The Hose

The Turkey is on the two-year plan with respect to colonoscopies, due to a chronic condition called polyposis. So, it was with the usual unbridled delight that I retrieved my telephone messages one day last week, hearing a reminder from my colorectal surgeon’s office that it was time to schedule my biennial fun encounter with the six-foot hose. However, this is not a rant about the joys of this invasive procedure. Instead, it is another installment in my ongoing series of bloviations about the health care morass.

As those of you who have read my prior posts on the subject know, my travails in looking for and presumably finding a new so-called primary care physician have been only mildly successful. In The Turkey Finds a Doc, But…, I spoke of having to wait a month for an initial appointment, and at that appointment being told that it would be a wait of five months for a physical exam. Furthermore, took some blood for lab tests, but two weeks later, I still do not have the results.

I should mention here that my health insurance is a PPO plan that costs me a lot of money. Not my employer. Me. Being self-employed, I am responsible for paying for health insurance. I chose an expensive PPO plan that allow me to pick and choose among physicians and see specialists without the need for a “gatekeeper,” benefits I would not be accorded with a cheaper HMO. I pay dearly for that privilege. Nevertheless, what I have been running into is the restrictive “HMO gatekeeper mentality” and a whole lot of obfuscation. But I digress. Back to my test results.

When I called the doctor’s office last week to ask when I might expect those results, I was told by the anonymous phone receptionist after having been on hold for five minutes, “The results are back, but Dr. D needs to see them.” I asked when that might be happening, given that it had been over a week and, no doubt, the results had been in hand since a day or two after my blood was drawn. The haughty, pre-emptive response was, “It takes 7-10 days.” Well, in fact I had called on the eighth day and the tenth would have been Saturday of Memorial Day weekend. I asked the phone person what would happen once the doc saw them. She said that if results were normal, I’d be getting a postcard; otherwise, they’d call me. In other words, don’t bother calling—they’ll be in touch when they damn well please.

I expected to hear from them on the Tuesday after Memorial Day. I’m still waiting.

I can almost hear them commiserating with each other about having to deal with anxious patients. “What do these patients expect? We have insurance billing to do, and there’s the filing, and do they think we shouldn’t have lunch? We’re doing them favors all the time and they want more.” Yeah, like getting blood test results within a couple of weeks and scheduling a physical exam fewer than five months distant. We obviously know nothing about the current state of primary care practices.

So if all is well, they’ll drop a card in the mail. And if everything is not OK? Well, they’ll call me and schedule an appointment. For when, I wonder? Five months from now? How long will the little yellow sticky scrawled note to call me and make an appointment remain affixed to someone’s computer monitor until she deems it appropriate to call me? What if it falls off?

I have to wonder what 7-10 days means to this practice, in view of today being the 15th day since the blood was drawn. Even if what was meant was 10 working days, the time is up. Of course, I might need to add two or three days for mail delay if I’m in the postcard category. Although I don’t want to call them again, I firmly believe that this project will be like drawing blood from a turnip. I know I’ll get the arrogant excuse that we had a holiday weekend, so things are delayed. Is this what the rest of you have come to expect from primary care practices, or is it just I? What a crock!

Anyhow, back to the colonoscopy. The difference is like night and day. I called the hosemeister’s office today to arrange the procedure. I told the pleasant receptionist that I wanted to have a consultation with the doc before doing the colonoscopy because I’m having some symptoms that might be of interest to him. I expected to have to justify the need to see the big doc at length and then wait at least a month for the privilege. The receptionist said, “Would Friday at 11:00 be OK?”

“Yes!” I replied, thinking that this is the way it should be. A specialist, who is up to his ears in butts can see me on two days’ notice, whereas my primary care doc needs a month for an appointment, two-plus weeks for blood test results, and five months for a physical exam. I’ll be able to schedule the colonoscopy with a few weeks notice, and this is a fairly major production, an out-patient procedure at a hospital involving a surgeon and a supporting cast. But to get to see my primary care doc, well, I can come in anytime next October. There’s something wrong here.

What happens if I get sick—I mean with an acute illness that requires prompt treatment? Will I have to go to the ER instead of seeing my doctor? When I call, I know that the first thing I’ll hear—via recorded message—will be, “If this is a medical emergency, please hang up and dial 911.” If I actually have the patience to wade through the interminable menu options, will the human being I eventually reach tell me that I can’t be scheduled on short notice, so therefore I must call 911? I recall having two bouts with pneumonia, one in 1998 and one in 2002. In both of those cases I needed immediate care. My doctor’s office of the time was able to accommodate me with an appointment within a couple hours. I have no great amount of confidence in that same level of service being provided by the practice I have presently engaged.

Yes, I know. Don’t cry until you’re hurt, you say. Well, because of the length of time it takes to schedule appointments coupled with the other indicators of a practice that seems more concerned with which billing codes to use than it is about how patients feel, what else am I to think? I hope that if and when the time comes to test my preconceived notions, they pleasantly surprise me. My life might depend on it.

As The Redhead cynically postulated in her excellent rant, Dealing with Doctors: The Third Circle of Hell, it is not possible to schedule our illnesses to make them convenient for our doctors’ offices’ schedules. If we cannot get sick on their schedule, we are faced with two alternatives: 1) get sicker until they’re damn good and ready to see us, or 2) call 911.

Anyway, end of rant. I’ll keep posting these things. If enough patients demand more of their doctors and the way they (or their office managers) run their practices, perhaps they’ll bend just a little bit. I’ve said it before and I’ll say it again: primary health care needs to return to doctor/patient relationships being at the core instead of the stupid, insular health insurance/Medicare-driven system into which it has evolved. I know I’ve painted this with a pretty broad brush of negativity. However, in view of the negative experiences I’ve had, it is easy for me to be cynical about the entire profession. I’m beginning to feel as if the situation is hopeless. The stress created by these unresponsive, unconcerned, and unrepentant primary care practices frequently outweighs their dwindling positive accomplishments.