Wednesday, April 29


Hmm. That one week break from blogging seems to have projected me into a whirlpool of political rants. One industry after the next. It also seems to have made me 20% more likely to start my posts with "Hmm." Hmm.

Today's lucky winner? Health care. Plenty to say, of course. But like most things in our me-obsessed culture (from which I am obviously not immune, as ashamed as I am to admit it), it doesn't really hit me over the head until I experience it myself. So now, as I'm nearing one week of far-too-intimate interaction with the health care system, I'm edging ever nearer to self-proclaimed expert status (ha!). At the very least, I'm qualified to point out some of the, shall we say, "curiosities" of my experience. So here goes.

Our system of health care in the United States is completely f&*@ed up. There. I'm done now.

Well... that was just completely unsatisfying.

Back to rambling. I've got a reputation to support.

First, there's a backstory. (isn't there always a backstory?) The backstory is needed because many of you who are reading do not live in Massachusetts. And in this case, it matters, becuase one might be tempted to see Massachusetts as the maverick (I hate how that word was tainted by Sarah Palin, when it's a perfectly good word. I'm gonna use it anyway), because we have universal health insurance, mandated by the state. We're admired for it, we're envied for it, we're the "model". Massachusetts is good at that kind of stuff. And there are places where it is well deserved, inspirational, even. Witness Rev. Peter Gomes' comments about Massachusetts at the State House in favor of equal marriage:

"We, after all, have the Mayflower Compact. We have John Winthrop and his vision set on a hill. We have John Adams and the oldest Constitution in the world. Why should we yield to the sentimenets of the main street or the mainstream? We set the mainstream, we don't follow it!"

I'm getting off topic (how very unusual). It was a great speech and a great moment, though.

So, I'm sure you've heard that our rock star President, who happens to be good friends with our governor, is modeling his proposals for universal health care after the plan that was implemented in Massachusetts three years ago (do YOU have to list your health insurance policy number on YOUR income taxes? I do.). Or maybe it's the other way around--maybe Massachusetts modeled it on the federal plan that apparently exists but has never been implemented, because, well, that would be kinda proactive, and that just goes against our grain. So one way or the other, it was somebody's idea, and somebody else followed it, and we have in in Massachusetts and you don't. Whatever.

Important Caveat: The killer (pun intended) here is that you couldn't find anyone more in favor of universal health care than me. I'm not only in favor of it, I am a fervent proponent. It's just my feeling, crazy as it is, that it has to work. That's where these things always run into know, "it was such a good idea..."

First off, I'm sure there are a number of things we can agree on:

1. Emergency rooms are for emergencies. Not for routine care, or even for urgent care. Not the place to go when you're feelin' poorly (why do I always feel like I'm in a Mark Twain story when I use that phrase?). Emergencies.

2. Colds go away by themselves. They're unpleasant, but barring some sort of problem with immunity, they do go away.

3. Being sick can be scary, especially in this age of 24 hour media sensationalism.

4. If you're really sick, or really worried about symptoms you're having, it's a really good idea to see your doctor (Note to my friends: Pick Jaw Up Off Floor.)

5. It's good to have a doctor who knows you and your history.

6. It feels a little bit better (and a good deal more rational) for medical professionals to make medical decisions rather than insurance agents.

...and perhaps the most important one:

7. It's pretty much true that, no matter what is wrong with you (if something is, indeed, wrong with you), it's better to "catch it early). Way better.

Agreed? Good. Let's go on.

I have a great doctor, and that's saying something, since in my experience those two words rarely belong in the same sentence. I feel lucky about that, and grateful to the person who referred me to him. So naturally, when I was having, well, let's just say "some symptoms of concern" last Friday, I called his office. On another occasion, they actually got me in right away. It was encouraging. This time, it made me long for the days of country doctors, I gotta tell ya. First, I got the recorded line that offered me lots of choices. Those people aren't even located at my doctor's office. I pushed "2". Next, I got the receptionist at my doctor's office. She asked me for my symptoms (do receptionists know something about symptoms?), and forwarded me to my doctor's nurse. I talked to her, she asked me questions, I gave her answers. She told me to go to emergency.

Since I was sitting in the emergency room parking lot of a hospital at the time (trying desperately to come up with some alternative to going inside), that wasn't too tough, at least logistically. So I went. I was there for seven hours. Lots of tests, some of them rather unpleasant. They were very nice, and seemingly thorough. Everything (or close enough) came out okay. No conclusions, no ideas, no particular relief. No news is good news, eh? And so I left. But before I left, I got my instructions.

Pay attention. This is where the plot thickens.

My instructions? Follow up with your doctor. Good idea! (especially if there is some intention to figure out what these symptoms are about, which seems like a pretty good idea to me.)

So, I called my doctor, like a good do-be (see #4). Pressed "1" this time. (I thought you'd want to know). Told them I was told by their office to go to emergency last Friday, and that the ER told me to make a follow-up appointment right away.

