Capitalism is the best. Free enterprise. Barter. Gimbels, if I get mad at the clerk and I say, “Oh, I don’t like this,” how do I fix it? If it gets really stupid, I say, “Suck it up, I’m leaving.” What can this guy do at Gimbels, even if he’s the president of Gimbels? He can always kick me out of that store, but I can always go to Macy’s. He can’t really hurt me. Communism is like the big phone companies. Government control. And if I get mad at the phone company, where can I go? I’ll end up looking like a jerk with a Dixie cup on a string.
Lenny Bruce
This is one of my favorite books from the early 1970s, David Friedman’s ” Freedom Machine.
That thought occurred to me last Wednesday as I lay in bed at Sutter Health in Santa Cruz, waiting for a biopsy to test for prostate cancer.
Here’s what happened: In late April, after experiencing worrisome symptoms and a very elevated PSA score, I went to Community Hospital of the Monterey Peninsula (CHOMP) for an MRI. The test was ordered by doctors at Montage Medical Group, a physician group affiliated with CHOMP. The MRI showed that I likely had prostate cancer. The next step was a biopsy, which the doctors at Montage scheduled for June 11th. It seemed a little late, but what did I know?
As June 11th approached, the biopsy was postponed to July 30th. Again, I wasn’t too worried – prostate cancer tends to grow slowly and I planned to spend two and a half weeks at my vacation home in Canada without worrying about the results.
However, while I was in Canada on July 16th, I got a call from a Montage scheduler saying that the doctor had decided to postpone my surgery until September 24th, eight weeks later. I asked her why the change, but she gave me no explanation.
I decided to follow Lenny Bruce’s strategy: find a competitor. Before I went to Canada, a doctor friend of mine who is a fellow pickleball player said he’d heard good things about Sutter Health in Santa Cruz.
I got home on Friday, July 26th and decided to call Sutter Health on Monday. I opened their website and found 6 urologists. The woman who answered the phone told me to pick one as 3 of them had openings. I didn’t have any criteria to choose from so I let her pick. She chose Dr. David Greenwald and I made an appointment to meet with him on Wednesday, July 31st.
I took an instant liking to him. When he came in, he introduced himself as David Greenwald, not Dr. Greenwald. I told him I especially liked his first name. He smiled a little and then got to work.
I had Montage fax my records to him and he clearly did his due diligence, he told me that one indicator in the MRI suggested a biopsy needed to be done ASAP and my Montage doctor asked why there was a delay, I replied I didn’t know.
So he scheduled the biopsy for August 14th, just two weeks later. There were two options: rectally or under the scrotum. The latter would require more anesthesia, but the chance of infection afterwards would be orders of magnitude lower. I liked it, and he also gave me more information in five minutes than my Montage doctor gave me in 10-15 minutes, who didn’t even tell me there would be multiple steps.
Dr. Greenwald gave me very specific instructions for how to prepare: sleep with clean sheets the night before, shower with antibacterial soap the night before and the morning of the surgery, fast for 8 hours before arriving at my appointment, drink only clear liquids until 3 hours before my appointment and no alcohol after, etc. I followed all of the instructions.
As I lay there waiting for my surgery, I could hear the nurses talking. They all seemed to get along well. Interestingly, the three nurses I spoke to the most – two pre-op and one post-op – were men. The anesthesiologist introduced himself. He was from India and we shared stories of immigration. He seemed competent and had a great sense of humor.
I was rushed into the operating room, given some medicine, I didn’t feel anything, which was great, the next thing I knew I was waking up in the operating room and being rushed back in.
The next day, one of the nurses called me to follow up and said that I liked everyone I dealt with there and that there was a world of difference between Sutter Health and Montage (and I do like the staff at Montage, but I’m not a fan of the doctors).
At least in this case, competition in health care has worked.
