11/23/2011
Slightly disjointed rant forthcoming.
Can I rant about the medical establishment again? Because, really, it boggles the mind that family doctors and primary care physicians are paid these huge amounts of money but the only time I ever see them are when I schedule a checkup or have a non-urgent matter.
Yesterday Margaret was diagnosed with pneumonia (by a PA). Last night I started feeling a little squirrely and had some pain in my lungs while coughing or breathing all the way out. I did get vomited on last week and have been in close contact with her, so of course the first thing I'm thinking is "I hope I didn't get her pneumonia." I give it the night and woke up today feeling more sore in my lungs, specifically in one spot on the left side and in my bronchial tubes right around my trachea (it feels a little like I'm choking). The pain isn't huge or pronounced, but it's there and it wasn't yesterday. I took a hot shower and did a bunch of deep breathing and coughing, when I plugged my ears I could hear a slight crackling and a wheeze at the very end of my exhale.
So, here lies the conundrum. Clearly something is going on. Typically I would wait a day and call my doctor tomorrow, but tomorrow is Thanksgiving and no one is open on Friday, either. I decided to call my PCP's office to see if I could get in today, at the risk of jumping the gun and not having anything definitive to diagnose. Still, it seems ridiculous to wait and get worse.
Now, I understand that doctors are just people and can't be everywhere at once - perhaps my beef is with the medical establishment in general, how it's all set up. Because I don't think I've seen my PCP in at least three years, every time I've needed to go I see a PA or a nurse practitioner. Which is fine, I don't mind that so much, but the fact that my PCP needs to be the hub of all of my referrals and medical information when I don't think she would even recognize me if she saw me on the street, it's just too much.
Even worse I hate receptionists at doctors' offices. They are not medical professionals and I cannot stand needing to pass whatever arbitrary test they give me to get through to someone who can actually help. Today I called and got one of the regular know-nothing gatekeepers that I am very used to dealing with, by now.
Me: Hi, I'm a patient of Dr. Xxxxxx. My daughter was diagnosed with pneumonia yesterday and I have recently developed pain in my lungs and I can hear a crackling when I exhale. I was hoping I could see someone today.
Her: Uhhhhhhhhhhh.
Me: (waiting, thinking, "WTF? The last thing I want to hear from you is 'Uhhhhhhhhhh.'")
(We verify my information.)
Her: Okay, well...Dr. Xxxxxx is out of the office until the middle of December. The earliest I could schedule you to see her would be...
Me: Is there anyone else there I could see? Do I have to see Dr. Xxxxxxx? (At this point I'm thinking, "Did you not HEAR the whole part about pneumonia?")
Her: Hmm. Okay, well, let me check. Please hold.
(I am on hold for five minutes.)
Her: Hi. Okay. The thing is, we have a half day today, and Dr. Xxxxxxx (the other doc in the practice who is very nice) is seeing his last patient. We're closed for the rest of the week.
(Silence for a few seconds.)
Me: All right...well...what would you recommend, then?
Her: Um...the earliest I could get you an appointment would be December 2nd.
Me: What should I do in the meantime? I'm concerned I might have pneumonia or bronchitis.
Her: Well, if you think you might have bronchitis you can go to the walk-in clinic at Walmart. If you think you might have pneumonia, you can go to the ER.
Me: That's just it, I DON'T know, I'm not a doctor. So you're saying that my only options at this point are to go to the walk-in clinic or to the ER.
Her: Hold on a moment, let me check to see if the nurse practitioner is still in the office.
(I am on hold another three minutes or so.)
Her: Okay, we can get you in at two o'clock?
Me: Yes! Great, that would be perfect, thank you.
Her: Okay. Since this is an urgent matter you just need to pre-register before coming in. I can transfer you, or I can give you the number as I don't know how busy they are.
Me: Why don't you give me the number and then transfer me, just in case I get disconnected?
Her: Okay, the number is XXX-XXXX. Thanks, have a good day.
(She disconnects.)
