True story. Diabetic develops sudden infection in his foot. Over the course of three days the lateral/distal part goes from basically normal with a small chronic wound to red/swollen/fifth toe bluish. He goes to the ER. Blood counts are up, sed rate is up (infection), xray shows no bone infection. A podiatrist—foot surgeon—is consulted. His prescription---schedule surgery to remove half the foot, because obviously there is a infection in the bone and part of the fifth metatarsal and all of the fifth toe have got to go. He cancels the MRI request. He does not need an MRI to know that there is a bone infection. Nope. In the last four years he has taken off 4000 of these lateral fifth metatarsals (foot bones) for infections…
Patient is ready to sign on the dotted line, except a friend with medical training says “Hold on sec. Why not get the MRI? Just in case it isn’t a bone infection? Maybe it is a cyst instead. It sure sounds like a cyst. Maybe you can save your fifth toe (which you don’t really need to walk) and half your foot (which you really do need to walk)?”
So the diabetic decides to be a bad patient. He demands the MRI that his surgeon refuses to order.
“It’s a waste of a $1000. It will only tell us what we already know.”
“I’ll pay for it myself,” says the diabetic.
“Oh, I am sure you’re insurance will pay for it,” admits the surgeon grudgingly. “If you want it, ask the internist to order it. I won’t do it.”
The diabetic asks his internist to request the MRI, a very easy to obtain, reliable test which can show right away if a bone is infected. Plain xrays may take up to two weeks to show the changes of osteomyelitis (bacterial infection of bone). The MRI reveals….
An infected skin cyst just as the friend with medical training suspected (there were clues which the surgeon refused to consider). No bone infection. Seems that the surgeon’s xray eyes failed him. Or maybe he was just eager to lop off half a foot along with the fifth toe.
To make a long story short, the diabetic fired that surgeon, got another surgeon, the infected cyst was removed, the metatarsal was saved, the fifth toe was also saved, and that Little Piggy got to cry “Wee, wee, wee” all the way home.
Now, why is the VA better than private practice? At least in my experience, the VA will do everything possible to save a foot even if it means a long hospitalization and intravenous antibiotics. Might have something to do with the fact that no one at the VA has a financial incentive to do unnecessary surgery and every incentive to keep veterans healthy.