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.
