Of Doctor Dick Turpin, MedicalTesting and Telephone Tag
Today was a day that illustrated, more than anything, that one of my doctors is out of touch with reality.
I went for a checkup at the Wound Center today. Oy vey iz mir.
A bit of background: my left leg is considerably more swollen than it was last time because I suffered a bad bout of cellulitis in May. The leg has gone down since then and is no longer red and painful, but it's not back to where it was before the flare-up.
This is more annoying than anything else. When you have lymphedema, cellulitis comes with the territory. I get periodic flare-ups; this is part of my medical record. It's pesky but it's expected. (I'm also colonized with MRSA and I get periodic outbreaks of that. MRSA is less painful but more dangerous, as it involves lesions that take forever to heal.)
I explained to the medical personnel about the leg. No problem; the nurses know me and my medical history. They were sympathetic about the cellulitis.
The doctor to whom I have been assigned, however--who would be a skilled and ruthless highwayman, if not a romantic one--does not believe the following:
1) That I have lymphedema.
2) That lymphedema even exists. (Yes, he's said this to my face. Not today, but he has said it.)
3) That lymphedema massage therapy even helps. (It's one of the few things that does.)
4) That the many, many outbreaks of MRSA that I've had are really MRSA and not just me thinking it's MRSA because I've heard something about MRSA on TV. (Yes, he said THAT to my face too.)
5) That I have bouts of cellulitis.
We are not well-suited.
After talking to the nurses today, I spoke to him. He was all gowned and gloved up as if he was going into surgery. He did not even touch my legs (neither of which had open wounds, so there was no risk of infection) nor come anywhere near me. He told me that I couldn't say that I had cellulitis or MRSA without undergoing tests to prove that I had either.
I pointed out that when you have a history having a recurring condition and something happens that has the exact symptoms of that condition, it's generally logical to conclude that what's wrong IS that condition. (Basically, this is the zebra theory of medicine.)
He got mad about that. He doesn't like aware patients that pay attention to their health, and he really doesn't like intelligent women. It's not just me. He doesn't like nurses to offer opinions at ALL, even if the opinions are well-founded. So he decided that I would get a test done to prove that I didn't have a blood clot.
I asked if I wouldn't know if I had a blood clot. (It seemed to me that if I had a blood clot, there would be pain, as well as swelling in a particular part of the leg where the blood wasn't flowing properly.) I started to explain this, but he cut me off, saying that I wouldn't necessarily know and that blood clots can take months for the body to re-absorb and that it COULD be a blood clot--after all, I'm not on anti-coagulants, right?
I pointed out that I'm not SUPPOSED to be on anti-coagulants and that I've never had a blood clot. I've been tested for blood clots repeatedly in the past and I've never had one.
He pounced and demanded to know when I'd been tested for blood clots. I got mixed up and said recently; this is probably because I did recently have a blood TEST done for my neurologist.
He immediately marched off and called the vascular testing facility at the hospital, telling them that I'd be coming in right now. I didn't find out he'd done this until the nurse came in a minute later, saying that the doctor was demanding that I get the blood clot test done.
I was expecting Dial-A-Ride to show up very shortly. You can't re-schedule DAR on the day of the trip. They don't allow it.
I asked the nurse how long the test would take. She said not very long. I said good, because I was under time constraints. The nurse insisted that if I didn't go today, I would HAVE to go tomorrow because they wouldn't let me leave otherwise.
I tried calling DAR to schedule such an appointment for tomorrow, but the person I spoke to at DAR couldn't hear me. She said my signal kept breaking up. And at this point, every alarm bell in the world was clanging in my head. Thanks to being imprisoned in the hospital and nursing homes for months, I have a phobia about "will not let you leave." So I said that I'd get the test done today.
Then I checked my phone. It was 9:49 a.m.
Dial-A-Ride was scheduled to arrive at 10.
I called the nurse over and told her that unless I could walk over to admitting, get to the testing area, get tested and get outside in ten minutes, the test wasn't going to happen today, because I would be stranded here. The nurse rescheduled the appointment for tomorrow.
So I escaped. And Dial-A-Ride WAS outside waiting for me. Good timing on their part.
On the way home, however, I realized a couple of things:
1) I did not know where the testing facility was. Forget not knowing the room number--I didn't even know which hospital building it was in.
2) I did not know if Medicare would pay for this test. Medicare is brilliant about paying for essential and routine stuff, but random tests done on a doctor's whim--not so much.
