Primary Care—Not!

I am incensed! I just got off the phone with my physician’s office, having called to change my October 12 appointment for a physical exam. The phone person told me that if I wanted to change it, the next available date would be in February 2007. What the hell kind of arrogantly incompetent bullshit is that?

I should have anticipated it, I suppose. Recall that when I initiated my relationship with this practice, it took me a month to get a routine appointment. At that appointment, they did some blood tests and scheduled me for a physical. That was May 17. The earliest they could schedule a physical exam was October 12. Five months! Furthermore, it took me one month to receive the results of the blood tests. One month! I had to call the office three times at one-week intervals asking for the results, each time being given a stock response: “Test results take seven to ten days.” I eventually had to go there to physically retrieve them. When I did, I noted that the lab had returned them the day after the blood was drawn and the doctor had reviewed them five days later (there was an intervening weekend). (See Postcards from the Edge.) What is the excuse for delaying another three weeks?

Answer: they don’t think they need one. Patients get their reports whenever the office is damn good and ready to send them, at their convenience.

Now, today, after wading through their interminably annoying telephone menu system that tries to get me off the phone more than it helps me to get through, I am told that when I call these people two months in advance to change an appointment, I have to wait six months for the next available slot? What were they planning for my physical, a Mayo Clinic three-day workup? I asked the hapless yet stalwart telephone person what a physical entails that it requires so much advance planning. The answer was that it was a half-hour appointment. A half-hour! Big flippin’ deal!

I should have gotten an inkling about the cursory nature of what this office considers a physical exam when I told the doc at my first appointment what was done at my last physical—essentially blood tests, EKG, urinalysis, and a chest X-ray—and he asked, “Why the chest x-ray?”

This is a large group practice with lots of physicians. I asked how much advance notice they would need if I was sick. The answer was that if it was an emergency, I should go to the emergency room. If I “broke an arm or something” and had a lot of pain, they might be able to see me the same day. I asked the Spanish accented lady what would they do if I had a bad cough. “That depends on whether we thought it was serious or not—we might be able to see you the same day or maybe the next day.” Recalling the time I wound up in the hospital with pneumonia, I figured I probably would be better off giving all my business to the ER than relying on the phone receptionist’s triage.

(I know, I know…ER’s are loaded with non-emergency cases and I’d be contributing to the overcrowding. My local hospital established a 24-hour clinic staffed by PAs to which they whisk away non-emergency cases who present themselves at the ER. There, one waits several hours for attention. That’s enough of a disincentive—for me, anyway—to go to the ER for any little thing. But I digress.)

High on my relevance scale is the notion that I’m paying $12,000 a year for what I thought was a halfway decent PPO plan (I’m self-employed), yet what I get is tantamount to el cheapo HMO treatment. Wait, I think HMOs can do better than five or six months scheduling for physical exams. I’d save some money by switching to one. One thing holds me back. I like dealing with a single doctor for my primary care needs. Isn’t that a significant part the whole primary care concept? I don’t need a gatekeeper with the PPO plan, but it is helpful to be able to discuss and resolve health issues with someone who knows much more than I do about medicine.

I had one primary care doctor for over 20 years, during which we learned about each other. I got what I needed. I was taken seriously. Our communication was at a mutually negotiated level—the doctor didn’t have to use baby talk with me and waste time explaining things that everybody should have learned if they had paid attention in their high school biology classes. If his office people treated me with apathy or discourtesy, he wanted to know about it. I was shaken when he made the decision to exit his practice. That was 2003, and as yet I have not found a suitable replacement.

I’m now wondering if I ever will.

Back to the telephone person, I tried to reason with her (a mistake, no doubt). “If you can get me in today or tomorrow with a broken arm, it would seem reasonable that you could change my half-hour physical exam given two months’ notice. Why can’t you do that?” (“Why” questions always evoke interesting responses from wielders of clerical rule book power.) The predictably pre-emptive response: “A regular appointment is ten minutes. We don’t have any half-hour slots until February.” Being obnoxiously persistent, I once again asked her just what I would have to do to get scheduled any earlier than that. Her answer was, “You would have to call every day to see if someone cancelled.” So, they’re not even willing to look for a cancellation for me. I would have to call every day.

Then, she decided it was time for an ultimatum: “So, do you want to make the appointment in February, or have you decided to keep your October 12 appointment.” That put me over the top. It took all the self-control I could muster to avoid unleashing a profane tirade. I only slightly raised my voice when I said, “No. I’ll take Alternative Number Three, which is to terminate my relationship with this unaccommodating practice.”

Now, I’m once again out in the cold. That’s too bad, because the doctor himself seemed to be someone with whom I could build a relationship. All these front-office machinations could be going on without his knowledge, I suppose, but I still have to hold him responsible for them.

On a humorous, PSU-related aside, it is because I have tickets to the PSU-Michigan game on October 14 that I am changing this appointment. I can imagine that the telephone person would have given me a big lecture about my health being more important than a football game had she known this. I would have had an answer for her, too! I got yer physical exam right here!

My conclusion is that regardless of why a particular practice creates inflexible, anti-patient policies, it can only get away with operating under them as long as patients accept it. I am not yet prepared to believe that my experience with this practice is typical of what I can expect elsewhere. Perhaps unlike a lot of people with employer-provided health coverage, I actually feel that I am spending my own money on health care. Accordingly, I’m not ready to take whatever I’m given without considering whether I’m getting my money’s worth.

My CPA, my lawyer, my dentist, and my stock broker have never—and would never—run their appointment schedules this way. Neither would they ever take a month to give me a routine report. They’d have no clients if they did.

I thought that writing a rant would get the vitriol out of my system, but I feel myself being worked up to a bilious frenzy even as I wrap up this piece. I think I’ll go kick the neighbor’s dog or something.

Better yet, let me mention that the name of this group practice is Physician Associates and the office I have dealt with is at 300 N. Lake Destiny Drive, Maitland, Florida. I’ve sent a letter to Dr. D, hoping that he wants to know about such things. I would be very surprised to get a response, but if I do my readers will be among the first to know.