I've been dealing with a serious health issue that is a major problem in my life, I am in constant pain, I can barely work. My experience with the US healthcare system has been abysmal - I go to a doctor, the doctor sends me to get tests, it's 3 weeks, after that another 3 weeks to see a specialist, 3 weeks more for more tests, etc, etc. I've been ping-ponged around for 4 months with little progress in terms of diagnosis.<p>I'm sure that there is a way to buy better healthcare. Surely Satya Nadella doesn't have to go through this. What I would love to do is pay a large amount of money ($50K out of pocket not counting insurance for just the diagnosis) and go through all of the doctors/tests in two weeks. Does anyone know where I can do that? The US would be best, but can travel internationally for this too.<p>Would appreciate any pointers people might have, I don't even know what to Google. If necessary, the issue is neck-spine related, relevant doctors might be neurologist, rheumatologist, spine surgeon, etc.
So, other medical systems around the world are cheaper, but that doesn't make them magic. Chronic pain - especially back pain - is often an unsolvable quagmire for most doctors.<p>Not a doctor, but several family members have had to go through something similar. So here is my advice:<p>- Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherently obvious and doctors are sending you down obscure test panels, cut bait early - they're out fishing and you shouldn't expect anything worthwhile.<p>- For back pain, there is almost no medical solution other than surgery. If surgery is optional, don't take it. The recovery from a back surgery is brutal and long and can come with unintended consequences.<p>- <i>Talk to a fitness instructor</i>. Especially one with a formal education. This is the most underrated option - these are the true experts on kinesthesiology and recovery. You'll be surprised how much good advice they can give you in a single session - identifying which sets of muscles can be developed to take strain off your back, giving you targeted workouts to try, pain management techniques, etc.<p>- Patience. My father-in-law spent a year recovering from back problems. Despite trying every medical intervention under the sun, his recovery ended up taking exactly as long as his original doctor said it would. But the important thing was lifestyle interventions to prevent reaggravating the problem.
Concierge healthcare. It's also gotten more widespread than when it first became a thing, so even there I would make sure to do due diligence to see what level of service you're getting. But if you're willing to fork over the money, the level of care that you're supposedly given seems far better than even anything in stories you hear about in Europe or Asia.<p>Seems like you should expect to pay five digit amounts per year for the privilige though, in addition to fees per visit/service?<p>This is the kind of thing where I feel that if you are making FAANG tier salary in the US, you can bulldoze your way into getting better quality of life benefits privately, than someone living in say, Europe who would be making a fraction of your earnings but with better publically provided benefits.
Private clinics/hospitals in Europe can do this, and I'm assuming at a lot less of a price than 50k. I always go to private clinics in Europe and for getting your entire body tested costs, in Estonia, maybe a few thousand USD. I recommend Confido (<a href="https://www.confido.ee/en/" rel="nofollow">https://www.confido.ee/en/</a>). No health insurance or residency or anything required, just make an appointment, and pay for it. That's it.<p>In Spain I was very happy with Sanitas (<a href="http://sanitas.es/" rel="nofollow">http://sanitas.es/</a>).
My Dad had something similar to what you want done at Mayo clinic. It was more of a pre-emptive high tech complete check up that took several days. He got MRI's, stress tests, etc. They received and discussed results throughout the process.<p>My wife just went through a serious spine/back problem. Our experience was that the turnaround between visits is so slow because the specialists are in such high demand. She is in recovery now but the time from first onset of symptoms to recovery was six months.<p>My suggestion is find a good doctor that specializes in managing pain to make the waiting more bearable. In my mind, a pain doctor was someone who hands out opioids and gets people addicted to drugs. Nothing could be farther from the truth. There are tons of effective treatments for pain that don't involve opioids. These range from cortisone shots to drugs that target specific nerves.
Look into medical tourism if that's an option for you. Country like India is a great choice for the money. They have excellent hospitals and doctors for a fraction of the cost of US healthcare. I say this as an Indian American who has lived in the US for half of my life. Don't be fooled by "Oh India is 3rd world". Not when it comes to Healthcare (if you have some money which will always be much less than what you need in the US), telecommunications and banking.<p>US is just not an option if you cannot deal with Insurance or don't have enough money. Unfortunately.
The term you're looking for is "concierge healthcare". Check r/fatfire for recommendations - the abysmal state of US healthcare is a frequent topic of discussion.
Direct Primary Care might be a good place to start: <a href="https://www.dpcare.org/" rel="nofollow">https://www.dpcare.org/</a><p>I gave it a try last fall, and the difference is night and day: my current Dr actually works for me, whereas the last one very obviously worked for my insurance company.<p>Rereading your post, this is exactly what you want. He had me do a whole bunch of tests right off the bat and set about optimizing different things. His job is to keep my body working well, and he takes it seriously. In-network docs are, in my experience, mainly about hitting arbitrary metrics imposed by insurance companies.
