The 3 most important things I’ve learned as a health care reporter

You probably know that I spend a lot of time thinking and writing about the health care system — it is my job here at Vox, after all.

But what you might not know is that, over the past year, I’ve have spent a lot of time as a patient of the American health care system — more than any year of my life.

In the past year, I’ve had two significant surgeries: a C-section to deliver my son last June and an operation on my foot to remove a bunion in December. I had the first emergency room visit of my adult life (yes, I held onto my bills) and spent months in physical therapy teaching my foot how to walk again.

That’s a lot of health care for a generally healthy 34-year-old. Along the way, I’ve changed the way I approach health care — and hopefully have learned a few things.

I got picky about doctors. This was especially true when I was exploring how to treat the chronic pain in my left foot, an issue that I’ve dealt with for most of my adult life. When it became clear I’d exhausted all nonsurgical treatments, I ended up meeting with three different surgeons to discuss how they would deal with my problem.

I treated each of these visits like interviews, arriving with a list of questions. The most important question was one I cribbed from Ezekiel Emanuel: How many times have you done this surgery? As he’s written for the New York Times, the best predictor of quality is the volume of work a surgeon has done.

At first, this felt a bit uncomfortable for me and the doctor. We were both accustomed to visits where the doctor asked the questions. I always felt a bit sheepish pulling out my notebook. They were the ones with medical degrees, after all. Who was I to question their treatment plans?

Well, I was the person who was having a foot cut open, and the person who cared more than anyone else about my surgery going well — and that motivated me to work through the awkwardness and have some pretty long discussions about the best treatment plan.

After three surgeon interviews, I picked a doctor who took a lot of time to answer my questions in his office and over email. I was especially impressed that, when I went back to him with things the other surgeons recommended that conflicted with his own advice, he didn’t shrug it off. Instead, we scheduled another appointment to talk through the difference of opinions — and even incorporate some of the other doctors’ advice into his plan.

As patients, we are making huge decisions about our health. So it’s well within our rights to ask a lot of questions — those answers are going to help us find the right treatment, which is the outcome that everybody wants.

I tried to spend as little time in health care settings as I could. One of my first big series here at Vox was about preventable medical harm: things that go wrong when we become patients that can sometimes have deadly consequences. Medical errors, it turns out, cause more deaths than AIDS or drug overdoses.

That series made me think about medicine differently. Hospitals are, without a doubt, places where fantastic, lifesaving work happens each and every day. But there are also risks associated with that work, things like infections and bed sores.

After learning about those risks, I take them into consideration when planning out my own health care. I thought about them a lot last summer, when my obstetrician recommended that I be admitted to the hospital for treatment of a breastfeeding infection that had gotten especially severe.

In that case, I pushed back: I questioned whether the treatment they could give me in the hospital was worth the risk of infection that my newborn and I would face staying there. After a long discussion, we settled on a middle ground: I would have some imaging done at the emergency room, and spend the night at home rather than the hospital. It was an outcome I don’t think I would have pushed for if I hadn’t been thinking about the risks of medical treatment.

I’ve gotten more realistic about what medicine can and can’t do. I’m really happy that I can tell you my foot surgery went well. It’s been five months since my operation, and I’ve been able to take my dog on long walks and ride my bike to work — two things I couldn’t do before the operation.

I am, in a lot of ways, astounded that modern medicine gave my surgeon the tools to cut my foot bones in two places, put in five screws and a metal plate, and give me back the ability to have closer to normal mobility for someone my age. I am so grateful that he was able to do this.

But I’m also frustrated and more acutely aware of the limits of modern medicine. I used to be an avid runner and would love to go on a run again, even a short one. But right now that doesn’t seem to be in the cards. The risk of reinjury is pretty high, and my physical therapist has advised me that running probably isn’t a realistic goal for someone like me.

A few years ago, I reported an episode of my podcast, the Impact, talking to chronic pain patients who had used opioids to treat their condition. One of the things that episode drove home for me was how the opioid epidemic really showed the limits of modern medicine: patients often turned to opioids because modern medicine didn’t offer any safe, effective treatment for their pain. Even as we recognize that opioids are often not safe or effective, the patients I interviewed were still left with their chronic pain, no treatment to eradicate it, and doing their best to live within the constraints of their disease.

Human bodies are fickle, complicated things. And my own experience with medicine has really driven home that there is still a lot we don’t know, especially when it comes to treating pain. I’m really grateful for what medicine can do but also cognizant of what it can’t — and still working day by day to accept those limits in my own life.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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