ADVENTing: The Fight Against Big Box Healthcare

On this episode of ADVENTing, Dr. Kandula Dr. Handler take on why big box healthcare doesn't offer you simple in-office solutions. Learn more
ADVENTing: The Fight Against Big Box Healthcare
Reviewed by
Published on
November 13, 2019
Updated on
November 20, 2019

We take on why big box healthcare won't offer you simple, in-office solutions on this episode of ADVENTing:

Our reason for being.

It's what we train to do.

It's to do things to help people. Like, we exist to bring it to out patients, it being that we're going to deliver every ounce of our skill set and energy to try to help someone. Now, we're not going to twist anybody's arm, ever, to do anything, so I think that's where I'd say that doesn't happen here, and it never will as long as I'm a part of this thing. That's not what we're about. But, on the flip side, I'd say absolutely, we were talking earlier about there's a philosophy or opinion in medicine, and the cure that you seek is going to be coming with a specific philosophy or opinion. Now, in a typical medical environment, in Milwaukee which is where we're sitting right now, the medical environment is dominated by big box health care. Big, big systems with thousand of doctors and they've got a certain viewpoint. And their viewpoint is really more about, how do you say this? They can treat a lot of different conditions, and they can do that in an adequate manner. None of these systems can do what we do, and part of that is because back to that point is part of the reason we exist is to do what needs to be done, period. And the next sentence is the reality is the things that we do on an hourly basis are things that these big systems cannot do. They've outlawed them from being done. Not because of medical reasons, they outlawed them from being done because it doesn't fit their model. You go to a big box healthcare system and their model is about keeping you coming back, Band-Aid after Band-Aid, That's good, that's great for them. Alternatively, if you need something, well, we got to take you to the operating room to do it because they've got hundreds of operating rooms that need to stay filled. They've got anesthesiologists and O.R. crews that need to be working. It doesn't work for them to do office procedures, and therefore they do not allow their ENT doctors to do that. That's truth. And then the additional truth is, they don't care about ENT. Their ENT docs care about ENT issues; their ENT docs are certainly highly trained and are experts in the field. The challenge is those ENT docs have basically, by necessity, they need to be neutered to be a part of that system.

Handcuffed, yes.

Yes! Handcuffed is maybe a better word for it. Because, if you want to play in that system--

Because there are male and female ENT docs.

Neutered is a gender neutral term, is it not?

Is it?

I don't know.

We won't go there, but yes, handcuffed.

But you have to play by the rules of the system that you're in. In our system we have a world view, we have a mindset, there's how we do things and how we do things is entirely-- you know, the sun in our solar system is the nose and the throat. Everything we're about revolves around that.


There's nothing more important to us than those areas, versus in a big box healthcare system, the nose and throat issues are like in some other galaxy, far, far away that nobody cares about because it's so low on the totem pole of things that they care about. Versus the big ticket items that they really want to, you know, fill their beds up with.

But those nose and throat items account for a phenomenal amount of cost of healthcare.


And lost productivity.

And misery, and it's important stuff. It's paramount. Somebody's got to take this stuff seriously and we do take it seriously,


And that's out of necessity, it needs to be.

Let me ask you, what percent of surgical procedures that are done, do you think are elective versus emergent?

In all of healthcare?


Oh, I'd say ninety-nine percent of healthcare is elective procedures.

Right. And I totally agree. And what we do here are elective procedures, right?


And so I feel like if we do a lot of procedures here, electively, because patients want them done. And like you said, we go through different options. I've never told a patient, 'you need to have this done.'


I've never said that since I--

But you do offer guarantees, right?

I never offer guaranties either, right?

No, because you can't. Because you're human, as am I, and so the wonderful thing in medicine is that you cannot be all-knowing, you can do the best procedure in the world and there's still a percentage of the time that you're not going to get the outcome that you're looking for.

Well, and it feels crummy. And I think that that's the bar. One of the worst things in medicine is doing something on a patient and them not having the outcome that you guys hoped that they would have. That sucks, but it happens.

It sucks it happens, there will never be a world, never, even when robots are doing our job, there'll never be a world where that doesn't happen.

Right, but I think that also that helps us set a bar for, okay, when we decide that we want to bring some sort of procedure into our office, and let's say it's an office-based procedure, that's why the threshold is this going to work for our patients. It has to show at least some quality of outcome, right? That's why we're not going to do something that's 50/50, because that just doesn't work in our model. Like, that doesn't make any sense. The balloon sinuplasty, the turbinate reduction, and other things that we do, it has a high threshold for success. Otherwise we wouldn't bring it here; we wouldn't do it.

Yep, correct. Absolutely.

Because, one, we don't want to then turn around and talk to a patient who didn't have a good outcome, and have that be a consistent thing. Fortunately it doesn't happen often. Wonderful, but it still happens. We're not a hundred percent, like you said, we're human and to human is to err at times.

