Twenty Days and Counting…

Physician, heal thyself! Yes, I’m back on that rant again. It has been twenty days since my new doctor’s office took my blood and sent it to the lab. It’s been thirteen days since I called that office and was told that test results take seven to ten days. I have no idea if or when I’ll ever see those results.

I’m walking a tightrope here. While I’d love to let this negligence go on longer, inasmuch as it would tacitly prove my point, I am also concerned about what the tests will reveal. I gave them my blood in good faith on May 17, expecting that results would be reported timely. My previous doctors’ offices would have called me in a couple of days. On May 25, I was told that it would take up to ten days. Inasmuch as twice that number of days have now elapsed, they obviously either had no intention of honoring their end of the deal, they stuffed the results in a drawer somewhere, or they lost my phone number. (No excuse there. I’m in the book.)

What is wrong with these people? Would this sort of arrogance be tolerable in any other context? No, it wouldn’t. It is not tolerable in this context, either. The problem is that most patients merely accept treatment of this by medical office personnel as par for the course. They’re too nice to complain. But what about the doctor himself? Is he clueless about what is going on around him? Or is he as apathetic as the insouciant office staff? Or is he hamstrung because whoever is running this large group practice essentially makes him a slave to the administration, its rule book, and its precious bottom line?

One might surmise that if something was seriously wrong with me, they would quickly contact me, if only because they would risk being sued otherwise.

Sometimes, I don’t even know whether they worry about being sued for their incompetent and irresponsible treatment of patients. Perhaps managers of large practices figure that some lawsuits are an acceptable risk if costs can be reduced by providing poor service to patients. After all, the individual doctors pay for their own malpractice insurance.

This situation has transcended a single incompetent incident. Couple this with the other issues, such as a month lead time for a simple checkup appointment and five months for a physical exam, and you’ve got a practice that is severely broken. They must have a lot of patients. Are they all getting the shaft like this? Why are they remaining silent?

In any case, the trend of the past twenty years toward managed care (a euphemism for manged revenue and expenses, which TV/radio consumer guru Clark Howard might well call “managed don’t-care”) is the root of most of the evils in the primary care game. Doctors are more and more pressured to do less and less for patients. The latest in cute little devices for screwing patients is called Pay for Performance (P4P, for short). It rewards doctors’ performance (which means generating more revenue while reducing costs) with little regard for patient advocacy and treatment.

Do these primary care operations treat anything more involved than sniffles anymore? bet356 I have gotten little satisfaction from them in treating serious problems. That’s why I pay big bucks for a PPO plan that allows me to see specialists as necessary, without a referral. Nevertheless, these primary care docs are now so well trained in containing costs that they still try to act as gatekeepers. I get no better service from them than I would if I had a cheapo HMO. God forbid that it should get back to the insurance organization that I went to see a specialist—it might result in some performance demerits on my so-called primary care doc’s record. There is no escape from this pervasively oppresssive managed care philosophy short of being a multi-millionaire who can afford medical treatment on one’s own terms. Managed care is a failure on so many levels, but the worst failure of all is the failure to give sick patients the treatments they need—in both the medical and humanitarian sense.

In an email discussion about the many deficiencies of primary care practices, a friend told me today about her experience with a doctor we both know, one who was involved in a practice with which I did business for many years. This doctor once essentially accused me of malingering when in reality I had a case of double pneumonia, which he was for some reason, either laziness or otherwise, impelled not to treat. I’ll get to that in a bit, but first I want to tell you of my friend’s experience. It is sanitized of names and anything else that would identify the individuals involved.

Yup, that’s [Dr. A]. The [expletive deleted] goes out of his way not to treat ANYTHING. I get the same [expletive deleted] thing every time, you’d think I would have learned. When I had my neck problem, I had no feeling in my fingers and 30% strength in my arm, I was scared to death and I had to beg him to send me for an MRI. I ended up seeing an acupuncturist who fixed me in 2 visits. I have a lingering cough from a cold I had in March, he said it as exercise-induced asthma and generously handed me a sample of the latest allergy drug. He makes up his mind about something and then doesn’t listen to a [expletive deleted] thing. [I] also asked him about a wart on my toe and thumb, he said there was no point in treating them, they just grow back. […] I still have the cough, though it is slowly becoming less of a bother.

It might be apparent that my friend was more than a little bit angered by this charlatan’s cursory treatment of some serious health issues. She is by no means alone in having been burned by the primary care morass. Alas, people have come to expect this sort of mistreatment, as it is more the norm than their silence would suggest. I wish more would speak up and exercise what little freedom of choice they have left.