Next available appointment? Monday, June 13th. 7 weeks.

Now of course, I don't know for a fact that this is due to the implementation of universal health care, so that people can see their doctor rather than going to the emergency room (since there are really no other points of entry between, which just doesn't make any sense at all). I have no evidence of that at all, really (well, except for an article in the New York Times). I do know that before universal health care, I always got an appointment with him within a week, often within a day. Maybe it's just coincidental.

So here's where the whole thing falls apart for me. That's where I start to say "I don't get it". I still have symptoms--not as bad, but still there. They know it. I know it. Yeah, I have a prescription for knock-me-out meds, but it's nowhere near that level of pain, so I'm not inclined to fill it. It's not even really "pain". It's...well...different. But it still counts (See #3 above).

So what I am I left with? Emergency again (not today, I'm pretty much okay today, just thinking ahead)? Highly unlikely (and besides, it violates #1 above). See a different doctor? Possible. Still a week out at the minimum and in violation of #5 (not to mention a bit challenging for someone like me who thinks the great majority of MDs are borderline incompetent, especially in the face of something "not obvious".) Block out 8:30-9:00 a.m. every day, and call and sit on hold, in hopes of a cancellation? I'm figuring I'm pretty much left with #2 (and a heaping and lingering serving of #7). What else is there? So I have a cold. I guess I'm going with that. Kinda expensive way to come to that conclusion, but rules are rules.

All of this, in the land of some of the biggest and best hospitals (and lots of 'em!) in the country.

Honestly, folks, at the risk of being overly dramatic, really all I'm doing is hoping to avoid ending up like one of these folks, and my guess is you are as well:

It just seems like we can't keep blaming people for going to emergency (with all the associated costs, which are admittedly gigantic) when we don't offer any other viable options. If you're sick, waiting seven weeks for an appointment just isn't going to do it for you--it's simple logic. Remember that "catching it early" thing? You'd think even insurance companies would subscribe to that one.

There's gotta be a better way. This ain't it.


Anonymous said...

I don't know where your doctor is, Robin, but this is definitely NOT the case at most clinics within BWH. In my experience, even the busiest clinics are willing to make more emergent appointments when there is a real need. In fact, as you say, the administration of the hospital STRONGLY urges clinics to work with patients where possible to avoid costly ED visits.
If I can lend any clout, let me know. We may have different expectations of what makes a good doctor, and as you know, I've had some HORRIBLE ones, but also know and work with some really great ones.

ConverseMomma said...

I just wish there was an effective way to ensure that all people had access to quality health care, especially children. *Big Sigh*

Robin said...

You and me both, Kelly. Personally, I don't think health care is the problem. I think the insurance industry is the problem, and a big one at that.

And thanks, Carrie. I'm just so not inclined to find a new doc. In my 51 years, this is only the third doc (one of them my daughter's pediatrician) who inspired any confidence. And for the record, my doctor's offices, no matter how busy, also will make faster appointments, but getting through the bodies who "screen" the process to get to someone who can make that happen is laborious. Sigh. Onward and upward.

Anonymous said...

I saw a good piece on MA healthcare recently. The mandate to cover everyone was done without thinking through the process (big shock there). There aren't enough basic care physicians to cover the population, and since they're the gatekeepers, there's no surprise you were having problems getting in to see your doctor. According to the story, consider yourself lucky to even be on file with a doctor, especially one you like.

I AM very surprised to hear that they couldn't work you in given the urgency of your condition. Even my very cranky doctor got me in to see her on a day's notice when I was having some very strange symptoms - and it normally takes a month to get an appt.

I think the state/feds should offer to pay tuition for doctors wanting to go into family practice - they already do this for underserved populations. This is a must if they're going to enact any sort of universal health care.


Robin said...

Was it the piece in the NYTimes (that I linked to in the article), Elaine? It touched on exactly your point, about reimbursing family practice docs, but it was discouraging to hear medical students and residents say that that still wouldn't convince them to go into family practice or internal/general medicine.

So what do we do, then?

Anonymous said...

I saw it on the News Hour; very similar to the NYT piece (notice how often they do the same story at the same time?). I know many med students don't want to enter general medicine because it just isn't as lucrative or interesting to them, not to mention the long hours they will have to work.

I think med schools will need to allocate a certain portion of their seats to producing these types of doctors, along w/ financial incentives. I'm positive you'd see an increase in people enrolling to become general practice doctors if they didn't have to worry about accumulating $250,000+ in student debt.


Anonymous said...

Hope you feel better soon.
Sounds like you already nailed the other big issue.
It's not just health insurance companies that are crap. The practice insurance is so horrid that doctors who are competent either 1) have to take way too many patients to cover this cost, or 2) refuse to go into general/family practice. You were lucky to find the doctor you have.