I called the number and talked to the receptionist there, she verified the same information I verify every time I go to the doctor - name, address, DOB, employer, insurance - not sure why I needed to do that over the phone when they HAVE it all already and it takes thirty seconds to veify. Amusingly enough while I'm on the call, the first receptionist calls me back to apologize for not transferring me. Durr.
So, okay. I got what I wanted - someone with authority to listen to my lungs and prescribe me something if I need it so I don't end up being sick as a dog over Thanksgiving and the weekend beyond (while trying to take care of my daughter who is legitimately sick as a dog). If it's nothing, great - but I really want to know before looking at four days of having the ER as the only feasible option. And trust me - I am NOT the kind of person who would call at the smallest sniffle, in fact it was my husband who insisted I call because I worry so much about being an alarmist that I often wait too long when it comes to myself.
The things that PISS ME OFF about this exchange, and I wouldn't bitch except this sort of thing seems to happen every single time I reach out for medical care, lately.
1. I had to counter the receptionist's excuses and non-answers THREE TIMES before getting an actual result. If the result had been "There's no one to see you" that would have been fine, but the fact is it took my insisting to even get that far, which makes me think - what if I hadn't advocated for myself and done what I felt was be borderline rude? I would have gotten nowhere. It was almost as if she were hoping I would just say "Oh, okay then" and give up.
2. My PCP's office is never available when I actually need it. Scheduled appointments, great, though I have to make them six months to a year in advance. In the meantime if I get sick I usually end up having to go to the ER. Aren't emergency rooms already overburdened with the uninsured using them for primary care since they have nowhere else to go? Wouldn't it make SENSE to fix the system for those of us who DO have healthcare and DO pay premiums for the privelege of having a doctor, so that we don't have to turn around and add to that burden on the ER? There are always appropriate times to use the ER, but I've had to lean on them a lot more than I think I should.
3. I hate being penalized. I have a job with health insurance, I pay premiums, and I am grateful to have it. I pay for the privelege of having a doctor, I jump through hoops selecting providers in the system, of paying co-pays, of getting referrals and doing paperwork to keep the insurance company happy. Yet when I actually need that doctor I am more often than not forced to go to the clinic or the ER, which are the staple of people without insurance beause they have no other choices. I swear that as elitist as that might sound I don't mean it that way - what I'm trying to express is that I'm paying for a service and not getting it. Since I don't qualify for assistance then I need to pay out of pocket for anything not covered by my insurance, so the $20 copay at my doctor's office becomes $100 at the ER. I am being penalized for needing medical care outside of my doctor's six-months-out schedule. It makes no sense at all.
Checkups are important, but they are not what most people go to the doctor for. People need medical attention due to illness or emergencies, and the system doesn't support that need. It only supports practice doctors who then end up taking on too many patients which results in a need to schedule out so far in advance that they're not helping people who need help when they actually need it. It's crazy. And even that is fine, too - if I were a doctor I'd make my goal to have a set schedule and a full patient roster - but there needs to be ADDITIONAL staff available for urgent needs. Or, the control needs to be taken away from the doctor and handed to the patient, so someone like me doesn't need to kowtow to the receptionist gatekeepers every time I need a referral to see the medical professional I really need to see.
So yeah, I'm not sure what the answer is. But there really need to be more options for those who are insured and pay for it, to be able to be seen for urgent matters without adding their own issues to the straining clinics and ERs who are already overloaded to begin with. I'm sure there's a whole lot more to it than I'm able to see, this is just one facet from my perspective, but it frustrates me to no end that things have to be so hard. I feel as if I am actively discouraged from seeking medical care, that I should wait for it to become much more serious before taking action and going to the ER. When I was a kid we NEVER went to the ER, everything was handled through our family doctor. Nowadays it seems like every other illness in our really quite healthy family ends up in the ER. Imagine what it's like for people who aren't fortunate enough to enjoy our relative level of health? It's a full time job just managing the bullshit that comes with advocating for your family to get adequate medical care.
Anyway I have that appointment at 2. The roads are complete shit so I get the joy of driving around in it just to get there. Here's hoping.
