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Ask HN: How can you buy high quality healthcare?
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Re: Ask HN: How can you buy high quality healthcare?
#72I went through something similar over decades with my migraines. "I don't believe you're in pain. Men don't get migraines." I heard, far too often.
This is not medical advice, but just what I would do in a similar situation.
I'd go in knowing I'm going to have to keep at this constantly until I'm on a treatment regimen that handled it well, for starters.
I can usually have mixed results speeding things up saying I'm ready to pay right now with a card for whatever medication/test. If someone's unavailable for scheduling then call around to every other place. Call out of the area if needed. Like you would call around for a dentist if you needed a root canal or crown asap.
Edit-Oh, also, the best time to call providers is 7-8 am on Monday or when ever they first open on their first day of the week. The worst time is anytime else, with within an hour of closing being a far maybe. But be persistent regardless, and especially if start of business Monday is too far away.
For back pain I'll try to outline some options for relief in the meantime:
-Try this shortly (20 minutes) and see whether it feels better/worse: Get something that does "far infrared" heat and try it on your neck/spine. You want to be careful to not overdo it on the heat though so use a towel between you and the heat and look for redness. Redness should be avoided. A low-cost/immediate way to try out far infrared are the instant hot packs sold at corner stores like Walgreens/CVS. Try to get the ones that are made with iron. They're basically a slow exothermic reaction that can last 8 hours+.
-Cold might work if hot doesn't.
-Lidocaine patches ("salonpass"/"icyhot") might help, too. Again, try temporarily (10-20 minutes) and see how you react to it. There are even sprays or gels (think, for sunburn) that can help locally fend off pain a little.
-A TENS unit has helped with muscle spasm pain for me before, too, but I had to leave it on the area for about an hour. Edit-look at some anatomy pictures for what muscles to target.
-A physical therapist might actually be able to help you. Look for good ones that are obviously kept up to date on things. I had one mixing ultra sound and TENS on my back and it helped immensely. The TENS made it so I could feel the ultrasound vibrations. You want to go to them to make sure you're doing stretches with proper form. X-Rays and such will help them know what to target.
Good luck, chronic pain in America is both common and not always treated equally.
Re: Ask HN: How can you buy high quality healthcare?
#73So, other medical systems around the world are cheaper, but that doesn't make them magic. Chronic pain - especially back pain - is often an unsolvable quagmire for most doctors. Not a doctor, but several family members have had to go through something similar. So here is my advice: - Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherent…
By “Fitness Instructor” I think you mean “Physical Therapist” (and definitely not a Chiropractor). In the US, a fitness instructor can be literally anyone who runs an aerobics class, while a physical therapist actually has medical training.
No, I mean a fitness instructor. Or perhaps a "personal trainer". There are certain certifications that exist (And some people are both trainers and physical therapists).
In my (limited) experience, physical therapists tend to have much broader recommendations. Like a PT might tell you to walk an hour a day, but a trainer might recommend a specific kind of crunch that targets the actual muscles in question.
And to OP's point, PTs are very much ingrained in the US medical system and consuming their services can be a pain in itself.
But the guys who get professional athletes back on the field every week are for the most part just personal trainers with a master's level education in sports science. THOSE are the guys you want to help your back recover.
Re: Ask HN: How can you buy high quality healthcare?
#74It depends on the tests. Urgent care centers can sometimes get you seen more quickly and do more tests on site. Scheduling the other tests at outpatient facilities that strictly do them (like Akumin) can have better prices and schedules.
None of this is a perfect solution though. It can take time to find the issue. Going to places with a high reputation for the area of the issue can get faster results.
Just recently I had an xray, blood work, and an ultrasound for unexplained swelling in my chest and armpit. They still don't know what it is and don't care to investigate farther. The only theory I have to go on is that it may be a medium/long term reaction to the Covid vaccine. I didn't even think of that until the ultrasound tech ask which side I got my shots on. Apparently short term swelling like this is normal enough that women are told not to get mammograms for some time (weeks) after receiving it. Additional research found this, which sounds very similar but in a different location.
https://pubmed.ncbi.nlm.nih.gov/35049235/
At least it's not cancer. Although I'm hesitant to truly believe that until a cause is found.
