I’ve been thinking about how awful U.S. healthcare is the past couple weeks, based on my latest experience as a patient. It’s made me wonder if there’s any lesson to be learned for the biotech business. And here’s what I keep coming back to: Healthcare innovators who want to prosper need to find new ways to engage with patients, and really help them, outside the usual channels offered by the hospital-insurance-industrial complex.
OK, let me back up and explain where this is coming from.
Just having finished up my usual morning run on Friday, July 15, as I was getting ready to jump in the shower, I was hit with a major back spasm. Intense pain shot up my spine, as my lower back muscles flexed and wouldn’t let go of my nerves. This has happened twice before, so I knew what to do. I carefully hobbled about three steps into my living room, and laid down flat on the floor with my feet propped up on a chair. My wife got me a couple of ibuprofen and an ice pack. I figured I’d lay there a few hours, let everything relax a bit, and probably shuffle off to work that afternoon with some stiffness.
But this wasn’t like those minor spasms of before. A few hours later, the pain was so intense that I lost consciousness when trying to stand. When I woke up on the floor, I figured, that was kind of scary. Time to call the doctor.
And that’s when things really got worse. Partly because I’m young, have no chronic conditions, and exercise fanatically, I’ve never developed a relationship with a physician. I’m fortunate to have very good health insurance, which I figured was there in case I ever got in a serious car accident. But this episode was concerning—I’ve never fainted before—so I figured it would be wise to call the 24-hour nurse hotline to see if I needed to get emergency help.
Sure enough, the operator at this organization (which shall remain nameless), told me to come in to an urgent care clinic to get checked out. So I manage to hobble into the passenger seat of a car, as my wife drove.
Once there, it couldn’t have been any more clear what this “urgent care” place was about—getting my insurance papers squared away. When that was taken care of, there was nothing urgent about this place, and it certainly didn’t care. The waiting room only had a couple other people there on a Friday afternoon. One nurse asked me a few basic questions, the same questions I had already answered an hour earlier over the phone with this same health organization.
After about a half hour, I got to see the doctor—in this case a physician’s assistant. I didn’t carry a stopwatch, but this exam lasted less than five minutes. The doctor shined a light in my eyes to see my pupils were OK. Then she had me stand up, put her hands on my hips and lower back, and asked me try to lean left, right, forward, and back. I could move a couple inches in every direction. I was able to move my legs, and didn’t have pain shooting down either one—everything was concentrated in the back.
“Yep, it’s back spasms,” she said. She prescribed a muscle relaxant, the addictive painkiller acetaminophen and hydrocodone (Vicodin), and told me to rest all weekend.
It should be fine in a few days, she said. Happens all the time.
OK, like a wiseguy, I asked, how do you know that’s really it? “From the physical exam,” she retorted, sounding unamused. Then I really crossed the line.
“Once this heals, what can I do to prevent this from happening again?” I asked.
She looked at me as if I had just uttered a phrase in Klingon. “There’s nothing you can do. These things happen all the time,” she said with a furrowed brow. Dumb question, I guess.
And then, like a flash, she was gone. No further instructions, like call her if things aren’t better by Monday. It was just time to go the pharmacy, then home.
All I could think about on the way home was how important it was for her to process that insurance claim in five minutes or less—never mind whether my problem was solved or not.
Six days later, the pain hadn’t gone away. I didn’t trust this physician’s judgment on getting a referral to a specialist, so I had to figure out what to do next. After my wife got recommendations from a chiropractor friend, and checking patient reviews on Yelp, I settled on a recommended chiropractor who could see me the next morning.
The difference was like night and day. This medical professional seemed actually interested in diagnosing the problem. He asked what I do for a living, what my daily habits are, what kinds of things might put pressure on the back. And he asked much more detailed questions about the symptoms. He reviewed a far more detailed questionnaire that I had filled out in the lobby.
X-rays were the first order of business, he said. The images, which he showed me on his screen, revealed a bulging disc. That was what was causing inflammation and the spasms.
A couple minutes later, this medical professional was feeling for the exact vertebra where the problem was, based on the image he saw. He did various functionality tests with my legs to see how far they could actually move before pain set in. He made a couple very minor adjustments of my spine, which I could barely feel.
On my way out, he said that if anything bad were to happen over the weekend, or if I had any questions, “send me an e-mail. I’ll pick it up on my iPhone.” I would have to come back for a follow up appointment a couple days later.
I walked out of the office, still quite stiff and with significant pain. But at least I had confidence that this guy knew what he was doing. This visit took almost 45 minutes of his time, which didn’t seem to bother him. He seemed properly incentivized to actually solve my problem. Sure, his assistant processed my insurance card, but it seemed clear to me that as an independent small businessman, he thrives based on whether he serves his customers—not whether he just churns out the highest number of claims per hour.
The next day, I got out of bed feeling much better. Each day, and at a couple follow-up visits, things got better and better.
And most importantly, I got a different kind of answer when I asked him about prevention. He showed me all kinds of stretches and exercises, which are already starting to work. When I asked about changing habits, like getting a standing desk as my home and office, he offered all kinds of ergonomic tips, and showed me how he set up his own office.
So what to take home from this episode? I realize that every patient’s experience is different, just like every condition is treated in its own way. There’s no way to generalize a recommendation for folks who develop new healthcare products that can only be delivered through this dysfunctional system.
But if it’s really about relieving people’s suffering from various conditions, then I’ve got to think there are a lot of businesses to be built that will flow through the hands of people like my chiropractor who aren’t quite inside players in the “system.” It made me think about a fascinating “direct primary care” model in Seattle, called Qliance Medical Management, that charges a fixed monthly fee for primary care, and won’t accept insurance, and whether this model might provide better service than the “urgent care” insurance-based facility I visited. There’s also Austin, TX-based WhiteGlove House Call Health, another company that circumvents these kind of hassles, by providing on-site checkups at the workplace.
Most drug, device, and diagnostic companies spend long years just trying to develop and test their technology to gather the evidence that it works. Given how hard that is, it’s even harder to think about the context in which your new widget or medicine has to be delivered to patients. But given how atrocious that U.S. healthcare delivery system is today, some smart entrepreneurs are going to figure out clever ways around it. It won’t work in every situation—new cancer drugs will always have to be given by oncologists. But some smart companies will soon be finding unorthodox healthcare delivery routes, because this is where many patients are going to be.
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