My Healthcare Prevention Story

Posted on August 16, 2010


My position on preventative healthcare as a way to help fix the current healthcare industry’s runaway costs is fairly well established. To prove how out-of-touch healthcare is, or has the potential to be, I offer a true story.

When I moved to Florida I had to re-establish my entire network of providers—dentist, eye doctor, physician. I had gone probably three years since seeing a doctor and wanted to get into a new habit of regular doctor visits, so I decided to set up a doctor appointment for a routine physical, something I do not enjoy but used to get every year when I was in high school and college.

I asked around and received a solid recommendation for a doctor that was professional, easy to talk to and very sharp, so I set my appointment. When I checked in I filled out the usual paperwork required to get a file started and the receptionist asked why I was coming in.  The exchange went something like this:

Why are you coming in today?

A routine physical.

A what? [looking at me like I have two heads]

A physical.  I have not had one in a while. [who am I, Rip Van Winkle?]

You mean you’re not sick? [asking incredulously]

No. I just want to get checked out and make sure everything is ok.

[Confusion.  Silence.  Sliding of the transaction counter glass.]

An inauspicious start to my preventative health adventure, and it was not much smoother with the doctor. When asked why I was in, I said a routine physical. At this point, I half expected him to say:  we don’t do those anymore. Though, it seems to me a doctor might be at an advantage if he had a baseline of information on me to go off when I am healthy so the next time he sees me and I am as sick as a dog, he might know what is normal for me. We talked about my general health history instead, more like a consultation, but it was definitely not a textbook physical.

I thought I was doing a good thing, scheduling a physical. To me it is like taking my car in for a tune-up:  give the major systems a once-over, check the belts and hoses, top off the fluids. I thought:  is this not supposedly the model for retail healthcare—more convenient, more often, less expensive, less formal? What am I doing wrong here?

Physicals are apparently not physicals anymore—how gauche! Only when I learned a little more about insurance reimbursement years later did I realize physicians have a hard time getting paid for time spent on anything that is not treatment of ailment, a.k.a. “preventative”. No wonder everyone gave me a look like ‘what do I do with this guy’? In any other industry if I asked for something that was apparently superfluous or silly, someone would still provide the service for a fee, even they personally thought it was a waste of money.

For instance, if I decided to get my hair cut every two weeks, the barber would look at me funny and dismiss me as either crazy or obsessive about my hair, but he would do the work and I would pay him. Why is this concept so foreign in healthcare? If I feel healthier by making an appointment every week to just talk to my doctor about health, I would be willing to pay for his time, and likewise I should get my appointment every time no questions asked.

My routine physical experience has affected how I use my healthcare. Apparently wellness visits are frowned upon if you are not a child, so I only go when I am sick. I self-ration my care just like the insurance companies want. And I suppose in twelve years when the doctor finds a lump or suspect splotch on my skin, I will be able to use the care I paid into the system all those years because the insurance company is now an accomplice in my ailment for structuring “care” monies to exclude prevention. Some days I wonder how I can go to work and design for a system as backward as that.