By Kathy Day
I wish I could share the photo of my 4mm boomerang shaped kidney stone. I labored for 2 months, back in early 2009 to pass it, the second stone in 5 years.
During my ordeal with these stones, I had the following healthcare encounters, tests, medicines, lab and imaging tests.
- At least 5 sets of blood work, with CBC and chemical profiles, parathyroid studies
- Several urine tests, including urinalysis and urine culture, and 2 24 hour urine tests (a third 24 hour urine test was recommended but I declined)
- 2 CT scans
- 1 MRI
- 4 specialist visits, 2 primary care visits, 2 ER visits (involving IVs, pain meds, lab studies)
- Prescriptions for antibiotic (no infection) and Flomax
- Lab analysis of my kidney stone
The actual costs generated because of these things evades me, because until recently, I have been a passive insured healthcare consumer. Now that I work on healthcare issues as a patient safety advocate, I am more aware of overuse and the costs associated with it. More care does not mean better care and it is depleting our healthcare resources. My estimate for all of the items listed is around $15,000, and probably more. My out of pocket costs were insignificant because my copays have always been very small.
The point of my story is that the outcome, my tiny kidney stone, would have been the same if I had paid $0, instead of generating all of these costs. At the time I thought I was doing the right thing, but by the time I visited an endocrinologist, and he ordered the exact same tests that my urologist had done within a few months before that visit, I knew it was time to say whoa.
As anyone who has had a kidney stone can attest, the pain is excruciating. I have a new determination that if I ever have another stone, I will find a way to get pain control through my primary care doctor and avoid an ER visit. An ER visit pretty much guarantees you a CT scan, IV, lab tests, prescriptions and so much more. I don’t need to know anything more about my kidney stones. Pushing fluids, taking pain medication, stopping my calcium supplements and watching certain foods in my diet are all that are necessary. Passing a stone will be the final outcome of any future kidney stone encounters, with or without all the tests and other expensive tests, medicines and doctor visits. My slightly elevated blood calcium level will be followed by my primary doctor at annual visits.
I am a consumer member of a Choosing Wisely leadership team in Maine. I become more aware and educated all the time about medical overuse. Confidence comes with experience. During my last ER visit because of kidney stone I questioned the need for a CT scan, since my stone had moved and I didn’t even need pain medication. I could have easily left the ER at that time, and been no worse off. The doctor insisted and I got the scan. That will not happen again. When I sense that something is not necessary, I will discuss then reject overuse of tests and other medical recommendations, unless there is a strong argument for it.
Kathy Day is a Patient Safety Advocate, member of the Maine Quality Counts Consumer Advisory Council and the Choosing Wisely in Maine leadership team. She is also affiliated with the Consumers Union Safe Patient Project.