I get this question all the time. I’m sure many fellow doctors do too.
In a way, it’s the question.
Who you seek help from can be the difference between getting the right answer and the wrong one. It can mean getting answers early or suffering errors and circuitous missteps before getting answers far too late.
Who you see can determine whether the experience of health care makes you feel safe, cared for, and in good hands, or anxious, alone, and regretful. On top of all that, it can mean a ten-fold difference in costs to you, or more.
For a choice so high-stakes – who to see for a specific medical question – there must be robust systems in place ensuring that you’re going to the right expert, every time.
Well. Not exactly.
“Steering” patients to specialists, as insurance companies and health systems affectionately call what they’re doing to us, is designed to meet these companies’ interests. That interest is to keep you in their network. The insurer wants to minimize costs by sending you to their cheaper in-network contracted partners, and the health system wants to maximize their revenue by sending you to in-network specialists they own.
In a classic example of being penny-wise and pound-foolish, seeing a poor fit may be cheaper for the insurance company for that visit, yes. But if they don’t solve your problem well, that cheap visit will just beget other, potentially more expensive care as your medical issue advances or worsens.
A health system may make more money off of you by sending you to their owned partners. But if that wasn’t the right person, the health system erodes your willingness to trust them to solve the next problem you have.
A client of ours smashed his finger in a door. The ER referred him to their system’s on-call hand surgeon, who operates a plastic surgery center and told him a visit would be $3000 cash pay. Then our client asked his insurance company, who referred him to an orthopedic surgeon - who specializes in knees.
Meanwhile an excellent hand surgeon, better regarded by his peers in the community for hand trauma, accepted his insurance and was happy to see him the same day. The best choice was not suggested to him by the health system or the insurance company - but by us.
What do I want you to take away from this? Don’t rely on insurance companies or health systems to “steer” you to the right expert. Unfortunately, neither has aligned incentives to find the right doctor, diagnosis, or treatment for you.
The only party incentivized to maximize your health in our broken system is you. The choice of specialist is a critical, often overlooked one, for which you must be in the driver’s seat. You can only outsource this choice to others who have your best interests as priority number one - friends, family, fiduciaries.
Next I’ll talk about how to go about this.
Critical Decision Medicine, our n of 1 medicine approach sized for your one most pressing medical decision--like who to see for your new diagnosis, or which treatment option to take--launches January 5. Join the waitlist to find out how you can get one of 5 free preview slots in November.
