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  • #31
    Originally posted by Lordosis View Post

    They must go quite deep in order for it to cost that much :O
    Thats what she said?

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    • #32
      Originally posted by Tim View Post

      I think my spouse has a torn meniscus. Her daughter an ortho sports med doc thinks so too. Of course, yours truly who knows absolutely nothing about medicine thinks she should get it fixed.

      The doc says, fix it now, fix it later or fix it never. Those are the 3 options. I don't know if it is actually operative, haven't seen a thing other than you two quibble.
      Knee surgeries are so cool now.
      How old is your spouse?

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      • #33
        Originally posted by Bdoc View Post
        So this is stemming from my recent visit to the dentist and my reading the many discussions here about dental xrays and possible un-needed procedures. i would first like to say this is not a dig against only dentists as I trust my fellow MDs just as much.

        First i will talk about my fellow MDs. Orthos have been the big culprit for myself and my friends. I know multiple experiences where myself and other people have gone to orthos with MRI results already done of either a shoulder or back for chronic pain and without even seeing the doctor, the office demands an xray. This is a complete money grab that even my non MD friends can identify and im honestly appalled. (one payed 300$ out of pocket for it bc he doesnt have insurance).

        Now, onto my recent experience at the dentist. I am not the most compliant dental patient but have never had a cavity or any surgery. They did xrays and found an asymptomatic cavity(great! Fix it before it becomes a problem) Now here is where i become skeptical. The hygenist recommends a "deep clean" that is conveniently not covered by my insurance and costs 1800$ out of pocket. My initial reaction was wow, my teeth are disgusting and i should definitely do it, but then i thought about it. Medicine/dentistry is now a business. $$ trumps everything and they might be possibly trying to gouge me. That realization really bothered me and which is why im posting here. I truly did not trust her recommendation. Does anyone else feel this way?


        Also, they are doing a laser clean next week. I have never heard of it but maybe thats the new standard and i dont go to the dentist enough to know.
        instead of perpetuating distrust in the healthcare professions just do what you know you should do and get a second opinion at a different office.

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        • #34
          as an orthopedic surgeon, I take issue with your insistence that the "orthos" were doing you wrong by taking x-rays.

          First of all, x-rays cost between 25-50 dollars. So much for a money grab.

          second, the x-rays that are taken at some outside facilities are of such terrible quality that I question how the technologists sleep at night and how the radiologists can interpret the images at all.

          Third, x-rays always come before more advanced imaging and there is a reason for that. They tell a different story. An x-ray for the spine for, say scoliosis, is taken standing up. MRIs are done laying done. The results are different and tell a different story. I had an MRI the other day that showed a severe "DISI" deformity on a wrist MRI. The x-ray was completely normal on the lateral. At surgery, the scapholunate ligament was entirely normal.

          At some point you have to trust the extra training that goes into medical specialties.

          Now the dentists, they're all crooks.

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          • #35
            Originally posted by Medstud21 View Post

            How old is your spouse?
            Fits the profile you described. Unfortunately, I know the tripping incident where she banged up her knee. It’s not new. It’s not a high priority.
            Context: Bodies age and age differently. It’s like driving an old beater car. Little things make a difference. Fix it radiator leak, fix the tire air leak, ignore the scratch and dent from the parking lot.
            Priorities. She got the results of a ENT mri yesterday. That little report warrants immediate attention. Monday sees an ENT that did his fellowship at Penn, schedule her colonoscopy, and schedule a trip to see her son. Her frustration? What next!

            The gardening that irritates will just need to slow down. Find her pace. Some little things are important and some are not. An old car well maintained is still OLD. The meniscus is way down her list.

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            • #36
              Originally posted by Lordosis View Post

              They must go quite deep in order for it to cost that much :O
              Like, doing a complete walletectomy?
              Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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              • #37
                Originally posted by Tim View Post

                Fits the profile you described. Unfortunately, I know the tripping incident where she banged up her knee. It’s not new. It’s not a high priority.
                Context: Bodies age and age differently. It’s like driving an old beater car. Little things make a difference. Fix it radiator leak, fix the tire air leak, ignore the scratch and dent from the parking lot.
                Priorities. She got the results of a ENT mri yesterday. That little report warrants immediate attention. Monday sees an ENT that did his fellowship at Penn, schedule her colonoscopy, and schedule a trip to see her son. Her frustration? What next!

                The gardening that irritates will just need to slow down. Find her pace. Some little things are important and some are not. An old car well maintained is still OLD. The meniscus is way down her list.
                Hope the ENT issue gets resolved with success. Wishing her the best.

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                • #38
                  It's hard to trust a profession that doesn't have pricing transparency, where you are sent a bill after the fact, based on a policy determined by your employer, based on negotiated rates determined by the insurance company and the provider. The system and trend towards cost shifting is a set up for erosion of trust.

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                  • #39
                    Originally posted by HandFellow View Post
                    as an orthopedic surgeon, I take issue with your insistence that the "orthos" were doing you wrong by taking x-rays.

                    First of all, x-rays cost between 25-50 dollars. So much for a money grab.

                    second, the x-rays that are taken at some outside facilities are of such terrible quality that I question how the technologists sleep at night and how the radiologists can interpret the images at all.

                    Third, x-rays always come before more advanced imaging and there is a reason for that. They tell a different story. An x-ray for the spine for, say scoliosis, is taken standing up. MRIs are done laying done. The results are different and tell a different story. I had an MRI the other day that showed a severe "DISI" deformity on a wrist MRI. The x-ray was completely normal on the lateral. At surgery, the scapholunate ligament was entirely normal.

