The Upper Hand: Chuck & Chris Talk Hand Surgery
Sep 13, 2026 · 31 min · 13 segments
Chuck and Chris briefly review challenges with the US healthcare system but spend most of the episode discussing difficult hand fracture cases. Meyer ZI, Goldfarb CA, Calfee RP, Wall LB. The Central…
And, you know, if you go on social media, you'll see some, sometimes people record these interactions, which I think is really interesting.
I kind of wish I'd recorded this one, but you know, the American healthcare system is so difficult in so many different ways.
And so I had a patient with a, um, malunion, talking about our fracture cases we're going to discuss later, but this is a patient I didn't treat, came to me six, nine months after fracture of the second and third and fourth metacarpal necks that healed in a malunated posture, but it didn't look terrible on x-ray.
And so I'm like, well, let's get a CT scan to better understand the malunited position.
But in this case, it wasn't clear to me, do I need to address any of them? Do I need to address all the malunions? What should I do? So I requested a CT scan and was told by the insurance company that it was declined and that I should get an MRI instead.
And I'm like, what? You want me to spend more money and get the test that's going to help me less? And sometimes I'm just like, screw it, I'll get the MRI.
They said I had to do a peer-to-peer, and my nurse called me in the middle of surgery and said, you gotta do it now.
The peer, of course, was not an orthopedic surgeon, and the person gave me grief for needing a CT.
Why would you need a CT scan? Why don't dudes do an MRI? So I explained the logic, And then I was put on hold for five more minutes before they came back and said that it was approved.
I think it's the goal of any service industry when you make a phone call, your power company, your water company, your phone company, and they just put you on hold hoping you'll hang up.
And, you know, if you go on social media, you'll see some, sometimes people record these interactions, which I think is really interesting.
I kind of wish I'd recorded this one, but you know, the American healthcare system is so difficult in so many different ways.
And so I had a patient with a, um, malunion, talking about our fracture cases we're going to discuss later, but this is a patient I didn't treat, came to me six, nine months after fracture of the second and third and fourth metacarpal necks that healed in a malunated posture, but it didn't look terrible on x-ray.
And so I'm like, well, let's get a CT scan to better understand the malunited position.
But in this case, it wasn't clear to me, do I need to address any of them? Do I need to address all the malunions? What should I do? So I requested a CT scan and was told by the insurance company that it was declined and that I should get an MRI instead.
And I'm like, what? You want me to spend more money and get the test that's going to help me less? And sometimes I'm just like, screw it, I'll get the MRI.
They said I had to do a peer-to-peer, and my nurse called me in the middle of surgery and said, you gotta do it now.
The peer, of course, was not an orthopedic surgeon, and the person gave me grief for needing a CT.
Why would you need a CT scan? Why don't dudes do an MRI? So I explained the logic, And then I was put on hold for five more minutes before they came back and said that it was approved.
I think it's the goal of any service industry when you make a phone call, your power company, your water company, your phone company, and they just put you on hold hoping you'll hang up.
The rest of this transcript — segmented and speaker-labeled, so you land on the exact moment something was said
Search every transcript — by keyword, by phrase, or by meaning, across every show Radar indexes
Trends — what is surging across podcasts, measured against its own baseline
Alerts — when a name you follow appears in a newly indexed episode
No account is needed to search Radar.