I spent most of the day on the phone. These are the people and organizations I spoke to:
a) The automated admissions desk at the hospital. I got that number from the website.
b) That number got bounced to a patient referral service. The patient referral service transferred me to a person at the admissions desk.
c) The person at the admissions desk told me to come to admitting a half hour before the test and that the test itself--a venous doppler evaluation, it's called--would take about an hour. I was then given another number for Central Scheduling.
d) Central Scheduling's number turned out to be a fax number.
e) I then called Medicare to see if Medicare would pay for this. Medicare said that they didn't pre-authorize ANYTHING, but that if I had a procedure code, they could tell me approximately how much Medicare usually paid in such cases. Or, they said, the person authorizing the procedure could call their provider line and find out this information.
f) I called the doctor's office, figuring that he was the person authorizing the procedure. This bounced me back to the Wound Center. The nurses and secretaries were VERY sympathetic. They also told me that the person authorizing the procedure wasn't the doctor but the vascular testing facility. So I got that number.
g) At the vascular testing place, I hit paydirt. I got hold of a woman who worked in the office (and who had apparently been expecting my call, because her reaction on hearing my question--even before I introduced myself--was to call me by name) and found out the following:
I. The procedure code for Medicare (93971).
II. The cost of such a test with no frills: $653.00.
III. That Medicare would probably pay, but that this wasn't guaranteed.
She was also very sympathetic and felt that cellulitis was far more probable, given my medical history, and wasn't best pleased the doctor had assigned the test without checking to see if it was affordable or not. (Seriously, Doc, not even any discussion of payment options or installment plans? Not even telling me the cost?)
h) Called Medicare back and gave them the code. According to Medicare, the MOST they will pay for the procedure (and it might well be less) is $192.82.
_653.00
-192.82
__________
460.18
So I'd end up having to pay almost five hundred dollars that I cannot afford because a doctor got pissy and decided that he was going to bully me into taking a test that I don't need.
Yeah, this isn't happening. I've cancelled the test for tomorrow and I have NOT rescheduled.
If it were not a hardship and if I were convinced that there might be a clot, I would consider this. But he didn't examine me. He didn't touch me. He just stood with his back against the privacy curtain, stared at the leg and disregarded everything I said. He didn't like being told that the patient knew her body and her health better than he did.
I'm going to have to call the Wound Center tomorrow. It is appallingly clear that I need a new doctor--stat.
I went for a checkup at the Wound Center today. Oy vey iz mir.
A bit of background: my left leg is considerably more swollen than it was last time because I suffered a bad bout of cellulitis in May. The leg has gone down since then and is no longer red and painful, but it's not back to where it was before the flare-up.
This is more annoying than anything else. When you have lymphedema, cellulitis comes with the territory. I get periodic flare-ups; this is part of my medical record. It's pesky but it's expected. (I'm also colonized with MRSA and I get periodic outbreaks of that. MRSA is less painful but more dangerous, as it involves lesions that take forever to heal.)
I explained to the medical personnel about the leg. No problem; the nurses know me and my medical history. They were sympathetic about the cellulitis.
The doctor to whom I have been assigned, however--who would be a skilled and ruthless highwayman, if not a romantic one--does not believe the following:
1) That I have lymphedema.
2) That lymphedema even exists. (Yes, he's said this to my face. Not today, but he has said it.)
3) That lymphedema massage therapy even helps. (It's one of the few things that does.)
4) That the many, many outbreaks of MRSA that I've had are really MRSA and not just me thinking it's MRSA because I've heard something about MRSA on TV. (Yes, he said THAT to my face too.)
5) That I have bouts of cellulitis.
We are not well-suited.
After talking to the nurses today, I spoke to him. He was all gowned and gloved up as if he was going into surgery. He did not even touch my legs (neither of which had open wounds, so there was no risk of infection) nor come anywhere near me. He told me that I couldn't say that I had cellulitis or MRSA without undergoing tests to prove that I had either.
I pointed out that when you have a history having a recurring condition and something happens that has the exact symptoms of that condition, it's generally logical to conclude that what's wrong IS that condition. (Basically, this is the zebra theory of medicine.)
He got mad about that. He doesn't like aware patients that pay attention to their health, and he really doesn't like intelligent women. It's not just me. He doesn't like nurses to offer opinions at ALL, even if the opinions are well-founded. So he decided that I would get a test done to prove that I didn't have a blood clot.