Re: Ask HN: How can you buy high quality healthcare?
#75Direct Primary Care might be a good place to start: https://www.dpcare.org/ I gave it a try last fall, and the difference is night and day: my current Dr actually works for me, whereas the last one very obviously worked for my insurance company. Rereading your post, this is exactly what you want. He had me do a whole bunch of tests right off the bat and set about optimizing different things. His job is to keep my bod…
Highly recommend this as I have one to. The issue though is there are limits as to what they can do. If you have an issue that is above their capabilities you'll be referred to a specialist.
This is the part that stinks as then you'll be bundled in waiting for the specialist to contact you, run their tests, and normally in a larger hospital group. So you'll be treated as a number again.
Re: Ask HN: How can you buy high quality healthcare?
#76So, other medical systems around the world are cheaper, but that doesn't make them magic. Chronic pain - especially back pain - is often an unsolvable quagmire for most doctors. Not a doctor, but several family members have had to go through something similar. So here is my advice: - Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherent…
It's worth keeping in mind that the quality of Xray and MRI machines vary greatly and the facility doing the scans typically won't be upfront with what machines they're using. You are the only person who is ever going to advocate for the treatment you get so you'll need to be very firm but polite to get this information.
In Eastern Europe they often advertise the make and model (and some weird specs like Teslas) on their web site, if it's a good one
Re: Ask HN: How can you buy high quality healthcare?
#77So, other medical systems around the world are cheaper, but that doesn't make them magic. Chronic pain - especially back pain - is often an unsolvable quagmire for most doctors. Not a doctor, but several family members have had to go through something similar. So here is my advice: - Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherent…
It's worth keeping in mind that the quality of Xray and MRI machines vary greatly and the facility doing the scans typically won't be upfront with what machines they're using. You are the only person who is ever going to advocate for the treatment you get so you'll need to be very firm but polite to get this information.
"and the facility doing the scans typically won't be upfront with what machines they're using."
All one has to do is ask. I've even had scheduling assistants ask me what power of machine the doctor wanted.
Re: Ask HN: How can you buy high quality healthcare?
#78Earlier quoted context omitted.
It's worth keeping in mind that the quality of Xray and MRI machines vary greatly and the facility doing the scans typically won't be upfront with what machines they're using. You are the only person who is ever going to advocate for the treatment you get so you'll need to be very firm but polite to get this information.
In Eastern Europe they often advertise the make and model (and some weird specs like Teslas) on their web site, if it's a good one
Teslas aren't really a weird spec. In general they correspond to a better level of detail, which could be necessary for certain imaging/conditions.
Re: Ask HN: How can you buy high quality healthcare?
#79Earlier quoted context omitted.
Be aware that if you travel to India, you will almost certainly need to bribe people during the travel process. It's something westerners tend to be really uncomfortable with and usually stresses them out.
Can you elaborate? I get that there is huge transactional corruption but you probably should almost never have to deal with cops/government officials there.
Traffic stops may target you if you look like a tourist. It's like a $10 bribe
Re: Ask HN: How can you buy high quality healthcare?
#80So, other medical systems around the world are cheaper, but that doesn't make them magic. Chronic pain - especially back pain - is often an unsolvable quagmire for most doctors. Not a doctor, but several family members have had to go through something similar. So here is my advice: - Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherent…
By “Fitness Instructor” I think you mean “Physical Therapist” (and definitely not a Chiropractor). In the US, a fitness instructor can be literally anyone who runs an aerobics class, while a physical therapist actually has medical training.
So, you're definitely right- go to someone with actual medical training first. But a physical therapist's job is to get people back to basic functioning. From there, a good fitness instructor can help a person with stretching, light exercise and strength training, and stuff like posture/positioning and meal planning to maintain and improve on the initial work put in with the PT. A fitness instructor/coach is a fraction of the cost of a PT, and if you maintain a good relationship, you can just kind if drop in for guidance as needed vs going to weekly dedicated sessions.
But yeah, they can be literally anyone. A good one understands simple (bio)machines and pays close attention to how a body moves AND is a good teacher.
Edit: "A PT will get you to functional, a fitness instructor will get you to capable"