What knee surgery taught me about access to education

Unplanned additional costs and complicated, unexpected additional steps are issues in both healthcare and education. Instead of finding ways for people to navigate these challenges, true change will come when we find ways to eliminate them. And, when we can’t, finding ways to ensure they aren’t unplanned or unexpected.

About six months  ago, I had knee surgery to correct the damage done by years of athletics.  I anticipated the issues that come with any surgery, but what I didn’t realize was how closely the process would mirror the experiences of so many in the United States attempting to access education and afford educational necessities like textbooks.

The “hidden” costs of surgery, college

Luckily, I have good insurance, so the surgery itself only cost $200. A good deal, right? It is, but what you don’t think about is all of the additional costs that no one tells you to plan for, such as:

  • Special soaps and bandages
  • Special food/drink
  • Ice for an ice machine
  • Prescriptions for after the surgery
  • Over the counter medicines for after the surgery
  • Physical therapy and follow-up visit co-pays

These “unplanned costs” totaled over $2,000.

Often in the Open Educational Resource realm (OER) we hear the argument, “Tuition is the huge cost, so why not work on that instead?” Indeed, tuition is a huge cost and does need to be addressed. Thankfully there are groups that are addressing this very thing.

But the students that get past the tuition hurdle find themselves facing unexpected costs that can make or break their success. The College Board does a great job of estimating some of these, but so many people just look at the bill from the college or university and think “this is the cost” when in reality, it isn’t the cost. They’ve planned for that big cost, some saving for years to afford it, so while a $100 extra may not seem like a lot, when you find yourself in a position where “I have no money left” and someone says “here’s another $100 you need to spend,” all of a sudden $100 is the straw that broke the camel’s back and causes someone to give up.

When I was working at a community college, I saw how quickly an unplanned, hidden cost of college could impact student enrollment. The state I worked in passed a law requiring each community college student to get a meningitis vaccine before coming to college.  But here’s the kicker, the shot was $125. And that was the last straw for these students. They’d given all they had to give, paid all of the other fees, there simply wasn’t $125 left. And so, students started dropping out in record numbers.

Hey look! More hoops to jump through

If there’s one complaint I have against doctors in general, it’s that they can be notoriously bad about communicating all of the steps and expectations of something like a major surgery. Or, as some have posited, this may be intentional to keep you from backing-out, but I digress.

Major things my doctor missed telling me:

  • There’s a pre-op appointment you must attend, during working hours. In total, this’ll cost you an hour of driving (and gasoline) and 2 hours at the appointment, for a grand total of 3 hours.
  • You can’t drive for at least 10 days after the surgery. To really get the context of this shock, we found this out about 20 minutes after I came out of surgery. Imagine someone walking up to you right now and saying “Starting right now, you can’t drive for the next 10 days.” But wait Nicole, you say, shouldn’t that have been obvious since there’s crutches involved? Not really. I’ve been able to drive with a right foot injury and crutches before.
  • You’ll be averaging 2-3 follow-up appointments per week for 4 weeks. All must be done within normal working hours.
  • You’ll be averaging 2 physical therapy appointments per week for 12 weeks. Each appointment will take 1.5 hours plus 60 minutes of driving, for a total of 5 hours per week.

I’d like to take a moment to especially focus on bullet points two and three above, I couldn’t drive and I had to go to four appointments per week during working hours. This meant that my now-husband would have to take off from his work to drive me, or I would need to incur ride-sharing costs. On one hand, this really made me grateful for the flexibility in both my and my husband’s work, that we were able to do so many things within normal working hours with no issue. But it also left me wondering, how do people manage that don’t have someone who can do this for them and don’t have the money to pay for ride sharing?

This reminds me the processes that a student has to go through during higher education.  When I was the marketing director at a community college, I asked a friend of mine, who was enrolling in college, to let me shadow her during the whole process.  The first appointment to get her enrolled took 4.5 hours, the second one took more than 2. Orientation was a third night (did I mention she has 3 small children?) and was another 2 hours, which culminated in us both staring at a computer screen, trying to figure out to build her class schedule, at a total loss. I can see why so many give up.

tl;dr (in summary)

Unplanned additional costs and complicated, unexpected additional steps are issues in both healthcare and education. Instead of finding ways for people to navigate these challenges, true change will come when we find ways to eliminate them. And, when we can’t, finding ways to ensure they aren’t unplanned or unexpected.


Medical series: Building better doctor-patient relations

“Could it be strep throat?” I asked as I shifted from side to side, not feeling well, on one of those exam beds in a doctor’s office which some designer tried to make look like a lounge chair, but ends up looking like a sanitary torture device. “No, it’s not strep” said the doctor, not looking up and continuing to write.  I realized at this point that I had to be a little more aggressive, even though I was  not feeling well. “Then what is it?” I asked.

This was a game this particular doctor and I played a lot. She was by far one of the best doctors I had ever had, but her one weakness was how she answered questions. She answered exactly the question that was asked. Nothing more and nothing else.

Building Better Doctor-Patient Relations

I know it’s been said a million times already in seminars, blogs, books, and schools across the country, but this is yet another reminder for doctors out there: listen for what your patients are really asking instead of what they do ask. In my case above, my real question was “What’s wrong with me?” but because I had already been trying to sort it out in my head on my own, it came out much differently.

Sometimes the patients are passive-aggressive and that’s why they ask the question the way they do. Or, the patient could be more like me and be very logical in nature. Logical patients are going to try to figure it out on their own, get as far as they can down the road of a conclusion and then ask the question.

Regardless of why they do it, some patients won’t ask what they really want to ask or say what they really need to say. That’s why it’s so critical for doctors to slow down, and really think about what the patient is saying and then have a conversation from there.

More patients = More money?

With rising healthcare costs, rising office costs, etc., doctors feel pressure to serve a significant amount of patients every day to make money. The calculation, to many doctors, seems simple. More patients = more money. On the other hand, there are doctors offering concierge services where, for an annual fee, they agree to take fewer patients and devote as much time to you as you need. Their formula looks more like: less patients paying more money each = more money. Both of these formulas are at the extreme and both are riddled with issues, which we won’t go into in this post.

The point is, as with many things, the correct answer lies somewhere between the two and is the same as with any business; take on only as many customers as you can treat well. Any more than that, you’ll get unhappy customers and that will reduce your marketing effectiveness and your ability to recruit new patients.

How to Listen

So we’ve established a business reason for taking time to listen to patients and I’m hoping anyone that reads this understands the personal reasons for doing so, but how do you do it? Luckily, you already know how, it’s just taking the time to do it and having someone like me remind you:

  • Slow down and really take the time to listen to the patient.
  • Ask yourself not only what the patient asked, but what may be their underlying question or concern.
  • Ask probing questions and encourage the patient to talk.
  • Even though you think information may be irrelevant, still take time to listen to it. There might be something hidden in that information that can help you diagnose or treat the patient.

Now go forth and really listen! 🙂