For something in the neighborhood of $50k you can sign up with a concierge medicine practice such as md2. You would get an excellent primary care doctor with great connections who is able and willing to coordinate and expedite all your care. It doesn't scale to the broad population, it's not efficient, etc. but in the U.S. you can get excellent, timely care with no compromises as long as you're rich.
I'd apply to be seen at the Mayo or Cleveland clinic. While it sucks that there is a patient selection process, once you are in, they can line everything up, over a a few days, and get you an answer - at least all the testing will be done. They do have telehealth options and I found the digital experience compelling.<p>I'd second the medical tourism, but I've never done it myself.<p>I'm a patient at the Mayo.
Since many folks have mentioned medical tourism, I'll mention three other options.
1) Forward Medical - I have had nothing but good experiences with them but they are not going to solve, just help diagnose & are a replacement to primary care.
2) Working from your symptoms to try to find a community online that has built up around this. There are several, I know that I listened to a notable podcast recently about the person figuring out their diagnosis related to lyme disease when doctors couldn't figure it out. Once you figure out a pathway, then you find a specialist and test yourself. Doctors are not great at looking outside the box for stuff, so if you have something uncommon it's going to be hard.
3) Related to 2, once you have an idea, connect with some top doctors, especially researchers at top tier institutions (think Stanford, Zuckerberg hospital, Mayo, top clinics (one in Berlin I can't remember), etc. Maybe ask a friendly doc to also post on Sermo for you (a medical focused social network) to get a broader audience. I just read the new Michael Lewis book about the pandemic and there's this guy Joe DeRisi at UCSF whose lab I guess basically looks at absolutely crazy things and fields requests all the time, might be worth calling although it's a long shot.<p><a href="https://profiles.ucsf.edu/joe.derisi" rel="nofollow">https://profiles.ucsf.edu/joe.derisi</a>
If you're willing to read a book, I can recommend Back Mechanic:<p><a href="https://www.amazon.com/Back-Mechanic-Stuart-McGill-2015-09-30/dp/B01FKSGJYC" rel="nofollow">https://www.amazon.com/Back-Mechanic-Stuart-McGill-2015-09-3...</a><p>It gives you a lot of information so you can a) intelligently talk about your pain to your providers and b) build up strength and flexibility in your back to hopefully address the issue on your own.
If you are open to medical tourism, from experience would recommend Mexico private healthcare.<p>I have been very impressed with private facilities and doctors. Out of pocket costs are very affordable including lab and imaging (ultrasound, CT, and MRI). No insurance needed as long as you have proof of payment. They may request this for intensive surgical operations etc.<p>Another benefit is results are immediately given to you, for example say you got a CT as hospital/provider A and want to see a specialist in B, no problem just bring the findings/imaging with you. No filing petitions to get your own medical records which you may or may not get in 2-3 weeks....if they honor it, then have to file HIPPA requests etc. All this wastes time, normally in weeks in the US.<p>A thing that completely surprises me is the doctors provide their cell phone number, so if you have issues after hours or weekends, or they receive lab results and want to provide a recommendation, after hours, just a message away. I wish we did this in the US.<p>One of the better things since you are self pay is to not deal with insurance. Want to try a different medicine, don't need approval for that. Want a second opinion, don't need to run it by insurance.Is this facility/doc in my network?, no worry there. You control the entire experience.<p>My recommendation is to look for cities that are expat hot spots as they have medical tourism facilities, normally all speak English including the local people to cater to expats. Yucatan, Quintana Roo (cancun) and I think Jalisco.<p>If you are interested in more info please email me, email in my profile. My SO has problem and we have played the bounce around game along with a few ER visits mixed in. Few things are more frustrating then experiencing the US medical system first hand with no results and being helpless. Best of luck!
<i>Do not underestimate private clinics in Europe.</i> They saved my life after multiple rounds of doctors in the Washington D.C. area could not prevent me from getting repeated ear infections which led to eventual moderate hearing loss. The clinicians in a central European country took a fundamentally different approach to diagnosing me and resolved my health issue rapidly. I spent years of my life going to a dozen doctors in the Washington D.C. area without resolution prior to this. Give medical tourism a shot, it is legit.
Another more traditional approach, similar to concierge medicine, is executive medicine.<p>I think a lot of the big medical universities offer something like this:<p><a href="https://www.emoryhealthcare.org/centers-programs/executive-health-center/index.html" rel="nofollow">https://www.emoryhealthcare.org/centers-programs/executive-h...</a><p>They have the connections and services available to do it all in-house and thus can make diagnosis' quicker.
