Larceny on Laminectomy Lane
Dolors & Sense
by Sanford Rose
KISSIMMEE Florida—(Weekly Hubris)—3/19/12—Just a reminder: I’m a retired Floridian living in a gated elder-citizen community.
This means that I live at the junction of Arthroplasty Avenue and Laminectomy Lane—otherwise dubbed Orthopedist’s Oasis. Or, rather, Happy Hunting Grounds.
Most of my neighbors have bad knees, backs and hips. They spend their days lounging in orthopedists’ waiting rooms.
Orthopedics is the highest-paid American medical specialty. The average orthopod earns between $450,000 and $600,000.
I think I know why.
This is a brief tale of a relative who asked me to accompany her on a visit to her newly chosen orthopedist.
Call him Dr. Apple. (As usual, names are changed to protect the guilty.)
Relative has spinal stenosis, documented by magnetic resonance imagery done in 2008.
She has had the usual epidural steroidal injections in the back.
No help for the lancing pain—at least not for more than a few days.
So when Level-8 pain re-surfaced in her thigh, off we trotted to Dr. Apple.
Hope springs eternal.
After turning over the medical records to the office staff, we waited in Apple’s Orchard for the obligatory 90 minutes before being visited by a Physician’s Assistant, who asked about symptoms, took an X-ray of the affected area, and then pronounced magisterially that the patient had trochanteral bursitis (incidentally, not detectable on an X-ray). The doctor would be in shortly to give another steroidal injection—this time in the thigh; not in the back.
In breezed the doctor, who administered the injection and arranged for a follow-up in a month.
Slam, bam, thank you Ma’am.
No need to concern oneself with the medical records presented by the patient, which showed impingement of those nerves that branch out from the spine to innervate the thigh area. While patient might also have had thigh bursitis, her history clearly suggested that the primary source of the pain was spinal and that an injection in the thigh was very probably useless.
Proper clinical procedure would have been to re-image the back to establish whether the stenosis had ingravesced since 2008, and then discuss options, none of them terribly good.
The injection was, in fact useless; the snap diagnosis almost certainly wrong.
Dr. Apple is alright, however. He billed Medicare $1,754 for the injection, X-ray and alleged examination. He got $763, plus the $30 patient co-pay.
Nor is he the only rotten one. In my experience, Florida’s orthopedic barrel is filled with this kind of Apple.
Sanford Rose
Sanford Rose, of New Jersey and Florida, served as Associate Editor of Fortune Magazine from 1968 till 1972; Vice President of Chase Manhattan Bank in 1972; Senior Editor of Fortune between 1972 and 1979; and Associate Editor, Financial Editor and Senior Columnist of American Banker newspaper between 1979 and 1991. From 1991 till 2001, Rose worked as a consultant in the banking industry and a professional ghost writer in the field of finance. He has also taught as an adjunct professor of banking at Columbia University and an adjunct instructor of economics at New York University. He states that he left gainful employment in 2001 to concentrate on gain-less investing. (A lifelong photo-phobe, Rose also claims that the head shot accompanying his Weekly Hubris columns is not his own, but belongs, instead, to a skilled woodworker residing in South Carolina.)