I’m Fine, Thanks

Jim Molpus, for HealthLeaders Magazine , May 9, 2008
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I am costing the healthcare system too much money. Potentially, at least. I haven't used excess healthcare resources yet, but the system wants to make sure that I don't. A while back my health insurance plan sent a nice note informing me that a nurse would call to help me manage my lower back pain.

Spines are perfectly designed to offer humans the ability to run, flex, and throw a spear, yet we use them to perch on nothing more mobile than a desk chair. After years of such abuse, spines start to send signals that they are unhappy. After a month or so of ignoring mine, I found myself in the orthopedist's office with a bunch of X-rays.

“Well, we could get an MRI and see what is really going on there and think about surgery,” the orthopod said. “Or I could prescribe cortisone. Or we could just keep it simple and see what physical therapy does.” The diagnosis was sciatica, which one of my friends was kind enough to point out either made me an old man or pregnant.

The simple plan turned out to be four weekly visits with a physical therapist that showed me some stretching and strengthening exercises that worked quite well. She emphasized good posture and the benefits of getting up off the desk every now and then to walk around.

Still, a few weeks and a lot less Advil later, I got the letter from the health plan to sign me up for some coaching. As a healthcare journalist, I can see the reason why they would want to manage my health. A recent study in the Journal of the American Medical Association found that we Americans spent $86 billion on spine treatments in 2005, a 67% increase from 1997. That same study concluded that despite the increase in expenditures, age-adjusted outcomes for back pain showed no improvement. I was—at least to them—at a decision point where I could have gone down an expensive path with no promise of a reliable outcome.

Like most middle-age Americans, I spent my 20s and 30s in the days of the HMO gatekeeper, but I rarely needed my care to be actively managed because I was still young and invincible. Now that I am aging faster than a tomato left on the sun porch, healthcare is looking to protect me from my own potentially bad decisions. While that uninvited interaction is helpful, even friendly now, I can't help but wonder how the tone will surely change. Will the middle-aged guy who gets the first twinge of back pain in 2018 get a nice letter, or a notification? Will today's offer of help be tomorrow's denial of service?

Jim Molpus

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