How many visits does it take to get an ACL done?

Posted April 6, 2018

In August, I tore my MCL, ACL, and possibly my meniscus. Of course, I didn’t know at the time; I was just in a terrible amount of pain, and couldn’t put any weight on my left leg whatsoever.

Since that day it has taken…

5 months
4 visits to the sports medicine doctor
1 trip to the MRI place
1 totally unnecessary x-ray
3 hours of driving for a pre-op appointment that could have been done over the phone to finally get to my surgery date, which is scheduled for this Friday.
1 surgery

What took so long? Here’s a summary.

Who are we optimizing for?

I want to be clear. At every step of the way, I’ve enjoyed the people I’ve been working with. The nurses, doctors, schedulers, and everyone else have all been lovely.

However, this is clearly not a system setup with the patient in mind. Every part of this process feels like it’s been optimized for someone other than me. Note that even after correctly diagnosing the ACL tear, it still took 2 months to get to surgery! When you step back and look at the system and the process as a whole, you start to see waste everywhere. And now that I’ve seen it, I can’t stop seeing it.

What if we optimized for the patient?

It might look something like this:

So so many problems. And this is just an ACL.

It’s easy to misdiagnose. The tests that are definitive are often also expensive. Patients have to give up hours of their life for 5 minutes of time with a doctor. Even for a visit with my doctor that is 10 minutes from my house, it takes at least an hour every time. Doctors end up being gate keepers for the treatment that everyone knows is needed. Why do I have to have a follow up with my doctor just to have him tell me the results of my MRI? Send them to me directly and let me get on with the surgery!

No one knows the full picture. To get an accurate understanding of how much my surgery is going to cost, in my experience, is impossible. The doctor doesn’t know which codes they will be using yet, so they can’t even say how much they’ll bill for. And the insurance company needs to know the codes in order to say whether I need pre-authorization for the surgery and what my out-of-pocket would be. And the insurance company doesn’t yet have all the claims for all my doctors visits, so they don’t know how much of my deductible I have used. And…yada yada yada. It’s impossible to shop or be a rational consumer.

This is just for a torn ACL. Think about what this would be like for someone with a much more serious problem. Everything I experienced would be multiplied a hundred times over for someone with a life threatening disease, or a chronic problem they have to deal with for years.

I believe we can create a better system. Technology and government get most of the buzz in healthcare, but they will only play a part in the transformation. We need a system that is focused on the patients at every step of the way, and that requires a complete shift in just about every aspect of healthcare.