I asked if I wouldn't know if I had a blood clot. (It seemed to me that if I had a blood clot, there would be pain, as well as swelling in a particular part of the leg where the blood wasn't flowing properly.) I started to explain this, but he cut me off, saying that I wouldn't necessarily know and that blood clots can take months for the body to re-absorb and that it COULD be a blood clot--after all, I'm not on anti-coagulants, right?
I pointed out that I'm not SUPPOSED to be on anti-coagulants and that I've never had a blood clot. I've been tested for blood clots repeatedly in the past and I've never had one.
He pounced and demanded to know when I'd been tested for blood clots. I got mixed up and said recently; this is probably because I did recently have a blood TEST done for my neurologist.
He immediately marched off and called the vascular testing facility at the hospital, telling them that I'd be coming in right now. I didn't find out he'd done this until the nurse came in a minute later, saying that the doctor was demanding that I get the blood clot test done.
I was expecting Dial-A-Ride to show up very shortly. You can't re-schedule DAR on the day of the trip. They don't allow it.
I asked the nurse how long the test would take. She said not very long. I said good, because I was under time constraints. The nurse insisted that if I didn't go today, I would HAVE to go tomorrow because they wouldn't let me leave otherwise.
I tried calling DAR to schedule such an appointment for tomorrow, but the person I spoke to at DAR couldn't hear me. She said my signal kept breaking up. And at this point, every alarm bell in the world was clanging in my head. Thanks to being imprisoned in the hospital and nursing homes for months, I have a phobia about "will not let you leave." So I said that I'd get the test done today.
Then I checked my phone. It was 9:49 a.m.
Dial-A-Ride was scheduled to arrive at 10.
I called the nurse over and told her that unless I could walk over to admitting, get to the testing area, get tested and get outside in ten minutes, the test wasn't going to happen today, because I would be stranded here. The nurse rescheduled the appointment for tomorrow.
So I escaped. And Dial-A-Ride WAS outside waiting for me. Good timing on their part.
On the way home, however, I realized a couple of things:
1) I did not know where the testing facility was. Forget not knowing the room number--I didn't even know which hospital building it was in.
2) I did not know if Medicare would pay for this test. Medicare is brilliant about paying for essential and routine stuff, but random tests done on a doctor's whim--not so much.
I spent most of the day on the phone. These are the people and organizations I spoke to:
a) The automated admissions desk at the hospital. I got that number from the website.
b) That number got bounced to a patient referral service. The patient referral service transferred me to a person at the admissions desk.
c) The person at the admissions desk told me to come to admitting a half hour before the test and that the test itself--a venous doppler evaluation, it's called--would take about an hour. I was then given another number for Central Scheduling.
d) Central Scheduling's number turned out to be a fax number.
e) I then called Medicare to see if Medicare would pay for this. Medicare said that they didn't pre-authorize ANYTHING, but that if I had a procedure code, they could tell me approximately how much Medicare usually paid in such cases. Or, they said, the person authorizing the procedure could call their provider line and find out this information.
f) I called the doctor's office, figuring that he was the person authorizing the procedure. This bounced me back to the Wound Center. The nurses and secretaries were VERY sympathetic. They also told me that the person authorizing the procedure wasn't the doctor but the vascular testing facility. So I got that number.
g) At the vascular testing place, I hit paydirt. I got hold of a woman who worked in the office (and who had apparently been expecting my call, because her reaction on hearing my question--even before I introduced myself--was to call me by name) and found out the following:
I. The procedure code for Medicare (93971).
II. The cost of such a test with no frills: $653.00.
III. That Medicare would probably pay, but that this wasn't guaranteed.
She was also very sympathetic and felt that cellulitis was far more probable, given my medical history, and wasn't best pleased the doctor had assigned the test without checking to see if it was affordable or not. (Seriously, Doc, not even any discussion of payment options or installment plans? Not even telling me the cost?)
h) Called Medicare back and gave them the code. According to Medicare, the MOST they will pay for the procedure (and it might well be less) is $192.82.
_653.00
-192.82
__________
460.18
So I'd end up having to pay almost five hundred dollars that I cannot afford because a doctor got pissy and decided that he was going to bully me into taking a test that I don't need.
Yeah, this isn't happening. I've cancelled the test for tomorrow and I have NOT rescheduled.
If it were not a hardship and if I were convinced that there might be a clot, I would consider this. But he didn't examine me. He didn't touch me. He just stood with his back against the privacy curtain, stared at the leg and disregarded everything I said. He didn't like being told that the patient knew her body and her health better than he did.
I'm going to have to call the Wound Center tomorrow. It is appallingly clear that I need a new doctor--stat.