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Patients can't afford to blindly trust doctors

March 27, 2015 by MICHAEL DOBIE / michael.dobie@newsday.com

A parable on health care and where we're heading:

Last fall, I had my annual physical. A week later, my internist suggested I see an gastroenterologist. Blood work showed a low hemoglobin level -- 12.3, and anything below 13.0 is a source of concern, he said -- and he wanted me checked for iron deficiency anemia.

That sounded reasonable, so I made an appointment. Then I remembered I had donated blood -- a double unit of red blood cells, as usual -- one month before my physical. You must wait 112 days to donate again to allow your body to replenish the red blood cells, which contain hemoglobin.

I mentioned the donation at the appointment and the staff agreed that could be a factor. But they ordered more blood work and other tests to rule out various things. They also recommended an upper endoscopy -- a tube with a camera and light at the tip goes down the throat into the upper digestive tract -- to check for internal bleeding, one cause of iron deficiency anemia. Again, it all seemed reasonable.

I called for the test results a few days before the endoscopy to make sure it was still necessary. It's a low-risk procedure but is invasive and involves anesthesia. A staffer said everything came back negative but my hemoglobin level was still low and she said the doctor advised I have the endoscopy.

When I asked for the exact hemoglobin level, she said she didn't have it in front of her but repeated it was low and that I should get the procedure. I said OK and hung up.

That was my first mistake.

The endoscopy was routine. The doctor said everything looked good. I asked him what the hemoglobin level was on that second test and he said 12.8 -- a month after the 12.3. Had I known that, I would have postponed the endoscopy and done another blood test in another month. (When I donated again, after those 112 days were up, my level was 15.3.)

I left that afternoon a little aggravated about having had the procedure but relieved that apparently I was OK.

Then the bills started coming. And I realized I had made a second mistake.

Even after my insurer negotiated the bills down, they totaled nearly $4,000. And given the big deductibles so many of us have nowadays, I was on the hook for all of it.

After not insisting on the exact hemoglobin level, and not asking how much the endoscopy would cost, I finally found my voice and complained to the gastroenterology office. And the office, to its credit, listened and cut the bill by more than half.

The moral is that this is where health care is heading. Those big deductibles -- mine is $4,000 -- mean we have a lot more skin in the game. Now it's our money we're spending. We need to ask questions and need to be better informed.

But it's not easy, is it? It rarely is when we deal with someone who knows a lot more than we do, whether that's a doctor or a car mechanic. But when we're sick, and scared, we're a lot more vulnerable.

"We don't know what to ask, they speak a language we don't know," says Ilene Corina, president and founder of a local patient advocacy group. "We as patients have to recognize we can say, whoa!"

Understand, I'm not blaming doctors. Most prefer to err on the side of caution. They don't want to make mistakes. They don't want to miss something. And that's good. But most of us don't want to pay for things we don't need. That means getting information, evaluating risks and making good decisions.

What makes it difficult in health care are the stakes.

So ask questions. What were the results? What's the cost? Will insurance cover it?

"We're hiring these people," Corina reminds.

So I must take charge. I'm the boss. Now I get it.

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