                    At some point you have to trust the extra training that goes into medical specialties.

                    Now the dentists, they're all crooks.
                    If you cant admit there are perverse incentives with owning imaging or that orthos who have in office xray aren’t incentivized to order unnecessary xray then not sure what to tell you. 25-50 for every single patient adds up

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                    • #40
                      If most orthos started having MRs installed in their offices do we really think MR ordering for their patients wouldn’t skyrocket ? Come on

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                      • #41
                        Originally posted by Panscan View Post
                        If most orthos started having MRs installed in their offices do we really think MR ordering for their patients wouldn’t skyrocket ? Come on
                        We have one in our office and I send MRIs out because the images are better elsewhere.

                        You are correct that those incentives are there. But most all of us just order what's indicated. Because, you know, that's the right thing to do.

                        There is a conflict of interest for virtually every profession out there. You could say that truly salaried physicians don't have that conflict. However, one can argue that salaried physicians are incentivized to not treat conditions. Because it's more work for no more pay. At some point you just have to trust that we do the right thing.

                        If you're not an orthopaedic surgeon, you don't know what is and isn't a necessary xray in an ortho office setting.

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                        • #42
                          Originally posted by JWeb View Post

                          We have one in our office and I send MRIs out because the images are better elsewhere.

                          You are correct that those incentives are there. But most all of us just order what's indicated. Because, you know, that's the right thing to do.

                          There is a conflict of interest for virtually every profession out there. You could say that truly salaried physicians don't have that conflict. However, one can argue that salaried physicians are incentivized to not treat conditions. Because it's more work for no more pay. At some point you just have to trust that we do the right thing.

                          If you're not an orthopaedic surgeon, you don't know what is and isn't a necessary xray in an ortho office setting.
                          Right but this is inherently the problem.

                          You have a lack of transparency and a high degree of information asymmetry. That together just makes people naturally suspicious. Theres no way around the info asymmetry, only transparency can be improved.

                          Even if you fight the incentives over time I feel like people get worn down or become accustomed to it, or more likely find other reasons/narratives to make it more palatable. Few are out there truly just trying to bilk people left and right, but there are lots of structurally dumb things in our system that lead to simple over treatment.

                          Like an xray, its fast cheap and safe. There really is no reason in med/dentistry not to do it. Get sued once and lots of peoples perspectives will change, its just not how the world works and we have to operate in it as it is, not how it should be.

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                          • #43
                            Originally posted by Panscan View Post
                            If most orthos started having MRs installed in their offices do we really think MR ordering for their patients wouldn’t skyrocket ? Come on
                            Most handymen own a hammer and keep it in their tool box. At some point everything does not look like a nail. It is actually possible and best practice to use the right tool.

                            The silly problem with medicine is getting a correct diagnosis. That is why it takes so long to develop the knowledge and skills, to actually identify the problem and the necessary steps. Great equipment helps. Like therapy before pulling out a scalpel.

                            Full disclosure: I detest when I see physicians butchering patients with unnecessary operations or unnecessary tests. That does happen. Hopefully not.

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                            • #44
                              Thats a terrible argument. If you are doing an X-ray on literally every patient that comes in, by definition you are doing some amount of unnecessary x-rays. It doesn't take an ortho to realize that.

                              You prove the problem when you say you send stuff out bc your images suck. That means that a) you bought a cheap, low strength magnet (which is what every office MRI is because it's cheaper, yet a crappy 0.5T magnet from 20 years ago pays just as much as a cutting edge 3T brand new MRI) b) you have no one involved who has any idea what they're doing to protocol the studies to make them look good. I'm sure somebody is ordering MRIs from your magnet and you aren't running it as a loss leader. These things don't exist for fun or for patient convenience, they exist to make money.

                              I absolutely believe you can look at an MR and say if there is DISI or if the SL ligament is intact. I think you have no idea how to tweak protocols or acquire images which is also part of the battle. It's basically a printing press of money. You get to collect unlimited technical fees with doing essentially no work yourself besides the one minute you spend looking at the joint. Let's just recognize it for what it is and not lie to ourselves or patients.

                              The right thing to do would be for the patient to receive diagnostic tests that are indicated, not because it makes your group money. I have no idea what you're talking about with salary. I don't think there's a scheme of PCPs refusing to treat CHF or diabetes so their patients keep coming back to their office. In fact the opposite is true and with tracking of metrics, people are probably more vigilant about treating stuff than ever.



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                              • #45
                                Originally posted by Tim View Post

                                Most handymen own a hammer and keep it in their tool box. At some point everything does not look like a nail. It is actually possible and best practice to use the right tool.

                                The silly problem with medicine is getting a correct diagnosis. That is why it takes so long to develop the knowledge and skills, to actually identify the problem and the necessary steps. Great equipment helps. Like therapy before pulling out a scalpel.

                                Full disclosure: I detest when I see physicians butchering patients with unnecessary operations or unnecessary tests. That does happen. Hopefully not.
                                If you own the therapy group, you're probably more likely to recommend someone to try to attend therapy first even if they have an injury that automatically warrants surgery and has no chance of healing on its own. That's the point. There are perverse incentives that result in patients getting unnecessary treatments and tests so doctors can make money. It would take straight up delusion to suggest otherwise.

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