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Beyond opaque and variable pricing for the same service, there is also the question of whether something simpler would do the trick. Some years ago, I thought
by Stratoscope 7y ago
Beyond opaque and variable pricing for the same service, there is also the question of whether something simpler would do the trick.
Some years ago, I thought I might have broken my finger. I went to the doctor and it was actually the physician's assistant who saw me. I'd explained at the front desk that I had a high-deductible policy and I would be paying in full for the visit.
The PA said "Usually we would send someone for an X-ray, but since your insurance won't cover it, there is a quick test we could do and it would just be part of this office visit."
He opened a drawer and pulled out an instrument and asked me if I knew what it was. Being a musician, I said "Yeah, that's a big tuning fork. And with those weights on the end it must vibrate at a very low frequency."
He said, "You got it! The idea is we get the fork vibrating and then hold the end against your finger. If it's broken, it will hurt like the dickens, so just holler and we will stop and you go get that X-ray. If it doesn't hurt much, it's just a sprain, so take it easy and you should be fine."
We did it, and my finger was fine. Saved me a bunch of time and money!
Edit: Thank you everyone for the lively commentary! I would like to mention something that I forgot at first (it was ten years ago) and your comments reminded me of.
The PA didn't pull out the tuning fork until going through a complete set of manual range-of-motion and "does this hurt" tests. All indications were that my finger was not broken, it was just a mild sprain. I'd only gone to the doctor in the first place out of the proverbial "abundance of caution".
So it was my decision not to get the X-ray. Please, everyone, do not blame this on the American medical insurance system! I could have easily afforded the extra $150 for the X-ray, and of course I still had that option after the tuning fork test. But since both the PA and I were both so sure at this point that it was just a sprain, I figured I would same both time and money by skipping it.
It was my call how to proceed with this very minor injury, no one else's.
- rpmisms 7y agoThat's extremely cool, and has my gears turning about how to encourage that kind of behavior.
- beebmam 7y agoThat ISN'T cool, that's quite dangerous, because if it was indeed broken, that may cause harm. Rule #1 of being a doctor is violated. X-ray imaging on a finger is virtually harmless. Using a tuning fork to vibrate a potentially broken bone and causing a patient to feel pain is not harmless.
- thatoneuser 7y agoI don't see how it could be that dangerous assuming the doc first looked it over and couldn't find anything by hand. How would a tubing fork seriously hurt a small fracture if applied with skill?
- leetbulb 7y agoSure it's dangerous, but $400 out of pocket for an xray of your finger is also quite ridiculous. If my finger wasn't obviously broken, I'd probably take my chances with a tuning fork, too.
- konschubert 7y agoThe real problem is that the x-ray costs 400. It doesn’t have to be that way
- namibj 7y agoHere in Germany it's less than 20. I think it was between 10 and 15 € for a finger. This includes an expert's opinion, albeit a succinct one. I wish they'd do technical/industrial things in a similar fashion. Make appointment, bring piece, get xray, wait a few minutes, leave with xray image/dataset. For cheap. Require bagging for contamination reasons.
- novaRom 7y agoHere in Germany we pay highest healthcare insurance costs in the world. If you earn more than 55000 Euro/year, you have to pay 9600 Euro/year for health insurance alone! And you cannot opt out! Together with your spouse you have to pay insane 19200 Euro annually! No wonder it is between 10 and 15 Euro for a finger. In USA if you pay $20000 you will be fully ensured and you will not need to pay anything for your finger check.
- jopsen 7y agoIf the x-ray is better in any way, it's not wise to recommend anything else. It's better to ensure that the very treatment is affordable
- namibj 7y agoXrays are not universally good. It's always exposure to ionizing radiation.
- jopsen 7y agoTrue, but I'm not a domain expert, so I can't make that call. But I'm sure someone did the math on this risk. Mistreating a broken finger could also leave you with reduced function in the hand. Needless to say that's also a risk.
- rpmisms 7y agoOr perhaps leaping to the most invasive possible diagnostic isn't ideal.
- erikig 7y agoOut of curiosity, why would it hurt a lot more if a bone was broken?
- DaiPlusPlus 7y agoI think because more energy is transferred to a smaller piece of bone which then vibrates more and is presumably more painful as it contacts pain receptors around it - whereas an larger intact bone will vibrate less as there’s more bone mass to move around.
