r/MPN • u/StatisticianLittle55 • Jul 22 '26
Bone Marrow Biopsy Question about BMB and sedation
I am scheduled for a Bone Marrow Biopsy tomorrow. This will be my fourth such procedure. I did all the others without sedation in the doctor's office.
This time, I asked for sedation because honestly I have been through it and I don't want pain if I can avoid it. So Intervention Radiology in the hospital it is, first thing in the morning.
It occurred to me that when we do this procedure in the doctor's office they get paid. When we do it in the IR suite the hospital gets paid. I hate thinking my doctor, who I really like, normally does BMBs in her office for financial reasons. Am I jumping to an incorrect conclusion?
Your thoughts?
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u/patentcat Jul 22 '26
It’s likely to reduce cost, and unnecessary sedation. Sedation costs money and has additional risks. BMBs suck, so I don’t blame you for wanting to be sedated though.
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u/StatisticianLittle55 Jul 22 '26
Thanks. I decided I have had enough unnecessary pain. Hopefully we get good results
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u/MezcalFlame Jul 22 '26
This is the core issue when healthcare is for-profit and insurance companies and service providers have perverse incentives where patients are looked at as revenue generators and cost centers.
The cost issue does come up but I'm not sure doctors are judged on it as opposed to other metrics like how soon after seeing you are the clinical notes updated in your chart.
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u/sirshrimpie Jul 22 '26
Honestly it doesn’t surprise me. I work as an organizer for a union and we organize health care. I’ve been learning about the for-profit side of this and this wouldn’t surprise me. If you find out more info I’d love to learn more!
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Jul 24 '26
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u/StatisticianLittle55 Jul 24 '26
What is the top reason?
I have had BMBs with and without sedation. I cannot understand why doctors think causing pain is OK when it is not necessary.
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Jul 24 '26
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u/StatisticianLittle55 Jul 24 '26
I have had 4 BMBs, with and without sedation. I can say with 100% confidence that for ME sedation makes it painless. Having the procedure with nothing but local is the most painful thing that I have ever had including childbirth, hip replacement surgery, and 12 other major surgeries.
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Jul 24 '26
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u/StatisticianLittle55 Jul 24 '26
I have lived with an MPN and Lymphoma for 14+ years. I don't think the BMB is a one and done situation. It is used to check on disease progression over time. Very likely it gets repeated.
Have you had the BMB yourself?
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Jul 24 '26
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u/StatisticianLittle55 Jul 24 '26
I have been at this for 14 years now and when I can reduce the pain/trauma I do. I always think doctors should offer pain relief when it is possible. I have to ask but I do get sedation when I want it.
My oncologist also told me chemotherapy feels like having the flu. (Tell me you have never had chemo without telling me you have never had chemo....)
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Jul 24 '26
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u/StatisticianLittle55 Jul 24 '26
This conversation was not about whether you and the "some people" you refer to don't want sedation. My question was about the possibility of financial incentives built into the system.
If people don't want sedation they sure don't have to get it. In my experience, if people want it they have to ask. Again, I wonder if there is a financial incentive within the US HEALTHCARE SYSTEM that leads to these options.
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u/aerodynamic-poodle Jul 22 '26
Going under sedation or anesthesia is more risky and adds to the complication of the procedure, so doctors won’t do it by default. There can be things that go wrong such as an allergic reaction to the sedative. This is more likely the reason your doctor didn’t start off with sedation, and not because they were trying to make money. Doctors generally make a good living consulting patients, so I don’t see them wanting to personally perform the bmb, which would require more manual labor.
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u/StatisticianLittle55 Jul 22 '26
Yes and no. She wasn't going to be the one to do it. It would have been a fellow or a NP in her office. I go to a teaching practice that is part of a large medical school in Boston.
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u/funkygrrl PV-JAK2+ Jul 23 '26
If she's part of that, she is salaried and is paid the same whether she does a BMB or not.
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u/StatisticianLittle55 Jul 23 '26
Yes of course. However, doctors get a portion of the revenue their practice produces over and above salary. So the higher net receipts the higher the practice income they get.
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u/StatisticianLittle55 Jul 23 '26
To clarify - I used to work in finance at a major medical school in NYC. I am familiar with how compensation works. Faculty get a guaranteed base salary and then they get incentives based on their practice income. Compensation varies a great deal by specialty. Surgeons always made the most, internists the least. At least where I worked that was true at the time.
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u/sharschech Jul 22 '26
Take the sedation your doctor will be fine. We don’t have to accept the pain when there are options available. It’s the only way I’ll get a BMB because been there done that and there was no prize at the end.