Second Guessing a Physician’s Two Cents Can Save You Much More: A Summary of an Advance Medical Case

by Steven Chisholm

With inpatient costs, consultation fees, and an array diagnostic exams, orthopedic surgery can be a heavy financial burden, oftentimes costing hundreds of thousands of dollars. Furthermore, ensuring one chooses a reliable orthopedic surgeon, arranging transport to and from the hospital, and purchasing postoperative supplies can be a painstaking process. That’s why some patients prefer to exhaust all methods of conservative management before they resign to surgery.

A young man in his mid-40s recently approached Advance Medical advice with similar concerns. The patient had been suffering from left hand and wrist pain since 2015, which included symptoms of intermittent numbness. The patient underwent a series of imaging, resulting in multiple diagnoses such as moderately severe left carpal tunnel syndrome, arthritic changes in his wrist, a small ganglion cyst, and Kienböck’s disease, a painful condition where blood supply to one of the carpal bones is disrupted, resulting in bone death (avascular necrosis). Additionally, a cervical spine MRI, performed due to a history of intermittent neck pain, showed evidence of degenerative disc disease.

Due to the compilation of findings, his physicians recommended cervical spine surgery to decompress a pinched nerve, with the hopes that it would result in some pain relief.

However, when he presented his case to Advance Medical and received an Expert Medical Opinion under the care of a Physician Case Manager, Dr. Anuli Mkparu, and two orthopedic experts, he received a different and far more beneficial recommendation.

The experts at Advance Medical first recognized the needlessness of the cervical spine surgery. It was explained that degenerative changes are a very common finding, and although he has subtle pain as a result of the changes, conservative measures exist that would alleviate his pain, such as physical therapy and epidural steroid injections.

Furthermore, though the patient had several abnormalities present in his hand and wrist imaging, none of the identified conditions call for surgical intervention. It was noted that the ganglion cyst was a result of the arthritic changes in his wrist, as is a common phenomenon of arthritis, whereby the treatment merely consisted of over-the-counter anti-inflammatories. He even had a favorable prognosis in light of the carpal tunnel syndrome and Kienböck’s disease, considering the routine treatment for carpal tunnel syndrome is the use of a night splint and the process of Kienböck’s disease has a tendency to reverse itself with time.

With these recommendations backing a wait-and-see approach, Advance Medical was able to reduce the patient’s procedure cost from $195,000 to $600, a net savings of $194,400. Although the experts noted the unlikely need for surgery should the symptoms worsen, they explained there was no current indication that surgery is or will be required.

Although surgery often seems the only solution, especially when symptoms have been present for years, it is usually a decision made from desperation — a gut reaction when one jumps to conclusions without weighing the non-invasive interventions. In such cases, second opinions are essential in preserving quality of life, mitigating the risks of unnecessary surgeries, and drastically reducing procedural costs.