Monday, August 9, 2010


My cousin Shirlee and I commiserate a lot about what has happened to our medical system in the United States. There are times we think it is simply going to hell in a hand basket. We bemoan the fact that our primary care doctor doesn’t know us any more, that we are lucky if we get 10 minutes of the doctor’s time per visit, and probably most of all, we are totally flummoxed to think that our past history is going to be magically at the doctor’s fingertips via the computer.

HAH! We say. When the computer becomes as reliable as our Frigidaire refrigerator we’ll believe it. For now, I have no confidence whatsoever that the computer will tell them what they need to know, either because the computer is down again or that as far as the computer is concerned, my past medical history only started in 2007.

Another source of concern is that the patient is now expected to tell the doctor what they want him to do, and/or the patient is expected to know what he or she needs to do at every step of the way. My cousin and I are not stupid when it comes to knowing about medical things. She was a veterinarian for many years, while I did medical transcription. This doesn’t make us medical doctors, but we aren’t dummies, either. This knowledge has been to our advantage. But what about all those other people who don’t know the kind of stuff we know. They are truly at the mercy of Lady Luck.

My first experience with needing to stay on top of what the pre-HMO doctor and his office is doing came from the time that I developed some pain in my belly during the night. About 6 a.m. I put in a call to his doctor’s exchange to have him call me back, which he did. He advised me be at his office at 9 a.m. and he’d check me out first. I did, he did, and he sent me to the hospital for blood work. He said he expected appendicitis. I was told to go home and he’d call me when the results came in. At 4 that afternoon, after writhing on my bed in pain all day, I called his office and asked if he knew anything yet. “Oh,” said Roseann, his office girl, surprise in her voice. “We’ve never heard back from the hospital. I’ll call and get right back with you.” Within 10 minutes the doctor called and told me to go to the hospital immediately and to notify my husband, because I’d probably be in surgery by the time he got there.”

This all happened long before there were such things as HMOs, and my doc was a kindly fellow who had taken good care of me for 10 years. But it was then that I learned that I could not assume that doctors would do what they intended to do. Well, I’m sure my doc had my best interest at heart, but obviously his system broke down. What I learned prepared me for how the HMO world would operate. I have never again trusted doctors and their offices to do what they say they are going to do. From that time on, I make follow-up calls to make sure things are proceeding. I won’t ever let that happen again.

The other thing illustrative of what we as patients need to know about our own care is when I began experiencing what later was diagnosed as a frozen shoulder. I talked to two different primary care physicians about it (I was in the middle of retiring and had to shift HMOs) and both doctors diagnosed bursitis. I told the second doctor that it was worse than when the previous doctor saw it some months back. The new doc told me to get some chondroitin/glucosamine pills and see if that helped.

Three months down the road, when I could no longer stretch my arm out more than a few inches from my body, I made another appointment with my PCP; the soonest was a four-week wait. When I walked in to that appointment, I stuck my arm out into his field of vision, and said, “Doc, I would like a cortisone shot in my shoulder for the pain and I’d like to get started on some physical therapy. This shoulder is killing me.” He said to me, ‘Let’s do it.” I got the shot and a prescription for the therapy. At the conclusion of 6 therapy sessions I asked my therapist if she thought I was as good as I was going to get. Based on her response, we ordered 6 more sessions, and today I am normal again.

When would this have happened if I hadn’t specifically asked for it? I don’t know. It sure wasn’t heading in that direction. Any more I have no idea what to expect with regard to my health care. What I do know is that I have to speak up!

I also have to be pragmatic and believe that on the financial books of the HMO I show as a Medicare Advantage member and thus no longer an “income-generating unit” for either society or medicine. But on a person to person basis, my hurt feels like anyone else’s hurt, and I’d like my doctor to care without me pushing and insisting that I receive it.

But I’m still awfully bothered by what happens to the poor people who don’t know enough to ask questions or understand answers.

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