DEAR DR. GOTT:
I am a 48-year-old female and am enclosing a CD with an MRI on it provided by my insurance carrier, Kaiser Permanente. I’ve had back problems for years and the only relief I get from the pain is the epidural injections I can occasionally get. Between times, I take morphine and many other pain medications without relief. The pain on one side radiates down one leg to my foot, and on the other it radiates to my knee. Sometimes I fall when my knee doesn’t seem to want to hold me up.
My doctor said surgery is not an option. I can’t determine if his decision is because of the cost involved, or for other reasons. I’m on disability and have a very limited income. If I had surgery, I would have to depend on Social Services to help with the expenses. It may be that they have already refused my doctor’s request, and I don’t know how to find this out. Would it be a good idea to get another opinion? Do you have any advice for me?
DEAR READER:
I must begin by indicating I am a primary care physician, not a radiologist. To the untrained eye, the CD you sent only covers the lumbar/sacral spine and, in my opinion, is abnormal.
Without knowing all the circumstances, I cannot determine why your doctor stated surgery is not an option. Do you have other medical conditions that would have a bearing on the outcome of the procedure? As I have said repeatedly, the benefits must outweigh the risks. If your doctor feels you could end up in worse shape than you now are, then he is justified in his decision.
Could insurance be the issue? Whether your coverage is through disability or you have the best plan money can buy, you are entitled to proper medical care. The surgeon will be paid according to regulated state standards and will make up any perceived lost funds on other carriers that might pay higher rates. It has been my position to advise insurance companies of recommended procedures and state my reasons based on the patient’s physical condition. If quality of life is an issue, it must be addressed and managed appropriately — regardless of cost. I can confirm that I have had to make repeated requests to carriers when I have been rejected. They don’t want exorbitant bills (despite the fact it’s cheaper to provide necessary surgery than to provide several types of narcotics every month for years), but a doctor doesn’t want to see his patient in constant pain either.
Begin by making an appointment with your primary care physician. Write down all unanswered questions, beginning with why surgery isn’t an option. Take a friend with you who can maintain an objective view. If you are still dissatisfied after the visit, get a second opinion. Request pertinent information be made available to the new doctor. If he or she agrees with your primary care physician and is justified in view of the details provided, then you should probably back off. If not, put yourself in the hands of the new doctor and make a permanent change. Good luck.
To give you related information, I am sending you a copy of my Health Report “Choosing a Physician”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
About Dr. Gott