by Al Lewis
Does wondering how Quizzify got started keep you up at night? Wonder no longer…
In 2012 I was hired to host a radio series for the NPR affiliate in Washington DC (The Big Fix). After the first taping, the producer said so far so good, but I’d sound better after I got over my cold. Unfortunately, I didn’t actually have a cold. Newsflash to those of you who have heard me on podcasts by Josh Luke, Jen Arnold, Zeev Neuwirth, or anywhere else: this is the way I sound. I’ve been told I have a face for radio and a voice for newspaper.
Nonetheless, not wanting to be fired my first day on the job, and recalling that a few years earlier a doctor told me I had a deviated septum (“we ought to do something about that”), I immediately called my PCP for advice.
My PCP immediately set up an appointment to see an ENT, who determined that my stuffiness was likely being caused not by the deviated septum, but rather by a raging case of the polyps. (“Your deviated septum is the least of your problems.”)
The ENT suggested surgery, Flonase, or Flonase combined with a three-week course of antibiotics. “So,” she asked after quite literally six minutes explaining the options, “which do you want to do?”
“Um, shouldn’t we do the most conservative therapy first?” I inquired.
“Well, you could,” she replied, using a tone of voice implying that only an imbecile would.
Why was this diagnosis and treatment problematic? Six reasons.
First, the ENT didn’t mention any drawbacks or risks of taking a course of antibiotics at all, let alone for three full weeks. Antibiotics are far from harmless, which is why they still require prescriptions, almost a century after the discovery of penicillin.
Second, the ENT didn’t even hypothesize that the cause was bacterial. She asserted instead that “some people report getting relief by using the antibiotics,” which, more than coincidentally, is also the classic “before” comment in an evidence-based medicine continuing education session. Doctors are supposed to be guided by evidence and protocols, not their own perception of what happened with a few patients.
Third, she scheduled a CT scan for my sinuses to take place three days after the appointment. This short amount of time would not have given the nasal spray a chance to work. And I already had a diagnosis, so there was nothing she could learn from the scan other than whether the spray was working (which didn’t require a scan, just a scope).
Although the appointment was conveniently made for me (even though I didn’t ask), I had enough sense to cancel it. I was fortunate enough to know that—among other excellent reasons for avoiding them—sinus scans introduce a disproportionate amount of radiation into one’s skull, as well as a disproportionate amount of dye into one’s veins.
This particular CT scan proved shockingly difficult to avoid. The imaging center called me to tell me they had already scheduled it. At first, I just ignored them. Several unreturned voicemails later, it became obvious that if I didn’t affirmatively call back to cancel, they might send me a bill. So I did successfully wriggle out of that one.
Having now nixed the surgery, the antibiotics, and the CT scan, I settled into the most conservative therapy for my hoarseness, the Flonase. I took it for a few days until at one point I decided to read the Flonase FDA insert, which began: “Side effects include hoarseness.” Of course, I stopped using it immediately.
I was certain I would lose this radio gig, because I needed to 'fess up that I could do nothing about my voice. And after all that, the producer just said: “Oh, don’t worry about it. We’ll just give you tea with honey, and the studio engineer will take care of the rest.” The show eventually did go off the air for various reasons, but I’m proud to say that of the many complaints that WAMU received, none included: “This guy sounds like he needs his polyps removed.”
Meanwhile I was thinking: “What is wrong with this picture? I’m getting all this medical care thrown at me. And not by a fee-for-service surgeon, who would make more money by operating, but rather by an ENT paid a salary by the medical group who therefore had no financial incentive to propose operations. So what happens to people who don’t know enough to say no?”
That was the inspiration for Quizzify. The idea that Americans were massively overdiagnosed, overtreated, overdosed, and overscreened, at a huge expense to employers —was not new. Researchers had been saying this for years. But when it happened to me, it hit home.
But Wait. There’s More…
Just when I was thinking that I couldn’t get sucked any farther into the “treatment trap,” I received a nasty note from the pharmacy benefit manager verily excoriating my failure to renew the Flonase, a failure that the PBM said “may need immediate attention.” They graded me a 1 on a scale of 5 stars.
In short (and fortunately for my wife’s employer who was paying these bills) I became one of those noncompliant patients that wellness vendors complain about.
Meanwhile, my research showed this type of overtreatment was rampant, mostly because patients do not have the knowledge they need to make decisions about their own care. Further, no vendor was addressing what has been called the “epidemic of overuse.” Meanwhile, thousands of vendors were trying to reduce the cost of healthcare by advocating for more of it, usually using their doctors, call center, or screeners. If only I could figure out a way to make employee health literacy/medical education fun and memorable enough to get meaningful engagement and retention...
I had written and hosted two quiz show series on Boston-area network affiliates, wrote the best-selling Newsweek presents the Ultimate Trivia Game, and, like every other hardcore needs-a-life trivia buff, appeared on Jeopardy. The solution revealed itself almost immediately: create an online trivia game to teach employees, clinically speaking, to look both ways before crossing the street.
That’s where the idea came from, and that’s why industry thought leaders are endorsing the game, employees are sending testimonials, and organizations of all sizes are recognizing the value of our mantra: wiser employees make healthier decisions…and healthier decisions save money.
And, from all of us here at Quizzify, we wish you a very…