Please be patient…

The doctor’s staffer from hell — we’ve all been there. Medical practices should offer anesthesia to us before forcing us to deal with these dolts. Some of us accommodate it better than others. In my case, I don’t accommodate it at all. Accordingly, I wanted to tell the story of yesterday’s travails in the hopes that some of you who have been rolling over for the goons will think twice about being a docile and accepting good little patient.

“I’m mad as hell and I’m not going to take it anymore!” —Howard Beale, Network

Getting right down to the sordid details, it is time for my quintennial colonoscopy. Yesterday’s appointment with the GI guy (hereinafter referred to as GIJoe) was a preliminary consult, just to satisfy legal and medical requirements. In other words, it was to make sure I wasn’t too sick to undergo the procedure and too poor to pay for it.

Armed with the sheaf of pre-prepared homework that had been mailed to me for completion at my leisure, I arrived on time for a 3:30 appointment, yielding my driver’s license, insurance cards, and concealed carry permit upon the receptionist’s request. So far, so good. It was like a routine traffic stop — slightly annoying. The annoyance meter began to register. albeit mildly, when the receptionist stated that GIJoe was running “a little late today,” and he would be seeing five patients ahead of me. This is more the norm than not, so I resigned myself to a wait.

Before I go on, I want to make it clear that this blog post is not a complaint about waiting for doctors. I’m pretty used to waiting — after all, that’s why we’re called “patients” — and the receptionist in this case took care to give me some idea of the backlog at this point. Most of them just scratch your name off the clipboard and say nothing about potential delays. ???? ????? ??? ???? ??????? In any case, I am not here to rant about doctors’ punctuality. I know there are good reasons for lateness when it occurs. No, this is about something much more controllable.

After a mere 45 minute wait, I was ushered to the back. I should state that this is an impressive practice headed up by GIJoe who built the grand edifice and assembled a staff of five docs for our ass-reaming pleasure. Colonic humor aside, the facility is rather cavernous, and I was led deep into its bowels (oops!) for weighing and vitals. I reached the examining room at 4:22. GIJoe arrived promptly at 4:46, with a resident from the hospital around the corner in tow.

I should note at this point that I had scheduled a 3:30 appointment to put me in a position to get to a 5:00 pm meeting a few miles away. I figured that a consultation would take 10 minutes, and, jeez, how late could the doc possibly be? Next time, I’ll make it 2:30. LOL

Anyhow, I was still a patient patient. I had whiled away the one hour and fifteen minute wait by texting Artificially Sweetened, playing Scrabble and Words With Friends, taking pictures of unwitting subjects in the waiting room, in full violation of draconian HIPAA regulations, and collecting literature about ulcerative colitis, gastroesophageal reflux disorder, and diverticulosis, but I digress.

GIJoe did his thing pleasantly and efficiently, satisfying himself with my answers to his questions and interacting with me on an adult-adult level, which I really appreciate. (Too many doctors think their patients are complete idiots who need to be subjugated. patronized, or condescended to. It is always refreshing when one can discuss matters intelligently to an open mind.) He asked me questions about the cardiac treadmill test I underwent in 2011 and the catheter in 2012 — because any heart issues throw up a red flag. It does not do a practice’s reputation any good to have patients dying of heart attacks during a colonoscopy. However, I had noted that I had passed both of those tests, giving him the cardiologist’s name and phone number, so GIJoe was satisfied. He would turn me over to his schedulers to seal the deal.

I asked him when would be the soonest (sorry, Amar [private joke]) I could get in for the procedure. GIJoe responded, “You can do it next week if you want.” As it was already Wednesday (late Wednesday at that), I thought that was a pretty good deal. Furthermore, next week was the latest I could go without my ride options being severely restricted, especially since the doc’s self-owned endoscopy facility’s ground rules required the patient’s chauffeur to be on premises for the procedure’s duration. That’s a lot of time to whack out of a volunteer chauffeur’s schedule.

