I Broke Eight Bones. Here’s How I Avoided Surgery
(Bloomberg Businessweek) -- On the afternoon of Sunday, Oct. 6, I was finishing a 50-mile bicycle ride to Cold Spring, N.Y., when weeds from the roadside got tangled in my wheels. I lost control of the bike and hit the pavement hard, breaking my clavicle, six ribs, and pelvis, and puncturing my right lung. My helmet, which cracked, saved me from a head injury. (X-rays also found cracks in two thoracic vertebrae, which briefly worried the doctors, but those might have been old injuries, so I’m not counting them.)
The next day, as I lay on my back in the intensive care unit with multiple tubes and wires sprouting from my pain-wracked body, the Journal of the American Medical Association published an article estimating that waste in the U.S. health-care system costs $760 billion to $935 billion a year, or roughly a quarter of total spending.
I did not read the JAMA article that day. Merely breathing with a cracked rib cage and a partially deflated lung was hard enough. But like everyone who has ever spent a week in the hospital, I now consider myself an expert on what’s right and wrong with the health-care system. So I would like to share a thought about one aspect of that JAMA article—the estimate that $76 billion to $101 billion is wasted annually on overtreatment or low-value care.
I would say that I did not contribute to that waste. Although I was treated in a regional trauma center with all the fancy equipment, my doctors took a conservative approach. After closely studying X-rays and (costly) CT scans, they concluded that all my bones would heal without surgery. All I needed to do was rest and take pain medication, mostly Tylenol. The only operation was to insert a pigtail catheter to suck air and fluids out of the space between my lung and my chest wall, giving the lung room to expand to normal size. That was essential because you can die from a collapsed lung.
I got a chest X-ray every day to observe the lung’s progress. And I was given a plastic toy—called an incentive spirometer—that looked like the strongman game at a carnival. I was instructed to suck in as much air as I could, trying to make a blue disc rise to the top of a calibrated cylinder. Retail price: about $8.
As far as I can tell, the conservative, nonsurgical approach the doctors took was standard for my injuries. And I was fine with that. It wasn’t a financial issue for me because I have good health insurance through Bloomberg. (Thanks, Mike.) It was more about avoiding the pain of invasive operations, the extra time in the hospital, and the risk of complications from surgery or hospital-acquired infections. As it is, my week in the hospital is going to cost someone a bundle.
Letting nature take its course has worked out so far. My ribs are mostly healed, although they still hurt if I cough or sneeze. The acetabulum of the pelvis—the socket in the hip’s ball-and-socket joint—doesn’t hurt anymore, but I’m told I’ll need to use a wheelchair for a few more weeks. After I showed that I could transfer safely from bed to chair, the docs let me go home instead of to a rehab facility, saving thousands of dollars and much distress. Cost of readying our home: $80 for a shower chair, $30 for a cane, and $75 a month for a rented wheelchair.
Most of the remaining pain is in my shoulder. The doctors told me they could reset the clavicle with screws, plates, wires, or nails, but advised against it. We’re letting the two broken ends of the clavicle fuse naturally. The ends overlap, so my right shoulder will be permanently narrower than my left, but I should regain full range of motion. And I’m already typing again with both hands.
In May, before crashing my bike and becoming an overnight expert on the American health-care system, I wrote about a pair of studies in JAMA Internal Medicine which found that many drugs don’t work as promised. An author of one of those papers, Dr. Vinayak Prasad of Oregon Health & Science University, co-wrote a 2015 book, Ending Medical Reversal: Improving Outcomes, Saving Lives. He wrote that some practices which were once widely accepted have since been found useless or worse—for example, estrogen replacement for postmenopausal women, stents for stable coronary-artery disease, and high-dose chemotherapy and stem cell transplantation for women with breast cancer.
I’m not kidding myself that a conservative approach to treatment will solve every problem of the health-care system. For some conditions, aggressive, costly treatment is the best or even the only option. But I feel good knowing that in my case, at least, less has been more.
To contact the editor responsible for this story: Eric Gelman at firstname.lastname@example.org
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