Wednesday, February 18, 2015

The $735 Popsicle Stick Wound

     The United States health care system is broken largely because of patient fears of cancer and other horrible diseases and practitioner fears of getting sued for missing serious diagnoses.  Such fears then drive seemingly endless series of expensive followup appointments, referrals to specialists, and diagnostic tests for things as simple as wounds that take a bit long to heal, curious lumps, or headaches. 
     For example, after completion of Braden's recent regular dental cleaning the dentist called me in, shone a light on the soft palate toward the back of his mouth, and said, “I don't know what it is,” about a dime-sized whitish-gray lesion with a small poke hole in the middle. He said, It's probably nothing—perhaps a wound from a fork or pizza burn—but I want to see him again in two weeks because if it's not healed by then, I'd like to refer you to an oral surgeon. 
     Normally I blow off such follow-up appointments if I feel the doctor is being overly cautious and instead monitor wounds/sores myself for obvious signs of improvement such as reduced size and improved color. Absent other symptoms such as fever, swelling, puss, loss of appetite, change in sleep patterns, lethargy, pain, etc., with obvious improvement I'll assume its healing and cancel the visit, which is what I did for these very reasons after a week-and-a-half of monitoring. But a few days later, the wound had not improved and looked even worse, with an additional new poke hole beside the original. 
     When we went back to the dentist, he said, It still doesn't look serious, but I'll refer you to an oral surgeon who'll know better what it is and how to proceed. 
     To his credit, he didn't charge us for this follow-up examination. 
     Before the appointment with the oral surgeon, Penelope and Jaren had annual check-ups with our pediatrician, so we asked him to also examine Braden's wound. He said, I'm not sure what it is. To me, it looks like a Popsicle stick wound or something like that. The oral surgeon will know or possibly order a biopsy. If he wants to do more, see an E.N.T. (Ear, Nose, Throat doctor) for a second opinion.  
     The oral surgeon was a bummer because he refused to accept our medical or dental insurance coverages, obviously because he can charge more that way, so we had to pay out-of-pocket and settle for a puny fifty percent reimbursement from our carrier. After taking a look, the doctor said, I don't know what it is, though it's not likely to be cancer as that usually strikes older patients age sixty-five and older who've smoked all their lives. We can either wait two more weeks and see if it heals on its own or do a biopsy now if you prefer. 
     He did point out a new purplish, dime-sized blemish closer to the front of the mouth that concerned him even more as the back one appeared to be a typical wound which sometimes takes months to heal.
     Because of the low likelihood of anything serious with the back wound and because the front wound was recent and looked like a simple bruise to me, I opted to wait and see. 
     Before the appointment, both things looked a lot better, the back one nearly healed, but not quite. However, when the doctor shone his light on it, the back wound obviously had a ways to go. He said, We can wait two more weeks and do a biopsy then if it's not fully healed or do a biopsy now. Since two months have already passed since it was first discovered, time will be of the essence soon, because for serious things, the sooner we act, the better. 
     Because I knew it wouldn't fully heal in two weeks I said, Go ahead and biopsy it now. 
     After the surgery when I looked at the wound I noticed a neat, half-inch incision with a couple stitches, which surprised me as being much larger than what I'd expected given a minimal biopsy sample. Braden said that the doctor said that rather than take a small sample, he decided to take out the whole thing. I felt he should have at least told us of this beforehand, but he did do a good job, so I let it pass.  
     To his credit, the oral surgeon called us at home the following day to see how Braden was doing. 
     In the coming days, the surgical wound opened after the stitches self-dissolved and appeared dime-sized like before, but a lot cleaner, and the holes and purplish blemish which the doctor hadn't touched were gone. 
     At the follow-up visit, the doctor said, Queen's Medical Center's report shows the biopsy is normal. That means something poked or burned it. I'll see Braden again in two months to check its progress. 
     At that point I was relieved, but sick of doctors' visits. As long as the wound continues to improve I have no intention (having already had to pull Braden out of school early twice) to see any more doctors about it. 
     When I was a kid, my dentist would not have made a fuss over such a thing, perhaps only saying avoid aggravating it and call him if it gets painful or looks worse after a few weeks.
     Today, four doctors (including the one that analyzed the biopsy), on six separate occasions, had looks at it before the one that looked at it beneath a microscope finally had the courage to say in essence, It's nothing; don't worry about it.
     A couple years ago, I had a lump on the floor of my mouth looked at by a dentist, an oral surgeon, and an E.N.T. The E.N.T. said it wasn't a tumor, just a trauma wound that would heal on it's own, but ordered a CT scan to check for blockage in a salivary duct which wasn't even a concern of mine. I blew that off and things returned to normal in a couple weeks.
     I had a friend with minor headaches and his doctor ordered a half-hour MRI brain scan. This was a couple decades ago when MRIs were perhaps even more expensive and high demand than now. I knew his headaches were minor—probably tension or diet or lifestyle-related—and the MRI found nothing. 
     In short, our health care system seems to lack common sense judgment because it is obsessed with ruling out the often one-in-ten-thousand worse case scenario lest an error in judgment be made that comes back to bite everyone. And no one wants that to happen. Thus, it's no wonder health care costs continue to rise unabated as doctors milk the system with more and more follow-up visits, expensive procedures, referrals (do they get referral fees? Or reciprocal referrals?), and tests. My doctors are good and responsible, but even for something as simple as a Popsicle stick wound, we and my insurance carrier sure paid a lot.

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