How I Avoided Two Unnecessary Surgeries and Saved Thousands of Dollars
Discovering the value in expert second medical opinion services
By Nate Randall
I thought I did everything right. After all, I’ve spent my career in employee benefits – creating and optimizing health insurance plans, analyzing medical claims, and helping to design forward-thinking innovations in employer-sponsored health care. Given that background, I might be forgiven for believing I know how to make personal health care decisions.
About a year ago, I strained my right shoulder while working a stubborn bolt on my trusty, old 1987 Toyota Landcruiser. In fact, automotive therapy led to the discovery of my biggest blind spot within our complex medical system: the trust developed between patients and doctors.
Shortly after straining my shoulder, an aching pain developed followed by a concerning numbness in my right hand. Being of Alaskan breed and spirit, I decided I could “tough it out” and see if things would get better. This was a mistake because the numbness and pain did not improve. Instead, it continued for the better part of six months. Finally, after much prodding, I began searching for a doctor in or around the sparsely populated western Sierra slope that is home.
With a $13,000 family deductible, I was determined to make the best medical and financial decision possible. So, I did my research, read online reviews, and compared the transparency data available on my health plan’s website. I spoke to local nurse friends about who they might recommend. I called the doctors’ offices I was considering and asked pointed questions.
When my homework was done, I selected my doctor. A qualified, highly reviewed, and well-known orthopedic specialist in my area. After making my initial appointment, I immediately liked him. He listened, showed compassion, and had a bedside manner that put me at ease. After a little discussion around my symptoms, we decided on a course. He needed a better look at the interior of the shoulder and wanted to test for carpal tunnel in my hand. He also recommended that I try a few weeks of physical therapy.
With my orders in hand, I first booked my physical therapy appointment and then began my search for an affordable magnetic resonance imaging (MRI) provider. When we began working on medical price transparency at Safeway back in 2009, I never considered that the ability to look up prices through one’s health plan website would someday become table stakes. I was able to find an affordable alternative to my local hospital to obtain an MRI for a fraction of the price.
By fall, my short physical therapy stint was complete, and I had the results of my torture-like Electromyography (EMG) test and shoulder MRI in hand. I returned to my doctor for a follow-up, and to determine next steps because my symptoms had not improved. His diagnosis was that I had moderate to severe carpal tunnel and that shoulder “clean up” was needed. I listened carefully as we went through his proposed treatment plan while he pointed out the inner workings of my shoulder on the MRI image. I certainly couldn’t argue with his recommendations, as this was not my area of expertise.
My doctor could perform both the shoulder clean up surgery and carpal tunnel surgery simultaneously in December. Even though my holiday season would be spent in recovery mode, I left confident in my decision and my doctor’s abilities.
As fate would have it, I was scheduled to attend one of the largest and most innovative healthcare conferences in the country just two weeks after I scheduled my surgeries. While there, I ran into an old friend who had recently taken a vice president role with a growing healthtech company called 2nd.MD. We shared family updates, discussed how careers were progressing, and briefed each other on our different, yet similar, medical challenges. I told my friend of my impending surgeries and the hope that it would alleviate my symptoms so I could get back to normal daily activities. He asked if I would be interested in giving 2nd.MD’s service a try. I gladly accepted. What would I have to lose? If nothing else, I could give a colleague and friend some valuable feedback.
“From a user experience perspective, this is what medical care should be like.”
Within a week, I was set up on the platform and was scheduled for two virtual consultations: one with a preeminent hand specialist in Florida, and the other with a shoulder specialist in Arizona. A 2nd.MD coordinator pulled all of my relevant medical records and supplied them to the clinicians in advance of the video consultations with minimal effort on my end. I dialed into the video calls, and to my surprise, both specialists were on time and incredibly efficient. They had reviewed my case in advance and were prepared to discuss my chosen course of action. From a user experience perspective, this is what medical care should be like.
Though I was eager to hear their thoughts, I fully expected the opinions of these specialists to simply reinforce my doctor’s recommended course of action. I couldn’t have been more surprised when the hand specialist immediately questioned the course of treatment and surgery recommendation. Had we tried enough therapy? Am I wearing wrist braces? “Will carpal tunnel surgery fix the numbness in my hand?”, I asked. “Maybe,” he said, “but maybe not.”
And then the real kicker: if decided to move forward with the carpal tunnel surgery, was my current doctor the best person in my area to perform the procedure? “Absolutely not,” came the response from my hand specialist. Instead, I learned from him that there is another doctor in my area who has been trained at one of the top hand institutes in the country. “If it were me,” said my medical expert, “I wouldn’t consider anyone else.”
Reeling, I logged into my shoulder consultation to find a similar experience. “Your MRI doesn’t show anything abnormal that I wouldn’t expect from a typical 40-year-old male, so I would not elect surgery”, said the shoulder specialist. In fact, the shoulder surgery recommended by my original doctor was shown to be no more impactful than a placebo. Therefore, the recommendation was to pursue more intensive physical therapy, cortisone treatment, and a new doctor.
I felt like I had just been taught a life lesson, as well as a professional one. Originally, I was going to dive into two surgeries without a second opinion. How could I have gotten this so wrong? More importantly, how could my doctor have missed the mark on this? I Immediately canceled my surgeries and, feeling a tad guilty, I apologized to the staff profusely. I then booked an appointment with the newly recommended hand specialist and committed myself to starting the process over again.
The good news is that not only did I avoid an intensive double surgery, but I also sidestepped having to dole out my $13,000 deductible. Working with a new doctor, I elected a cortisone treatment in conjunction with intensive physical therapy. And you know what? The program worked. My pain level went from nine to one and after seeing this progress, I am confident that I can pare it down further to zero. In the end, I may have to get my carpal tunnel fixed, but at least I know who and what to look for in a surgeon now.
The incentives are misaligned in our system when a surgeon needs to perform surgeries to make enough money to keep their job within the medical group and make a living. An independent second opinion from a specialist who doesn’t stand to make thousands of dollars from performing a surgery on a patient is invaluable. In my opinion, it should be mandatory protocol.
I liked my original doctor, and still do. I want to trust he is doing what he believes is best for his patients to the best of his abilities. But in matters of our health and the health of our family and friends, we all want and deserve the best. Having access to an expert medical second opinion not only saved me thousands of dollars, but it helped me avoid two unnecessary surgeries. Better yet, I was able to spend the holidays with my family, healthy and happy.