Medically Induced Healthcare Issues

Healthcare can do better....

This weekend I had the good fortune to attend  a wonderful course, Comprehensive Management of Bowel Dysfunction.  As a pelvic health physio, patients with gastrointestinal, digestive, and bowel issues are always challenging.  And the fact of the matter is, if you ask your patients (even the ones coming to see you for their knees), they’d tell you about their bowels.

sitting on table

As much as I love talking about bowel issues, one of the most profound things that I experienced in this class was a completely comfortable, completely pain-free vaginal and rectal exam.  That’s right, even the rectal exam.


It got me thinking about what my patients go through on their quest for health.  The exams they experience, the things that they are told about their condition, and the testing they must endure are unfortunately unhelpful.   Many patients will come into the clinic ‘worse’ after visiting their physician for a recheck, or after undergoing ‘further testing’. Why are the examinations and tests people are put through making them worse?






In our clinic, we’ve started referring to these as ‘medically induced conditions’.

scary doctor

We unfortunately see this often.  Patients traumatized following their medical interventions or hospitalizations or physical therapy treatments.  Why does this continue to happen??  Is it necessary to ‘get worse before you get better’?  Is it necessary to endure further testing?  Here are some thoughts and questions for patients and clinicians to ponder.  I hope it makes clinicians (physios, physicians, anyone touching a patient ever) reflect and reconsider their actions/suggestions/prescriptions.  I hope it makes patients speak up if they’re being hurt.


  1. If you poke anything hard enough, it’ll probably hurt.  This goes double for poking into any orifice.
  2. Poking something hard enough to make it hurt won’t necessarily tell you what to do to help that person.  Especially if the person has already told you, ‘it hurts if this bit gets poked’.
  3. Testing should be done to help rule out red flags, or to help direct the plan of care.
  4. Patients should understand why they’re having a test, and understand how the results will impact their plan of care.cartoon
  5. Clinicians should take the time to make the healthcare experience better.  Make the patient comfortable.  Take the time to explain what you’re doing.  Take the time to answer the questions.  Pay attention to verbal and non-verbal indications that what you’re doing to them is causing pain.
  6. If a patient says ‘ouch, that hurts’, or they’re squirming on the table, stop hurting them.  Take a minute and reflect on what might be happening, and why in spite of your perfect technique this patient is not feeling better.
  7. If a patient isn’t getting better, doing whatever you’re doing harder, deeper or more often isn’t likely the answer.

I have a hopeful heart, that even when patients have negative healthcare experiences, the healthcare practitioners are basically good people with good intentions.  There are a lot of us who also fancy ourselves to be wonderfully qualified:  specializations, advanced degrees, conference and course attendance trying to acquire  new knowledge, new skills, and new evidence to educate those patients.  Professional development (heck, learning in general) should be life-long.  However that knowledge should not replace common sense and good manners.

What does healthcare really cost??

  This morning a potential patient called to cancel her evaluation, because Entropy Physiotherapy is a cash practice, and not covered by her insurance.  It surprises me how much this still stings.  We created Entropy Physiotherapy to provide expert care at an affordable, transparent price.  So I decided to do a little recon work, and see if our efforts to make good care affordable were successful.

I called my insurance company to verify my benefits.  I got through to a representative fairly quickly, but it still took me more than 25 minutes to have him answer 4 simple questions:

  • What are my in-network PT benefits?
  • What are my out-of-network benefits?
  • How do they know if in-network PTs are any good?
  • Do I have different deductibles to meet for in and out of network services?


He had to go look up some of the info, but I actually ended up getting a lot of good  answers.  I’ll do all of the math on another post, but the good news is I have coverage to some degree in and out of network, after meeting my deductible.  The bad news is that in-network ($1000) and out-of-network ($2000) deductibles are separate.

For any readers who don’t know, the appropriate deductible needs to be met before the insurance company will pay anything.  So I’d be having $1000 come out of my pocket, even if I stayed in-network.  That’s a hefty chunk of change.  This led me to 2 more questions:

  • How does an insurance company choose the physical therapists to send their members to?
  • How long will I be in treatment before I meet my deductible?


The nice man at my insurance company could only answer one of those 2 questions.  He said that any provider could go online and fill out the paperwork to become an ‘in-network’ provider.  There is a process, but nowhere is ‘interview’ or ‘review of CV’ listed.  They appear to check and make sure you’re a real person with a license to practice.


I wasn’t’ terribly surprised by this, because Blue Cross Blue Shield of Illinois recently implemented a ‘tier’ system for reimbursement, which currently only applies to private physical therapy practice.   Clinics are arranged into tiers based not on outcomes, or on patient satisfaction, but rather how many visits they saw patients on average.   I’d like to think that my therapist would make the best decision for me for my outcomes.  But the hands of the therapist may be tied by how many visits my insurance would be willing to pay them.

As for the cost of a visit, he had no idea.   He did suggest I see a massage therapist.  And that he thought it was great I running, because it would make my knees stronger, which would help my hips

I decided to find out just what a Physical Therapy evaluation would cost me if I hadn’t met my deductible….

I called 3 different Physical Therapy clinics that were in-network for my insurance.  As a consumer, I’d like to know what I’m paying for any product or service.  As a PT, I’m painfully aware that I’ve had several jobs where I had no idea what my patients were being charged for my services.    So just how much is a Physical Therapy evaluation?  Nobody had any idea.  I was told it would depend on what needed to be done. …  I said just an evaluation….  They still said they didn’t know, but they could guesstimate for me.  Answer from Clinic #1:  $327, but likely I’d only be responsible for $275 after the insurance discount.  Answer from Clinic #2:  $300-$400, but likely only $150 after insurance discount.   Or $114 if I paid cash).  Answer from Clinic #3:  $250-$350, and we should know in about a month what my financial responsibility would actually be.

I’m asking as a Physical Therapist and as a consumer:  Why can’t we find how much a treatment will cost?  There doesn’t seem to be anything else I consume where the price is a complete mystery.   I know how much my dinner is going to cost, as well as how much the bottle of wine will cost.  I know how much my haircut with Ryan is going to cost, and because he’s awesome, I’m willing to pay a little more than I would for a haircut elsewhere.  All very upfront, and I can make my decisions based on what I can afford and what I find value in.  How do we expect patients to accept a randomly selected therapist and sign papers stating that they will be responsible financially for anything that insurance won’t cover (without knowing what services cost, or what insurance will or won’t cover).  In my opinion, we shouldn’t expect anybody to agree to be financially responsible for an unknown amount, and consumers of healthcare shouldn’t accept that ambiguity.