Can I rant about the medical establishment again? Because, really, it boggles the mind that family doctors and primary care physicians are paid these huge amounts of money but the only time I ever see them are when I schedule a checkup or have a non-urgent matter.
Yesterday Margaret was diagnosed with pneumonia (by a PA). Last night I started feeling a little squirrely and had some pain in my lungs while coughing or breathing all the way out. I did get vomited on last week and have been in close contact with her, so of course the first thing I'm thinking is "I hope I didn't get her pneumonia." I give it the night and woke up today feeling more sore in my lungs, specifically in one spot on the left side and in my bronchial tubes right around my trachea (it feels a little like I'm choking). The pain isn't huge or pronounced, but it's there and it wasn't yesterday. I took a hot shower and did a bunch of deep breathing and coughing, when I plugged my ears I could hear a slight crackling and a wheeze at the very end of my exhale.
So, here lies the conundrum. Clearly something is going on. Typically I would wait a day and call my doctor tomorrow, but tomorrow is Thanksgiving and no one is open on Friday, either. I decided to call my PCP's office to see if I could get in today, at the risk of jumping the gun and not having anything definitive to diagnose. Still, it seems ridiculous to wait and get worse.
Now, I understand that doctors are just people and can't be everywhere at once - perhaps my beef is with the medical establishment in general, how it's all set up. Because I don't think I've seen my PCP in at least three years, every time I've needed to go I see a PA or a nurse practitioner. Which is fine, I don't mind that so much, but the fact that my PCP needs to be the hub of all of my referrals and medical information when I don't think she would even recognize me if she saw me on the street, it's just too much.
Even worse I hate receptionists at doctors' offices. They are not medical professionals and I cannot stand needing to pass whatever arbitrary test they give me to get through to someone who can actually help. Today I called and got one of the regular know-nothing gatekeepers that I am very used to dealing with, by now.
Me: Hi, I'm a patient of Dr. Xxxxxx. My daughter was diagnosed with pneumonia yesterday and I have recently developed pain in my lungs and I can hear a crackling when I exhale. I was hoping I could see someone today.
Her: Uhhhhhhhhhhh.
Me: (waiting, thinking, "WTF? The last thing I want to hear from you is 'Uhhhhhhhhhh.'")
(We verify my information.)
Her: Okay, well...Dr. Xxxxxx is out of the office until the middle of December. The earliest I could schedule you to see her would be...
Me: Is there anyone else there I could see? Do I have to see Dr. Xxxxxxx? (At this point I'm thinking, "Did you not HEAR the whole part about pneumonia?")
Her: Hmm. Okay, well, let me check. Please hold.
(I am on hold for five minutes.)
Her: Hi. Okay. The thing is, we have a half day today, and Dr. Xxxxxxx (the other doc in the practice who is very nice) is seeing his last patient. We're closed for the rest of the week.
(Silence for a few seconds.)
Me: All right...well...what would you recommend, then?
Her: Um...the earliest I could get you an appointment would be December 2nd.
Me: What should I do in the meantime? I'm concerned I might have pneumonia or bronchitis.
Her: Well, if you think you might have bronchitis you can go to the walk-in clinic at Walmart. If you think you might have pneumonia, you can go to the ER.
Me: That's just it, I DON'T know, I'm not a doctor. So you're saying that my only options at this point are to go to the walk-in clinic or to the ER.
Her: Hold on a moment, let me check to see if the nurse practitioner is still in the office.
(I am on hold another three minutes or so.)
Her: Okay, we can get you in at two o'clock?
Me: Yes! Great, that would be perfect, thank you.
Her: Okay. Since this is an urgent matter you just need to pre-register before coming in. I can transfer you, or I can give you the number as I don't know how busy they are.
Me: Why don't you give me the number and then transfer me, just in case I get disconnected?
Her: Okay, the number is XXX-XXXX. Thanks, have a good day.
(She disconnects.)
