Who gets to ask the questions and who has to answer?

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Post by David Schleifer, PhD
Public Agenda

Two weeks before the pandemic shut down New York City, I was in a windowless basement endoscopy center on the east side of Manhattan. It was 12:30 in the afternoon, and I hadn’t eaten or had a drink of water since the night before. I was uncaffeinated, missing a day of work, and wondering if this diagnostic procedure was worth the roughly $1100 it seemed likely to cost me out of pocket, roughly one-third of the median amount that Americans have in their savings accounts. 

The administrator was friendly and efficient, and as she was running my credit card, she asked, “Will your wife be picking you up after the procedure?”

Was it worth the trouble to explain that no, in fact, my husband would be picking me up? Did I really need to come out to someone who I did not know and would probably never see again? I let it go, and figured she’d have the pleasant surprise of meeting him after the procedure.

Half an hour later, as I was getting situated in the pre-op area, a nurse was running through a series of questions:

“When was the last time you ate anything?” she asked.

“Last night at around ten o’clock,” I told her.

“When was the last time you drank anything, including water?” she asked.

“Probably around midnight,” I responded.

“Have you been pushed, shoved, slapped, hit, kicked, choked or otherwise physically hurt by your partner or by someone in your home?” she asked.

I knew why she was asking. I had only recently finished research on screening for social needs in pediatric primary care. Thankfully, the answer was no and that’s what I told her. That screening may be worthwhile if it picks up just one person who needs help. But I wondered how many people would feel comfortable telling a pre-op nurse in an endoscopy center about domestic violence – especially after having to decide whether or not it was worth coming out.  

The anesthesiologist opened the curtain around the bed, and asked if I had any questions for her before she got started.

“Just one question for you,” I asked. “Are you in-network?” 

She was flustered. I knew she would be. Maybe I was even kibitzing a little. But asking doctors about prices has become a bit of a habit for me.

“Um, I’m really not sure…” She was stalling.

Luckily for us both, the gastroenterologist who would be doing the procedure happened to walk by at that moment. “I’m in your network,” she said, “and all the anesthesiologists here bill through me, so she’s in network.” It took the anesthesiologist three tries to get the line into the back of my hand.

As I woke up from the procedure – groggy, hungry and very thirsty – the gastroenterologist launched into a long explanation of what she had found. Mostly nothing, a little something, and maybe it could be this but it’s probably that.

Despite being only half awake, I pressed her to try to understand what she meant. I know from my own research that listening is the top priority when people with Medicaid are asked how doctors can earn their trust – and I bet it’s a top priority for people with employer-sponsored insurance like myself.  Clearly in a rush, she said “I have another procedure – call the office and make an appointment.”

My husband picked me up, and brought a bagel. My Flexible Spending Account thankfully covered the bill. And I found a new gastroenterologist.

David Schleifer is Vice President and Director of Research at Public Agenda. He manages and executes Public Agenda’s research, including projects in health care, K-12 education, higher education and civic participation. Along with the rest of the research team at Public Agenda, David’s work elevates the views and voices of members of the public and other stakeholders through focus groups, surveys, in-depth interviewing and media analysis.