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  • Writer's pictureMario Nicolais

Inefficiencies in American health care are a real pain. I know.

Health care inefficiencies continue to plague an industry that represents nearly 20% of  the country’s economy. That reality seems to be driven home almost every time I seek out care. Even something as seemingly simple as a trip to a podiatrist.


In late June, pain began shooting through my left heel. This is not new for me. I play soccer regularly, I hike mountain trails and I take my dogs for long daily walks. And I am getting older (maybe just old?). Each of these contributes to potential problems with my feet.


Furthermore, it is not the first time. Rather, it is a recurrent problem that comes and goes. I know that I suffer from tendonitis near my achilles. But this round seemed a little more severe and lasted longer. I could not walk without pain and had to change my gait and stride substantially to minimize the problem. 


It seemed time to talk to my doctor about potential long-term solutions.


I called the physician practice where I am a patient. It is a large practice with multiple offices in the Denver metro area. I have had neither exceptional nor awful care through them. I choose them merely out of convenience and proximity.


When I called for an appointment, there were no available slots for a few weeks in the location I usually seek treatment. That would be fine if I were looking for a routine physical, but the feeling of a nail burrowing into my foot made my situation a little more urgent. I asked if they had any sooner availability — as in that day — at any other local locations. That is a tactic I have learned to ask about in similar situations in the past. Gaming the system is a necessary talent in American health care.


Sure enough, another office a few miles away had times available. I picked the first one and hobbled over.


As is the case most often with my physician practice, I did not get to see a physician. Instead, I saw a physician’s assistant. That does not bother me too much since I have a high opinion of PA’s as medical providers. It just seems ironic that I cannot remember the last time I actually saw a doctor in my doctor’s office.


Nevertheless, my PA confirmed that it seemed likely to be another bout of tendonitis and wrote me a referral for an X-ray and specialist appointment. Of course, they didn’t have an X-ray in the office, so I drove another few miles, walked into another office, and paid $60 out of pocket (not covered by my insurance) for a set of black-and-white pictures of my busted-up foot.


The podiatrist, though, was a different matter. The closest appointment was seven weeks out. One of the “benefits” of the American system of private health care, as opposed to government-guided versions in places like Canada or England, is the relative speed in which treatment can be provided. So much for that edge.


In the meantime, my heel pain subsided and went away after about two weeks. That is longer than usual, but consistent with my personal history. A week later, awful pain like incessant cramping struck my right foot. It was not plantar fasciitis — I’ve had that often enough to know — but something else.


Knowing I had a podiatry appointment, but also knowing that the podiatrist would only look at my left foot without a separate referral for the right, I started the process over: phone call to my provider, appointment at a third location, pay another $60, X-ray through another company.


And the pain dissipated again after a week.


But my feet are so bad that a week before my appointment a third ailment arrived! This time another typical affliction, pain in the padding just below where my left big toe meets my foot. Not gout (somewhere over the six weeks someone stuck me with a needle and drew blood to disprove that theory), but potentially more tendonitis.


So by the time I finally got in to see the podiatry specialist, I at least had some pain still remaining. That must be a win in some world.


But that is where it got even crazier. The assistant helping me could not follow the history I laid out and kept questioning whether it was my right big toe that was hurting. Furthermore, she could not find the X-rays in my electronic file.


Eventually, by the time the doctor came in, she told me they located the X-rays of my right foot  and my toe looked fine. I had to point out that I was complaining about my left toe, not the right. She told me they did not have an X-ray of my left foot. I told her they did and pulled up a text confirmation. She ordered another X-ray (they had one in the office). Just as I was sitting down to have it redone, she burst in and told the technician they had located the additional set from the second company that simply had not uploaded it into their electronic health record before.


In the end she diagnosed sesamoiditis — injury and inflammation to two tiny bones that sit within the tendon that connects to the big toe. She created a makeshift insole to relieve pressure and told me to schedule a follow-up appointment.


The health care system may be inefficient, but at least it is sometimes consistent. The soonest follow up time? Seven weeks. I can’t wait.




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