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.

  • 8/23 – Tear my ACL
  • 8/24 – Go to walk in clinic, see nurse, doc + bonus sports medicine doc. Misdiagnose as just an MCL tear
  • 9/30 – Check up. At this point my knee feels a lot better, but it is still very unstable at times. Stick with misdiagnosis of just an MCL tear.
  • 12/5 – Go back to sports med doc.
    • Explain that the knee is still very unstable, and despite the MCL healing, something else is still very much wrong.
    • Suspect and diagnose as ACL tear
    • Also have an x-ray here for no reason besides the insurance company said so
    • Schedule an MRI for 12/12 to confirm ACL tear
  • 12/12 – Have the MRI
  • 12/14 – Have the MRI follow up back with the sports med doc
    • Get a referral for ACL surgery
    • Schedule pre-op for 1/15. The doctor doing the surgery is 1.5 hours from where I live, and holidays plus a couple work trips forced this out a month
  • 1/15 – Have pre-op appointment.
    • Also realize there was no reason to drive 3 hours round trip for this pre-op appointment. Could have been done on the phone.
    • Get even more mad when I realize that I had to wait to schedule the surgery till after the pre-op appointment, and if the pre-op appointment could have been done on the phone, it could have been done a month ago!
  • 2/2 – Have surgery

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:

  • Sunday – Tear your ACL shooting hoops at the park
  • Monday – Identify that you tore your ACL. Schedule surgery for next Thursday.
  • Wednesday – Pre-op visit over the phone or via video chat
  • …limp around for a week
  • The next Thursday – Have surgery and get those sweet disappearing stitches

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.