stocky man who looked like he had spent a lot of time in the gym when he was younger. He cordially introduced himself to our couple and launched into his presentation.
“I looked at your bone scan,” he said. “Now keep in mind bone scans are virtually useless studies. I think Dr. Neurosurgeon ordered it to politely make you go away. I do see an area of some density on the scan, but it tells me nothing. You need to have a shoulder MRI.”
He went on.
“I’ll look at the MRI myself, because let me tell you something,” he continued. “Fifty percent of radiology reports are wrong. That is they miss things. Lots of doctors rely on the opinions of radiologists who do a half assed job and then end up sending their patients away telling them it is all in their heads. I’m not that kind of doctor.” [I ask you reader, to contrast this with Dr. Jape’s statement about trusting radiologists in a previous post].
Now I believe that when Dr. Boneanmussle said 50% of radiology reports are wrong, he wasn’t drawing from any legitimate statistic, but rather using a number that he thought reflected his experience as a shoulder specialist reviewing x-rays and MRIs. Whether this statistic applies more broadly isn’t really important here. Dr. Boneanmussle’s perception is important.
So Andrew went for an MRI.
Andrew and Dana returned, and Dr. Boneanmussle invited them to look at the MRI images with him. Boneanmussle was good, because despite the poor resolution on his Dell laptop, he identified problems with Andrew’s shoulder. He recognized some bone spurs, which he said may or may not play a role in the pain Andrew was experiencing. He also identified significant inflammation that may have resulted from past trauma Andrew had experienced in that area following both a car accident and athletic injuries. He offered Andrew treatment options: steroid injections into the site of inflammation, physical therapy, surgery to open the site and get a better look at what was going on, or to take no action and be referred to pain management for more drugs.
Andrew opted for the injections. Dr. Boneanmussle performed them right then and there. Andrew now reports about a 40% reduction in pain and a significant increase in mobility in the weeks following the injections.
This is all very interesting because Andrew had been complaining of neck pain for about a decade. He primary care doctor simply ordered neck MRIs that came back negative, and gave him pain meds. After about 8 years of pain meds, Andrew was done taking pills. He got two opinions from neurosurgeons. One visit is recounted in http://www.athinkingpatient.com/commentary/the-real-cost-of-healthcare/. His other visit to a neurosurgeon consisted of the doctor first telling him there was nothing visible in the MRI of his neck and then immediately inquiring about Andrew’s stress level. Because instead of considering the possibility of referred pain from a mechanical shoulder problem, the neurosurgeon went straight to at the possibility of psychological causation.
Dr. Boneanmussle ended up spending about 15 minutes reviewing the images with Andrew and Dana and counseling Andrew on his options. He spent about 8 minutes injecting the methylprednisolone into two sites in Andrew’s shoulder and inspecting the results. Andrew’s insurance was billed $135 for the 15 minute counsel, $213.00 for performing the injection, and $40.00 for the cost of the methylprednisolone from the pharmacy. This totaled $388.00. His insurance negotiated payment to $153.25.
From arrival to checkout, Andrew had spent about 30 minutes in the office. He had a 40 minute round trip drive to the office. So his net income loss for the visit was around $44.00. Andrew was given information and treatment options. He was given treatment at the time of his visit that proved to be effective over the following weeks. Andrew has no complaints about the cost of the solution to his shoulder problem. Even if Dr. Boneanmussle had not been able to treat the problem on the spot, Andrew would have been content with paying for the amount of insight he had been given into the problem.
This, my friends, is how doctoring should be done.