[Poncho]

Great thread Richard.....I have lots to say seeing that I have been in healthcare for over 12 years and on both sides of the fence giving and "receiving" the care.

Some of you may know my story - others not. I will try to keep this abbreviated.

I was an ER/Trauma nurse training to be on the flight team. At that time, I was the next "crop" of nurses to get in the air. However, although my spirit was going in one direction - the body another due to the physical working environment in the ER with lifting. I was injured at work and started off as a work comp patient...

So, my work comp doc was an arse - he would tell me anything to just get me out of the system. Good thing that I came from a medical background to argue my case.
---While in the work comp system, I was told by the surgeon that they eventually referred me to that my back would get better on its own. It will just take time. But offered NOTHING as far as managing the symptoms.

I finally convinced work comp to let my primary physician to have a look at my case. Of course the treatment was better and he helped me manage the symptoms better.

When the symptoms didn't go away - I started looking into alternatives to fusion (ADR) - I know that I went to atleast 7 surgeons specializing in both ADR and fusion. Some would do a tap dance around issues regarding ADR.

-----For example, I asked one ADR surgeon about the motion of the device. The specific question was: Does the ADR have a "shock absorber" effect? Does it cushion the spine like a natural disc? Of course the surgeon knew what I was asking, but answered "I don't know what you are asking me" - He knew the plastic core was hard as a rock - which was okay, but I just wanted someone to give me honest answers. I felt as though this particular surgeon was trying to be more of a "salesman" than a doc.

-----Then another ADR surgeon consult: We noticed that the alignment of the multi-level replacements that many of the patient's ADRs were not in alignment after looking at some x-rays of his previous work. When questioned, the response was "the placement does not need to be that perfect, the spine is VERY forgiving." - I knew better than that - The hell if it is....Placement is absolutely, positively critical to be a success and the ADRs need to be in perfect alignment to balance the spine. This doc really gave us a load of BS - didn't he!?!?!

The local ortho spine surgeon that I was referred to by my primary doc was okay. However, I question whether his interests were aligned with mine or lining his pocket.
----Now, this surgeon did refer me to pain management who did help me immensely with the symptoms.
----------However, when he could not offer me ADR here because of the device he was using in clinical trials was on hold - I asked him if I could have Dr. B perform my 2 level placement and then he could do the follow up. Well, that went over like a "lead balloon". He told me that if you have surgery abroad, you are no longer my patient. Even when you return. The only thing he could offer me was fusion. I said no thanks!!! I'll take my chances with or without you!!!
----------You see there is not as much $$$ in patient follow up care as there is with a surgical case.....I have to wonder about the conflicts of interest here.

If I had waited for my local surgeon to offer ADR to me - I would STILL be waiting!!!

As far as dealing with the front line staff of physician offices, it has always been a problem for me. It is my experience that physicians / surgeons purposely "layer" themselves away from patients until they are ready for them. The front lines staff job is to follow through on the layering - unfortunately. Atleast, this is my impression.

It is also my impression with the relationship regarding the kind of insurance one is holding as it relates to the speed of getting in with the doc. It just seems to me that if a patient is carrying Medicaid, they will be seemingly be waiting forever. However, private insurance seem to get in quicker. Again $$$ issue. Many will deny this - but it is funny that when working in the ER, a vast majority of patients that can not get in with their docs in a timely manner to manage their medical conditions are on......Medicaid.....Hummmmm

The "bottom line" here for us patients is to educate yourself on your particular medical problems. Also, know what your patient rights are.

I could droan on - but these are some of the things that stand out of the top of my head.