It’s not Ok!

When I was pregnant, I noticed that during regular check-ups when a midwife or a nurse was asking different questions, she would always listen to my answers with the exact same polite expression of her face, nodding considerately and taking notes: “Ok… m-m-m-Okay!” as if she wouldn’t even care what exactly I was saying. Almost all the nurses I was seeing had this same expression. Non-judgmental. Free of any sign of disapproval. Neutrally welcoming.

I started thinking their barely perceptible polite smile would still be the same whatever i say. I’m wondering, if someone would tell them she’s smoking while being pregnant, would they still nod considerately with a gentle smile: “Okay… Just so you know, research has shown that smoking pregnant women have bigger risk… …” Of course it’s my guess, and I don’t want to blame anyone for something that don’t know. But it’s a fact that it’s part of the job of medical personnel to be non-judgmental. They never know who are they going to care for tomorrow: drug addicts, alcoholics or prostitutes… No judging. They just give us treatment options, no judging.

But sometimes it’s good to express one’s opinion on something. To say that something is not ok. To differentiate between good and bad things and to encourage the first while try to detract from the second. Not just provide evidence why something has bad consequences and leave it to the person to make his own choices, but express one’s opinion on different options. I encountered that a lot in doctors’ offices in the US. Yes, everyone should make their decisions and nobody should make them for you. But at the same time I feel that doctors should take a more proactive role in helping patients with decisions and even make sure they understand what is the wrong thing to do. Or course, this should only be driven by patient’s well being, health wise and financially.

However healthcare is business in the US and doctors are financially interested. A doctor acts like your personal adviser who helps to make the right decision. But you are the one who makes that decision. The first thing he asks you when you step into his office is “How can I help you?” Haha! As if I could probably say: “Let’s just talk about something!” I was used to think that doctors have no other job than to cure your health problem. Not give you painkillers that won’t cure you, but make your problem invisible for some time. I thought their job is to eliminate the cause, not hide its symptoms.

When I came to dentists in the US, they always gave me choices: from “doing nothing” to “doing everything” which wold imply making my teeth ideal health wise and aesthetically by investing tens of thousands of dollars. I bet that’s not most people want. They, me included, are searching for the fine line between “nothing” and “everything”. But firstly, they often aren’t knowledgeable enough to define what’s more urgent, that’s why they need expert guidance. Secondly, they are’t billionaires neither, and can’t go for the most lucrative option available. Unless they want to burden themselves with credit obligations for years )) And the guidance is often lacking.

Certain things shouldn’t be ok. For example, health problems shouldn’t be left untreated. And doctors should be clear about that. I’m not saying the society should start blaming people that differ from others, but I think that we would all benefit from setting some sort of emotional norms that would “guide” people towards more healthy choices.


Some bad things about American healthcare and how I’d like this industry to be disrupted

There is one thing about the US that drives me nuts – healthcare costs and bills. I dream there will be a company one day (I’m sure some already exist) that will turn healthcare market more transparent and make people more informed so that they can navigate this market easier and shop around for a better deal. I would also love to understand medicals bills, at least what exactly I’m paying for. And in general it would be great to be able for myself to keep track of my medical history at any given time no matter who is my doctor is at this particular time.

When my Russian friends ask me why I’m not happy with American healthcare and why I always try to get some healthcare procedures done in Russia whenever I go there, while the rest of the world dreams to have treatment in the US, I tell them scary stories about healthcare costs for ordinary people like us. Before my husband decided to get us healthcare insurance through his own company, where he is CEO (which cost the company a huge amount of money) we weren’t eligible for any government subsidized healthcare program, so we needed to buy health insurance out of pocket. We paid around $500 monthly just for the very fact that we had insurance, this sum didn’t include any services, and we needed to pay around $3000 deductible for healthcare services per year per person to even start receiving benefits.

When after giving birth to my daughter I started getting medical bills, I spent many many hours desperately trying to figure out what services exactly I was supposed to pay for. On the bills that I received I couldn’t find any detailed information about procedures performed except medical codes that only medical coding specialists can understand (not even doctors) and generic formulations like “laboratory” or “other diagnostic services”. I still don’t know what exact services were included in my bill. People who have great heath insurance benefits are almost completely covered and don’t care about the specifics of billing, but what about people who pay for everything out of pocket?

Also when you are recommended a certain medical procedure with a specific provider, there is no way to know its costs in advance. That’s exactly what a medical journalist Dr. Elisabeth Rosenthal talks about in her book “An American Sickness”. People aren’t really given any opportunity to make an informed choice. So the first idea I would like to bring up (potentially business idea) is to make healthcare market more transparent.

Another idea I like is making a platform that would allow to store all personal healthcare history in a comprehensive manner and in chronological order. I dealt a lot of dental work recently. I much of this work was done by different dentists. I think my current doctors and myself would benefit tremendously from knowing when and what procedure was done, by whom and how my teeth looked like at the time of the procedure. The X-rays would show that. I realize this kind of project would be very hard to implement due to privacy policies. At every medical office we sign an agreement form that our doctor won’t disclose our private information to anyone. But I think I would benefit from having a complete history of my teeth health here and now with no need to keep an evernote blog where I write down summaries of each consultation and procedure I got and post X-rays.