Capitalism is the best. It’s free enterprise. Barter. Gimbels, if I really get into an argument with the clerk, “Well, I don’t like this,” how can I resolve this? When things get really ridiculous, I say, “Shut up, man, I’m walking.” What can this man do at Gimbels even though he was the president of Gimbels? He can always turn me away from that store, but I can always go to Macy’s. He can’t really hurt me. Communism is like one big telephone company. Government control, man. And if I become too highly regarded by that phone company, where can I go? I end up like a loser with a Dixie cup on a thread.
LENNY BRUCE
This is the opening quote from one of my favorite books from the early 1970s, David Friedman’s The machinery of freedom.
I thought about it as I lay in bed last Wednesday at Sutter Health in Santa Cruz, waiting for my biopsy to test for prostate cancer.
This is what had happened. In late April, after experiencing some concerning symptoms and a very high PSA score, I underwent an MRI at Community Hospital of the Monterey Peninsula (CHOMP). The test was ordered by a doctor from the Montage Medical Group, a group of doctors affiliated with CHOMP. The MRI showed a high chance of prostate cancer. The next step is to do a biopsy, and the Montage doctor scheduled this for June 11th. That seemed kind of slow, but what did I know?
As we got closer to June 11th, the biopsy was postponed until July 30th. Again, I wasn’t really worried. Prostate cancer tends to develop slowly, and I would spend my 2.5 weeks in my cottage in Canada without worrying about the results.
But on July 16, while I was in Canada, I received a call from the planner at Montage. The doctor had decided to postpone my procedure until September 24, a full eight weeks later. I asked why this change. She didn’t want or couldn’t tell me.
I decided to follow Lenny Bruce’s strategy: find a competitor. Before I went to Canada, a doctor friend at Pickleball said he had 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 visited the website and found six urologists. The woman who took my call said there were three available and I should choose one. Since I had no basis to choose, I asked her to choose. She chose Dr. David Greenwald and I had an appointment with him on Wednesday, July 31.
I liked him immediately. When he walked in, he introduced himself as David Greenwald, not Dr. Greenwald. I told him I especially liked his first name. He smiled briefly and then got to work.
I had Montage fax my details to him and he had clearly done due diligence. He told me that one indicator on the MRI suggested a biopsy needed to be done quickly and asked me why my Montage doctor had delayed. I told him I didn’t know.
So he scheduled a biopsy for August 14, just two weeks later. There were 2 choices: do it through the rectum or do it under the scrotum. The latter would require more anesthesia, but the chance of infection afterwards would be an order of magnitude smaller. I liked that. Plus, he gave me more information in 5 minutes than my Montage doctor had given in 10 to 15 minutes. The Montage doctor didn’t even tell me there was more than one procedure.
Dr. Greenwald had very specific instructions for my preparation: sleep on clean sheets the night before, shower with antibacterial soap the night before and the morning of the procedure, fast for 8 hours before arriving at my appointment, drink only clear fluids until 3 hours before my appointment, and then stop drinking altogether. I’ve followed them all.
As I lay there waiting for my procedure, I heard the chatter between the various nurses. They all seemed like they were getting along. Interestingly, the three nurses I had the most contact with – two before the procedure and one after – were men. The anesthesiologist introduced himself. He was from India and he and I compared immigration experiences. He seemed competent and had a great sense of humor.
I was wheeled into the operating room and they drugged me. It was great because I didn’t feel anything. The next thing I knew I was waking up in the OR and being wheeled back.
When one of the nurses made a follow-up call the next day, I told her that I liked everyone I dealt with there and that the difference between Sutter Health and Montage was night and day. (I actually like the Montage staff, but I’m not a fan of the Doctor.)
At least in this case, healthcare competition worked well.