Capitalism is the best. It is a free enterprise. Barter. Gimbels, if I get a clerk position, ‘Well I don’t like this’, how can I solve it? If it gets really stupid, I go and say, ‘Frig it, man, I’m leaving.’ What could this guy do at Gimbels, even if he was the president of Gimbels? He can always turn me down at that store, but I can always go to Macy’s. He can’t really hurt me. Communism is like one giant telephone company. Government control, man. And if I get a position too in that phone company, where can I go? I’ll end up looking like a schmuck with a dixie cup on a leash.
LENNY BRUCE
This is the opening quote from one of my favorite books from the early 1970s, by David Friedman Freedom Machines.
I thought about it as I lay in bed at Sutter Health in Santa Cruz last Wednesday, waiting for my biopsy to test for prostate cancer.
Here is what happened. In late April, after I had worrisome symptoms and a very high PSA score, I received an MRI at Monterey Peninsula Community Hospital (CHOMP.) The test was ordered by a doctor from Montage Medical Group, a group of doctors affiliated with CHOMP. An MRI showed a high probability of prostate cancer. The next step is a biopsy, and Montage’s doctor scheduled it for June 11. That seemed a little slow, but what did I know?
As we approached June 11, the biopsy was postponed to July 30. Again, I really didn’t care. Prostate cancer tends to grow slowly, and I could have had my 2.5 weeks in my little house in Canada without worrying about the consequences.
But on July 16, while I was in Canada, I got a call from an editor at Montage. The doctor had decided to postpone my procedure until September 24th, a full 8 weeks later. I asked why there was a change. He wouldn’t, or couldn’t, tell me.
I decided to follow Lenny Bruce’s strategy: find my competitor. Before I went to Canada, a pickleball doctor friend of mine said he had heard good things about Sutter Health in Santa Cruz.
I returned home on Friday, July 26, and decided to call Sutter Health on Monday. I pulled the web and found 6 urologists. The woman who answered my call said there were three and I had to pick one. Since I had no basis to choose, I asked him to choose. He chose Dr. David Greenwald and I got an appointment with him on Wednesday July 31st.
I fell in love with him immediately. When he entered, he introduced himself as David Greenwald, not Dr. Greenwald. I told him that I especially liked his first name. He smiled a little and got down to business.
I had faxed my records to Montage and he obviously did his due diligence. He told me that one indication on the MRI suggested that a biopsy should be done immediately and asked me why my Montage doctor was delayed. I told him I didn’t know.
So, he did the biopsy on August 14th, only 2 weeks later. There were 2 choices: do it through the rectum or do it under the scrotum. The latter will require more anesthetic but the chances of infection afterwards will be an order of magnitude lower. I liked that. Also, he gave me more information in 5 minutes than my Montage doctor gave him in 10 to 15 minutes. The Montage doctor hadn’t even told me that there was more than one procedure.
Dr. Greenwald had specific instructions for my preparation: sleep on clean sheets the night before, shower the night before and the morning of the procedure using antibacterial soap, fast 8 hours before arriving at my appointment, drink only clear water. fluids until 3 hours before my appointment, then no drinking at all. I followed them all.
As I lay there waiting for my surgery, I heard a fine line between the various nurses. They all seemed to get along. Interestingly, the 3 nurses I had the most interaction with—two before the procedure and one after—were men. The anesthesiologist introduced them. He was from India and he and I compared the immigrant experience. He seemed talented and had a good sense of humor.
I was wheeled into the operating room and drugged. It was nice because I couldn’t hear 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 loved every single person I had worked with there and that the difference between Sutter Health and Montage was night and day. (I actually like the Montage crew but I’m not a fan of the doctor.)
In this case, at least, competition in health care worked well.
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