- deleted 7y ago[deleted]
- Pfhreak 7y agoHaving a bone in my hand set without anesthetic, I suspect it's because when a broken bone becomes rapidly agitated it's causing a bunch of nerves to fire their pain signals. The tuning fork most likely resonates the bone rapidly -- if things are just sprained, the whole bone vibrates. If the bone is broken, it grinds against itself.
- Stratoscope 7y agoGlad you asked, I forgot to mention that. He did explain that if the bone is broken, the broken ends would vibrate against each other, and that would be as painful as it sounds.
- dragonwriter 7y agoBecause instead of being a smooth unit the bone has broken edges, and with vibration its moving rapidly within the surrounding flesh; its kind of like having an electric knife embedded in your flesh.
- alt_f4 7y agogreat anecdote and when you're having heart arrhythmia, since it is too expensive to send you to a specialist and hook you up to one of those EKG devices, why not just do a series of 20 pushups and 20 squats and see if you'll collapse? alternatively, we could have a system where patients are entitled to some basic care, but hey..
- Stratoscope 7y agoI don't quite see the connection. It seems unlikely that my doctor and his assistant would treat heart arrhythmia the same as a sore finger. And no one said I couldn't have an X-ray. They merely offered me a faster and less expensive diagnostic procedure at my own option.
- alt_f4 7y agoeh, it's just a reductio ad absurdum argument The underlying point is that it'd be nice if you are able to get first world care instead of "lifehacks" for a range of very common conditions, given that you're insured, and not have to pay a giant deductible.
- tdhoot 7y agoI think it depends on the efficacy of the cheaper procedure. It's rare for the cheaper procedure to be as accurate as the more expensive one. If you knew the tuning fork was 80% accurate and an x-ray 100% accurate, would you still take it? I'd personally pay extra to make sure I was diagnosed correctly.
- robocat 7y agoIt depends upon the medical issue, how much you can afford, and how much you know about the downsides if you should have the issue. If it looks straight, a hairline fracture will heal properly if unstressed for a few weeks. Probably not a huge risk if wrong. You could constrain a broken finger yourself if you are any good at looking up information and applying it.
- HarryHirsch 7y agoWith a hand injury one might lose fine motor skills, they should be taken seriously by patients and physicians. In any other first-world country the physician would have taken an x-ray, treatment cost would be nominal, there is some form of universal healthcare in place, but in America you have a choice! Your money or your range of motion! More worrying is that people support the racket! A tuning fork, like a barefoot doctor in 1950s China might have used is a good idea! You despair about the possibility of sanity in American healthcare.
- uoaei 7y agoExactly the situation with me and my shoulder. Never got it looked at, because I was in college and it "only hurts a little but it doesn't interfere with normal life goings-on". Now it's still screwed up and I know a lot more about human skeletomuscular back and shoulder anatomy.
- alexhutcheson 7y agoIn my experience, X-rays at urgent care centers are only ~$100. Hospitals are much more expensive and variable, though.
- Stratoscope 7y agoThat is true, I recall they mentioned $150 but we are in the same ballpark. It wasn't the cost that steered me away from the X-ray, I just didn't want to take the time to wait in line after I felt sure that it was just a sprain and all I needed to do was take it easy on my hand. (I updated my original comment to note some of these details.)
- Stratoscope 7y agoAh, too late to edit again, I was in a hurry on that update to beat the two hour limit. Just for clarity, that one sentence was supposed to read "I figured I would save both time and money by skipping it." (emphasis added)
- perspective1 7y agoFYI, even if you had broken your finger the treatment is almost always splinting and time. Most doctors wouldn't do an x-ray or a vibrating test. Does it hurt? Splint it, come back in a week. Next.
- AnimalMuppet 7y agoGet it set properly, then splinting and time. If you're sure you (or someone around you) knows how to set it, you maybe want to go that route. But if it's not set right, and you splint it there, that may not work out so well...
- truthseeker1 7y agoSure, but in the case that the "simple trick" didn't work and someone end up with something catastrophic (e.g. missed fracture that resulted in chronic disability), who do you think they sue? Yes, the guy who tried to do right by you by saving you money. In medicine, no good deed goes unpunished.
- Noumenon72 7y agoI presume you were billed $85 for the tuning fork?
- Stratoscope 7y agoNo, only the normal charge for an office visit.