Al Lewis on Jeopardy!
Al Lewis knows about Quizzes. Here he is (in the middle) on Jeopardy in 1987.

Did you know that a CT scan can have 1000 times the radiation of an x-ray? That heartburn pills can cause heart attacks, bone fractures and kidney disease? That annual checkups may be bad for you? That Advil slows recovery? That Benadryl causes ring around the collar?

OK, so I just made that last one up. (And even if it were true, Wisk around the collar beats ring around the collar every time.)  Even so, the amount of information that employees lack when they purchase healthcare services with their employers’ money boggles the mind. In no other instance are employees given unlimited budgets with no training in how to spend that budget.

And spend it they do. Since little of the cost falls on them, consumers are easy marks for direct advertising of prescription drugs—which, by the way, is not even legal in most other countries. Likewise, consumers rarely push back on doctors, and often push forward on them, demanding resources that are useless or inappropriate.

 

Quizzify

Enter www.Quizzify.com. Quizzify is the opposite of wellness. Whereas wellness pushes employees into the healthcare system with annual screens and checkups, Quizzify tries to keep them out except where appropriate. (And neither screens nor checkups should be done anywhere near annually for most people.) Whereas the wellness mantra is “know your numbers,” Quizzify is based on the proposition that the employed population has shockingly few heart attacks to begin with (about 1 in 800, <65 people), so why not train employers to “know” information that is more useful than their numbers? In any event, only a tiny fraction of employees—about a third of the 15% or so who participate in wellness—“know their numbers” despite wellness vendor efforts.

Rather than force employees to memorize a few numbers of dubious predictive value for a low-probability event, Quizzify believes that a corporate culture of health requires a corporate cultural of health literacy. And we achieve health literacy using an engaging Jeopardy®-meets-health education-meets-Comedy Central format. Visit the website and try the Launch Quiz for yourself.

The inspiration for Quizzify comes from this very blog, The Doctor Weighs In. Since I’ve already used up my 30-second shameless plug, I’ll shut up about Quizzify—and re-post the 2012 story of one 11-minute doctor visit best described as caveat morbidus (let the patient beware).

 

Let the patient beware

I had just taped the first episode of a new public radio show. I thought I sounded pretty good, and the producer assured me that I would sound even better after I got over my cold. This would have been reassuring, except that I didn’t have a cold. Fearful of being fired my first day on the job, I immediately called my primary care physician (PCP) to get some advice on how to sound less hoarse and nasal. The PCP’s office promptly scheduled a visit with an ENT, only four days later.

In twelve short minutes, this ENT proposed just about everything patients should learn to ask questions about. The ENT scoped my nose and announced that I had polyps in my sinuses. She said she would schedule me for a CT scan of the sinuses, and offered three alternative treatments, which, she added, may or may not work.

  1. Flonase, a steroid-based nasal spray
  2. Flonase with a three-week course of antibiotics
  3. Day surgery followed by a saline flush for a week.

So,” she asked, about seven minutes into the appointment, “which do you want to do?

Um,” I replied. “Shouldn’t we try the most conservative therapy first?

Well, you could,” she replied, using an intonation that appeared to imply: “but only an idiot would.

I begged off that one by quite correctly observing that I wasn’t very adept at flushing my nose out, so that I would prefer one of the non-surgical alternatives. “I’m not sure I need the antibiotics because I don’t think this is bacterial,” I said.

A lot of patients report relief with the antibiotics,” she replied, the classic cliché spouted by doctors who don’t believe in evidence.

Ok, but isn’t three weeks a long time to be taking antibiotics?” I asked.

Some people say that, but in this case, it should be fine.

I opted for Flonase alone, which she prescribed to be taken at double the frequency on the label. The sinus CT scan seemed like a lot of cost and inconvenience (plus the radiation, which she didn’t inform me of) …and didn’t I just get a diagnosis anyway? So I didn’t schedule it. Except that the sinus scan was thoughtfully scheduled for me, as I learned when a scheduler called me the same day. I ignored my first call from the scheduler, but after the third, I realized they really did expect me to show up the very next day, and it occurred to me I might get billed unless I affirmatively called to cancel it.

You’re probably thinking, “Well, once this practice gets capitated and becomes a medical home with an electronic medical record, all this will change.” But in fact, this practice is capitated, is a medical home and as far as their EMR is concerned, in 5 seconds, they could tell me my blood pressure in 2003.

 

So, what happened?

The codas on this story? To try to overcome this hoarseness, I took the steroidal nasal spray twice a day for a week. Then I read the FDA insert, which listed as a side effect: hoarseness. I stopped the spray, and told this story to my producer. My producer suggested tea with honey during each taping, surely the most conservative therapy.

Second, ultimately the show was canceled due to not altogether unreasonable complaints about my talents as a host, though as far as I know no listeners called to complain about my polyps.

Finally, several months after I successfully extricated myself from the treatment trap, I received a “report card” from my health plan. I got the lowest ranking. They were very upset that I hadn’t renewed my Flonase.

Shame on me. But if you still think wellness, providers and health plans are going to solve healthcare while the consumer goes along for the ride, then shame on you—and also shame on me, until this epiphany with my ENT. As with every other marketplace, the ultimate decision-maker is the end user.

And judging from the questions in the opening paragraph and this ENT, whether with Quizzify or not, the end user has a lot to learn.

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