I feel you. My ex girlfriend had chronic pain and the US health system is terrible dealing with this. You go from tests to tests, surgeons quickly want to do their favorite procedures and otherwise they happily give you hardcore painkillers.<p>Two pieces of advice:<p>- Find a pain specialist who treats you like a real human and not just a science experiment or revenue source. there are some but not many<p>- My company produces implants for Spinal Cord Stimulation. The main indication is chronic pain that can't be treated with other means. My ex has one of our implants and it got her from seriously contemplating suicide to a good quality of life. A lot of doctors don't recommend the devices based on experiences a long time ago but the tech is way better now. The implant process is fully reversible unlike most surgeries. The main players in this area are Nevro, Boston scientific, Medtronic and Abbott (I work for one of them). Please look into it. I know several people who got their lives back with SCS.<p>Hope this makes sense.
I believe I remember hearing that the Mayo Clinic does an extensive multi-day health checkup. They essentially shuffle you from specialist to specialist and you get a full thorough look over. I believe it’s the kind of thing that high level executives get done to make sure they’re healthy. Might be worth checking out.
Sounds like you are paying for what the NHS in the UK will offer - they'll get you there but it is often slow and quite convoluted, but it is free!<p>Private care in the UK can be very fast - e.g. I went from an initial consultation with a doctor for "knee pain" to having two sessions with a consultant and an MRI complete and booked in for physiotherapy within 48 hours. Things are often done the same day or within 24-48 hour turnarounds, although sometimes you can only get seen by specific consultants on certain days (e.g. they only see people on wed + Fri etc) . I am not sure what the on-ramp for that is as I go through my work health insurance but presumably you can just pay out of pocket.<p>www.hcahealthcare.co.uk seems to be what everything my healthcare insurance (from a BigCo) goes through, so could be worth starting there if you fancy a visit to the UK.<p>Good luck.
Depending on the pain, you may want check out Dr. Sarnos book “the mindbody prescription”. I found it a few months ago on the urging of other online commentators when dealing with debilitating wrist and back pain. After reading it and applying his plan my pain disappeared.
You might want to contact the Mayo Clinic (particularly at the MN location) and see if they have what you are looking for.
For example, they tend to do programs for executives where they get a comprehensive physical over a few days:
<a href="https://www.mayoclinic.org/departments-centers/mayo-clinic-executive-health-program/sections/what-to-expect/gnc-20253339" rel="nofollow">https://www.mayoclinic.org/departments-centers/mayo-clinic-e...</a><p>In general, I've heard they are good at getting multiple tests done and multiple visits with specialists quickly.
I suppose it depends on your general health, medical history and what actually happened to you. Did you have an accident or is it just wear and tear, have you looked after yourself. You don't provide much information so it's hard to know if you're an athlete or are 200lbs overweight. Back and neck problems can be resolved in all kinds of way or may never be resolved. If it was me (and I do have a few issues), I'd move as much as possible, stay healthy, avoid pain medication, do yoga or pilates, use hot and cold and see a good physio and massage guy.
I've see this kind of service offered in a few private hospitals in Lithuania. So basically they assess you and depending on the complexity/uncertainty of the problem, they'd form a panel of specialists to discuss the case,etc. This allow to skip that idiotic chain, where you bounce like a ball from one doctor to another whilst none of them talk to each other. I don't know your condition or budget, but I think there are quite a few countries in Europe where you'd get something like this.
1. Concierge Medicine is the answer, as others have said.<p>2. In the meantime, or if concierge medicine isn't available, you can contact your insurance company and ask them to assign a care coordinator to help you get the maximum benefit from your providers. <a href="https://www.webmd.com/health-insurance/terms/care-coordinator" rel="nofollow">https://www.webmd.com/health-insurance/terms/care-coordinato...</a>
I'm not sure if they do diagnostic work or just procedures, but the Surgery Center of Oklahoma is an interesting cash-only option. I know there are a number of similar operations. Concierge medicine is industry term doctors who directly bill patients for very personal care and skip insurance. Kinda like having a lawyer on retainer.<p><a href="https://surgerycenterok.com/pricing/" rel="nofollow">https://surgerycenterok.com/pricing/</a>
You can find a lot of world-class private hospitals in Turkey. They are quite cheap, because of the decreasing value of Lira, have great doctors, and short waiting periods.
