After surviving cancer, I knew what medical upselling looked like, and experienced it firsthand when a clinician tried to send me for more tests than I felt necessary.
Have you ever taken your car in for an oil change or service and wound up leaving with new windshield wipers, new brake pads, new shocks and struts and a bunch of other extras you didn’t go in for? This is called “upselling,” and it’s an age-old sales technique that, until recently, I didn’t realize happened in the medical profession as well. Basically, you go in for one problem or situation and are directed to something other than what you had intended all in the name of profit.
Several years back, I was driving home from chemotherapy on a two-lane road with no turn pockets, when a distracted adolescent driver rear ended me while I was at a complete stop waiting for the car ahead of me to turn left. The inexperienced driver behind me plowed straight into the back of my car at 40 miles an hour as I watched helplessly in my rearview mirror. I was unable to do anything but brace for it and hope she stopped in time. She didn’t stop. While my car was repaired, my low back hasnever been the same.
I’ve had intermittent low back pain that goes from a nagging dull ache to bring-me-to-my-knees spasms. Lately it seems to be getting worse, so I decided I would try an osteopathic doctor who does osteopathic manipulation, a bit different from what chiropractors do. His office is located in the same building as my oncologist, whom I adore, and they are part of the same hospital. I figured it would be simple, they already have access to my records and scans.
On the day of my appointment, I was brought into a room after having my vitals checked and am left to wait for the osteopathic doctor. It was ice cold in the room and the automatic lights shut off four times in the half hour I waited for the doctor to see me. As I’m contemplating leaving when the doctor finally comes in, and the first question he asks me is if I'm on edge. Umm, yeah. I’ve been waiting for half an hour, and I am sweaty and freezing from the air-conditioner and nerves, I thought.
With apologies for his tardiness out of the way, we went through the usual questions. He had glanced through some of my voluminous records and scans and was aware of my metastatic breast cancer, although I don’t think he really understood metastatic breast cancer.
Next, he started asking about my stress levels, anxiety and depression, which he explained can cause pain and inflammation. At this point, I'm already wondering if this could be a case of medical gaslighting, where my symptoms are being blamed on stress? Of course I have stress, anxiety and sometimes depression. I am living with an incurable illness of which an estimated 43,600 people will die from in the United States this year.
As we concluded the visit, I ended up leaving with a referral to physical therapy with a choice of locations all more than 50 miles one way from where I live. There are 58 physical therapists within a two-mile radius of my home. So why so far away? Upselling. The referred physical therapists are part of his same medical group. I also had a follow-up scheduled to have osteopathic manipulation.
The conversation was then quickly steered to him assuming the role of my primary care physician, when I didn’t ask for that, and then he wanted me to have a colonoscopy, cholesterol, glucose and hepatitis screening. Preventative maintenance has a time and place, and this visit was not it. I went to an osteopath for one reason — low back pain — and wound up being upsold.
There must be some checklist, “Oh, you’re this age, you need this, this, and this,” without stopping to ask if I had it done somewhere else. This, to me, is medical upselling at its finest.
I left the office that day feeling very irritated and will not be returning. If I had wanted a wellness exam with referrals for the screenings that he was upselling me on, I would’ve scheduled a wellness appointment. Being diagnosed at age 38 with de novo metastatic breast cancer I have an idea of what’s going to kill me and it’s most likely not going to be colon cancer, cholesterol, diabetes or hepatitis.
I will die of metastatic breast cancer along with more than 116 others who are dying of it every day. Until there’s a cure, stay in your lane and save the upselling for someone who came in for those add-ons. All I want is a simple tune-up, not a complete overhaul. Thanks.
Edited to Add: After filling out online feedback regarding this visit, the clinic manager and I had a meaningful conversation where my complaints were heard and will be used as a teaching moment to prevent situations like this in the future. Once again, the squeaky wheel gets the grease.
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