OK, so now my story about the same guy. In late 2002, I had been feeling bad for several weeks. I finally went to see my doctor, but it was around Christmas and he was away on vacation; I got an appointment with his associate (Dr. A) instead. At that appointment, he declared my illness an upper respiratory infection and wrote a prescription for some antibiotics, which I started taking that same day. Four days later, I was feeling even worse, so I went to see Dr. A again. When the nurse took me to the bowels of the operation, she took my temperature, which was over 101, and she weighed me, revealing a precipitous weight loss since my previous visit. When the doc came to see me, he refused to believe that I was sick. He told me that the scale was notably inaccurate, as he weighs less on it than on the scale at his health club. He took my temperature three more times, until he was able to display the results that he wanted. He told the nurse to take some blood to send to the lab, which she did. Afterwards, I felt lightheaded and nauseous and needed to lie down. Dr. A wrote that off to my being freaked by needles. (This had never been the case for hundreds of blood draws and blood donations in the past, and there was no reason for it to start then.) The fact that I was coughing up brown sputum was of no import to this [expletive deleted]. I found myself being defensive, arguing my case for being sick when I really was sick. I didn’t have the strength to plead my case very strenuously. So, after arguing with me at length about whether I was really sick or not, he sent me on my way, telling me that I might want to go to the ER for a chest X-ray if I really thought I was sick. To make a long story short, I was admitted to the hospital that evening, with what the ER doc called “big time pneumonia” involving both lungs.

As I told the friend whose story I included above, after I recovered I should have expended whatever resources I could muster to nail this [expletive deleted] [expletive deleted] for practicing medicine without a brain. Or for avoiding practicing medicine, willful and wanton.

I suppose that doctors are human and can guess wrong, but what of arguing that what’s there in black and white isn’t really there? What’s that about? It paints me as paranoid when I posit that this kind of behavior among primary care folks is instigated by health insurers instead of being an isolated manifestation of one incompetent or lazy doctor, yet in view of the trends I’ve observed, I cannot eliminate that possibility.

I remained there in the hospital, receiving intravenous antibiotics and undergoing a bronchoscopy, among many other tests, for a few days. I was fortunate to have been placed under the care of a pulmonologist while hospitalized. Specialists tend to get things done.

I have to say here that when I do see a specialist, I am treated as if I am an actual patient instead of being a “life,” the managed care vernacular for a nameless, faceless, revenue producing, cost inducing entity. Instead of getting a seven minute instant assessment of what’s not wrong with me while sitting on an uncomfortable examination table, I can sit down in the specialist’s office and discuss my problems at length.

Last Friday, I had an appointment with the colorectal surgeon who gives me my bi-annual colonoscopy. I mentioned his practice in last Wednesday’s rant, noting that I was able to arrange an appointment with him two days in advance instead of the one to five months it takes to get in to see my primary care doc. I sat down in his office and described some relevant symptoms, as well as talking about other, unrelated issues. One of the unrelated issues was the current state of primary care practices. He was appalled by the notion that it would take five months to schedule a physical exam and that blood test results would take over two weeks. “It’s the gatekeeper mentality,” he said, “It’s something that’s contrary to my training and I can’t bring myself to act that way.” On the way out, I expected to be asked for an office visit co-payment, which I would have happily paid, but there was no charge for this consultation. After all, I was scheduling a colonoscopy, and the doc would be paid for it. This was refreshing and it gave me hope for the medical industry in general, although this doctor might be the last of a dwindling breed of concerned physicians.

Back to my current primary don’t-care provider, what could be the motivation to delay my blood test results? Let me indulge my paranoid fantasies. Let’s say that his practice group’s second quarter results are way out of whack with the bogey set by their great managed care masters and their chief financial officer. Now, let’s say that I have some condition or ailment that will require expensive treatments. ???? If they can somehow defer my treatment (and that of other “lives” in the same boat) to the third quarter, they can shore up their results for the current quarter and make themselves look better with their third-party payer friends, too. ???? ???? ??? ??? ???? Far fetched? I know, I know, I’m thinking like an accountant, but isn’t that how those who run these practices think? Anyway, if my theory is correct, I can expect to hear from them sometime after the Fourth of July weekend.

When I eventually go completely nuts dealing with these yokels, will my health insurer add insult to injury by declining to pay for my institutionalization?