I called the number and talked to the receptionist there, she verified the same information I verify every time I go to the doctor - name, address, DOB, employer, insurance - not sure why I needed to do that over the phone when they HAVE it all already and it takes thirty seconds to veify. Amusingly enough while I'm on the call, the first receptionist calls me back to apologize for not transferring me. Durr.
So, okay. I got what I wanted - someone with authority to listen to my lungs and prescribe me something if I need it so I don't end up being sick as a dog over Thanksgiving and the weekend beyond (while trying to take care of my daughter who is legitimately sick as a dog). If it's nothing, great - but I really want to know before looking at four days of having the ER as the only feasible option. And trust me - I am NOT the kind of person who would call at the smallest sniffle, in fact it was my husband who insisted I call because I worry so much about being an alarmist that I often wait too long when it comes to myself.
The things that PISS ME OFF about this exchange, and I wouldn't bitch except this sort of thing seems to happen every single time I reach out for medical care, lately.
1. I had to counter the receptionist's excuses and non-answers THREE TIMES before getting an actual result. If the result had been "There's no one to see you" that would have been fine, but the fact is it took my insisting to even get that far, which makes me think - what if I hadn't advocated for myself and done what I felt was be borderline rude? I would have gotten nowhere. It was almost as if she were hoping I would just say "Oh, okay then" and give up.
2. My PCP's office is never available when I actually need it. Scheduled appointments, great, though I have to make them six months to a year in advance. In the meantime if I get sick I usually end up having to go to the ER. Aren't emergency rooms already overburdened with the uninsured using them for primary care since they have nowhere else to go? Wouldn't it make SENSE to fix the system for those of us who DO have healthcare and DO pay premiums for the privelege of having a doctor, so that we don't have to turn around and add to that burden on the ER? There are always appropriate times to use the ER, but I've had to lean on them a lot more than I think I should.
3. I hate being penalized. I have a job with health insurance, I pay premiums, and I am grateful to have it. I pay for the privelege of having a doctor, I jump through hoops selecting providers in the system, of paying co-pays, of getting referrals and doing paperwork to keep the insurance company happy. Yet when I actually need that doctor I am more often than not forced to go to the clinic or the ER, which are the staple of people without insurance beause they have no other choices. I swear that as elitist as that might sound I don't mean it that way - what I'm trying to express is that I'm paying for a service and not getting it. Since I don't qualify for assistance then I need to pay out of pocket for anything not covered by my insurance, so the $20 copay at my doctor's office becomes $100 at the ER. I am being penalized for needing medical care outside of my doctor's six-months-out schedule. It makes no sense at all.
Checkups are important, but they are not what most people go to the doctor for. People need medical attention due to illness or emergencies, and the system doesn't support that need. It only supports practice doctors who then end up taking on too many patients which results in a need to schedule out so far in advance that they're not helping people who need help when they actually need it. It's crazy. And even that is fine, too - if I were a doctor I'd make my goal to have a set schedule and a full patient roster - but there needs to be ADDITIONAL staff available for urgent needs. Or, the control needs to be taken away from the doctor and handed to the patient, so someone like me doesn't need to kowtow to the receptionist gatekeepers every time I need a referral to see the medical professional I really need to see.
So yeah, I'm not sure what the answer is. But there really need to be more options for those who are insured and pay for it, to be able to be seen for urgent matters without adding their own issues to the straining clinics and ERs who are already overloaded to begin with. I'm sure there's a whole lot more to it than I'm able to see, this is just one facet from my perspective, but it frustrates me to no end that things have to be so hard. I feel as if I am actively discouraged from seeking medical care, that I should wait for it to become much more serious before taking action and going to the ER. When I was a kid we NEVER went to the ER, everything was handled through our family doctor. Nowadays it seems like every other illness in our really quite healthy family ends up in the ER. Imagine what it's like for people who aren't fortunate enough to enjoy our relative level of health? It's a full time job just managing the bullshit that comes with advocating for your family to get adequate medical care.
Anyway I have that appointment at 2. The roads are complete shit so I get the joy of driving around in it just to get there. Here's hoping.