Yeah, which is either you deny that or you sort of embrace that. And the nice thing is that for procedures that we do the likelihood of success is really high. Now, that's a huge asterisk. It depends on each particular individual, their issues, there's other factors that come into play.

What they're trying to achieve and their goals.

As we're doing procedures we see folks back on the back end and it's a very rewarding- this is a very rewarding place to practice medicine. And in fact for the docs and PAs and folks who practice medicine elsewhere, to a man and woman, it feels like this is as good as you get that way, and not because they're drinking any special Kool-Aid but because the patterns and pathways and how we take care of patients is not one hundred percent successful, but when we strike out we strike out swinging. We put every single patient we're taking care of, we're going to bring as much of our force into getting you better as exists. And even then still sometimes that's still not good enough. But it won't be for lack of trying, and I think the reality, I know the reality unfortunately, is we see many, many patients, you know, hundreds, thousand of patients, who've been treated elsewhere come to see us for second opinions, or third opinions, or they've had procedures done elsewhere and the unfortunate truth is I'd say I don't find that, say, mindset, you know, elsewhere. Again, not to knock anybody else, because certainly we are not without sin, we are not without our own issues that way. But I'd say, when I see folks that have been been treated elsewhere I see a lot of folks who sort of had issues with things being, you know, they came into those other places with anatomy that was too shut down, had procedures that didn't get the anatomy open to begin with, and therefore they're still suffering.

And the patient, in their mind, feels like, 'Oh, I had this procedure done and it didn't work for me.' Whereas I think that the nuance around that is, you could have had a procedure done, if it's not done to the full extent that it could be done, then maybe it didn't work for you.


Right? But a person doesn't understand that outside of medicine, like, 'Hey, I had my ACL repaired and it didn't work, or it failed.' And there's a lot that goes into that.


And it's no different with the nose, and what we see, you know? And that's why we can get a scan in the office, we can look at the entire blueprint of what's going on and get a good assessment about what's going on.

Yeah, so for example the goal of sinus surgery is to open the sinuses so they can drain properly. Just because you've had sinus surgery doesn't mean that your sinuses are opened, unfortunately.

Right, correct.

And sometimes things are opened and then they shut back down and sometimes things weren't ever truly open. That's one example of that but there are other examples, same sort of thing, where it just sort of, and even there on sinus surgery specifically there's older techniques and then newer techniques and then there's just a wide variance in what that means. And even when we look at this, we talk about this all the time. When we look at studies, we read the literature, we're looking at these studies and what I just said is just because you've had a sinus surgery, it's not apples-to-apples. When you look at studies for success rates after sinus surgery-

You don't know who-

I don't know because, yes, you had surgery done, a procedure done, but did it get you where you needed to be? And it's challenging, and so, you know, anyway, I think it's, again, there's some things that people sort of assume, like, out of the gate like we were talking about medications and things like that before but I'd say on this one it's, just because you had a septoplasty doesn't mean your septum's straight. Just cause you had a sinus surgery doesn't mean your sinuses are open, just because you had a turbinate reduction doesn't mean your turbinates have been adequately reduced. All those things, on and on and on and on, and maybe so, maybe you had sinus surgery, everything's open and you're still having issues, that happens. Maybe you had a septoplasty, your septum's now straight, and you're still having issues, but I think that's where part of our job is to assess and us, we need to understand what's going on, and we need to explain what's going on, and we need to explain what the options are. And almost always, you know, there's almost always some option that we could think through. And not a procedure, maybe something medication-wise, maybe a combination of things we could do, but there's almost always something that can be done. And that's for the folks who've sort of swung and missed and aren't where they need to be. The good news is that for most folks, especially folks who've never had anything done, procedurally, is the success rates there are high, really high.

Even people with a revision, because again sometimes it's maybe even a small thing that we can address or if it's a turbinate issue and those turbinates are just gotten swollen again we can be a little more aggressive to get them reduced. Like, that could be a huge win for people that have even had procedures before. But that's the advantage of having imaging accessible is that we can really understand what's going on, and we can say, 'okay, this is the whole picture. We can look in your nose, we can see a picture with a CT scan and come up with a plan.' And I think that, as you alluded to previous that, okay, so we're ENT docs, right? Which means we have an additional skillset that all ENT's have the ability to bring to the table. Like, we can treat with medications, we can treat your sleep apnea issues with CPAP or whatever else. And we can look at those things, but we also have this ability to level up, whereas other providers out there, allergists and primary care docs and maybe sleep medicine neurologists, and I'm not knocking anybody, they all have their kind of specialty. But we just bring an additional, I think, skillset to the table that we can apply if needed.

Right, yeah, no I agree, and that's what we do.

First published by ADVENT on
November 13, 2019
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ADVENTing: The Fight Against Big Box Healthcare