Consider seeing a doc or PA/NP in Physiatry. They tend to take a much more holistic and thorough approach to diagnosing issues, including neck-spine related pain.<p>Physiatry is a small specialty which most folks have not heard of. I'd encourage you to research the specialty and what it's about at the very least.
I highly recommend that you checkout Christian Medical College, Vellore in India. It's a multi-speciality hospital and college of high repute in Asia with 2000 doctors and 3000 nurses - <a href="https://www.cmch-vellore.edu/" rel="nofollow">https://www.cmch-vellore.edu/</a>
I've heard you can go to thailand and pay cash, but that was more for cosmetic stuff or simple things like amputations not complex stuff like cancer treatment (or really anything where the barrier is the drugs rather than skilled surgeon + access to antibiotics)
It depends on the tests. Urgent care centers can sometimes get you seen more quickly and do more tests on site. Scheduling the other tests at outpatient facilities that strictly do them (like Akumin) can have better prices and schedules.<p>None of this is a perfect solution though. It can take time to find the issue. Going to places with a high reputation for the area of the issue can get faster results.<p>Just recently I had an xray, blood work, and an ultrasound for unexplained swelling in my chest and armpit. They still don't know what it is and don't care to investigate farther. The only theory I have to go on is that it may be a medium/long term reaction to the Covid vaccine. I didn't even think of that until the ultrasound tech ask which side I got my shots on. Apparently short term swelling like this is normal enough that women are told not to get mammograms for some time (weeks) after receiving it. Additional research found this, which sounds very similar but in a different location.<p><a href="https://pubmed.ncbi.nlm.nih.gov/35049235/" rel="nofollow">https://pubmed.ncbi.nlm.nih.gov/35049235/</a><p>At least it's not cancer. Although I'm hesitant to truly believe that until a cause is found.
Qualify for Medicaid or stay alive long enough to qualify for Medicare.<p>In the USA you'd have no problem walking into most doctor's offices and offering cold cash. They'd fall over each other trying to get you as a patient.<p>Cash is still king.
I went through something similar over decades with my migraines. "I don't believe you're in pain. Men don't get migraines." I heard, far too often.<p>This is not medical advice, but just what I would do in a similar situation.<p>I'd go in knowing I'm going to have to keep at this constantly until I'm on a treatment regimen that handled it well, for starters.<p>I can usually have mixed results speeding things up saying I'm ready to pay right now with a card for whatever medication/test. If someone's unavailable for scheduling then call around to every other place. Call out of the area if needed. Like you would call around for a dentist if you needed a root canal or crown asap.<p>Edit-Oh, also, the best time to call providers is 7-8 am on Monday or when ever they first open on their first day of the week. The worst time is anytime else, with within an hour of closing being a far maybe. But be persistent regardless, and especially if start of business Monday is too far away.<p>For back pain I'll try to outline some options for relief in the meantime:<p>-Try this shortly (20 minutes) and see whether it feels better/worse: Get something that does "far infrared" heat and try it on your neck/spine. You want to be careful to not overdo it on the heat though so use a towel between you and the heat and look for redness. Redness should be avoided. A low-cost/immediate way to try out far infrared are the instant hot packs sold at corner stores like Walgreens/CVS. Try to get the ones that are made with iron. They're basically a slow exothermic reaction that can last 8 hours+.<p>-Cold might work if hot doesn't.<p>-Lidocaine patches ("salonpass"/"icyhot") might help, too. Again, try temporarily (10-20 minutes) and see how you react to it. There are even sprays or gels (think, for sunburn) that can help locally fend off pain a little.<p>-A TENS unit has helped with muscle spasm pain for me before, too, but I had to leave it on the area for about an hour. Edit-look at some anatomy pictures for what muscles to target.<p>-A physical therapist might actually be able to help you. Look for good ones that are obviously kept up to date on things. I had one mixing ultra sound and TENS on my back and it helped immensely. The TENS made it so I could feel the ultrasound vibrations. You want to go to them to make sure you're doing stretches with proper form. X-Rays and such will help them know what to target.<p>Good luck, chronic pain in America is both common and not always treated equally.
Honestly, your wait times sound really fortunate. I’m currently in a 4-month wait to see a specialist and a 9-week wait for some standard imaging tests. (The imaging tests were delayed by staff scheduling errors combined with staff absences.) I sympathize, but also think you have it relatively good! There seem to be some issues with staffing shortages throughout the medical industry right now (possibly combined with an increase in demand now that many people are less fearful of Covid).<p>I don’t have any advice except to pester the scheduling staff at every turn (which is easier said than done when most places try to divert you with an automated phone tree ending in the option to leave a voicemail). It’s aggravating for sure. I have no doubt that people are dying who wouldn’t have if they had received more timely care.