I stood at a counter at the central nurse’s station in the bowels of the building somewhere near the appendix while the doc wrote out his final instructions and gave them to the woman behind the counter. She fiddled with them for a while, adding a few more documents for me to sign. I mentioned that I had seen a sign in the examining room that stated that they were changing computer systems and pardon the inconvenience — so did this mean that they were generating more paper than ever?

Still, the annoyance meter was barely registering — amazingly, for this turkey, I might add.

It was when I reached the scheduling operation (slightly to the left of the spleen) at 4:57 pm that things began to unravel. The unlucky scheduler called me to her cubby and promptly gave me more papers to sign while telling me that she couldn’t schedule me then because all the paperwork had to go to the anesthesiologist and it would take at least four days for today’s results to be dictated and transcribed. In other words, “Don’t call us; we’ll call you.” I told her that GIJoe told me it would be possible to schedule next week and that’s what I wanted to do.

“A clerk is a jerk.” —Robert Ringer, Looking Out for #1

Robert Ringer, in his 1978 book Looking Out for #1, devoted considerable verbiage to the notion that “a clerk is a jerk.” This was not meant to demean that humble occupation, but rather to instruct the reader to seek out people who can fix things when there are problems. Clerks live by the rule book, and to keep their simple lives orderly, they want us all to follow the rules. The rule book is their empowerment; their triumphal moment is leaning on it to say “no.” Whenever I run into a clerical logjam, I harken back to Ringer’s words and seek a higher authority — one who can actually make a decision.

About five minutes of arguing with the scheduling clerk, whom I’ll call María, I knew what I would have to do. She was thumping the rule book wildly, loudly ranting that because I had done a treadmill test and a cardiac catheter, I would have to wait a couple of weeks for all of this folderol that the book said was necessary. She wasn’t letting me get a word in edgewise. I didn’t raise my voice. She raised hers to preempt me. She finally took a breath.

“But I passed both of those tests!” I said, sensing an opportunity. “Doesn’t that mean anything to you?”

“Patients say things all the time,” she intoned. “We can’t go by that. We have rules.”

OK. I’m pissed off now. The needle of my annoyance meter was well into the red scale.  “Well, then someone must be making the rules for you to follow, right? You’re not just making them up, right?”

“You’re calling me a LIAR! You’re calling me a LIAR!”, she said.

“No, I never called you a liar,” I countered. “In fact, it was you who said that patients ‘say things’ all the time. I’m just calling you an imperious little snot! Tell me this: Who do you work for?”

She glared at me and repeated her “we have to follow the rules” mantra.

“Well, then, someone must be making the rules, right? Do you or do you not work for GIJoe?”

More avoidance of the subject. So, I took the other tack.

“I need to see GIJoe. He told me I could schedule next week, and he obviously runs the show here, whether you recognize it or not!” I declared.

“You can’t. He is seeing patients.” She walked out from behind her partition and disappeared into the bowels. Meanwhile, my metaphorical rectal pain was growing and the annoyance meter needle was hitting the pin.

She returned with reinforcements — another lady whom I shall call Lourdes (I kind of like that name), who attempted to placate me by more rule book thumping and telling me that I could talk to GIJoe “after hours”, if I could reach him (yeah, right!), and I should just sign my papers like a good patient and all would be well. Uh huh. Like that was going to work on me with my ears pinned back and the hair on the back of my neck bristling. What did I look like, a pleasant old fart? (Don’t answer that.) Now, my aggression alarm was blaring and glowing bright red to complement the broken annoyance meter.

I said, “I’m not going to wait until after hours. GIJoe is here and I’ll talk to him now, before I leave.”

She said, “Fine. You can sit over there in the waiting area and we’ll tell him you want to talk with him.” Oh, sure. Then he could sneak out the back door and I’d never see him. No way was I going to fall for that ploy.

“Nope. I’m going to go back there and wait until he emerges. I need only a minute of his time.”

“You can’t! He’s seeing patients!”

I walked back into the bowels and leaned against the gall bladder — right where I had last seen the doc writing my orders. The examining rooms (diverticuli?) are immediately adjacent to the counter there, so I knew I could catch him when he emerged from one of them.

“YOU CAN’T BE HERE!! WE MUST PROTECT THE PRIVACY OF OUR PATIENTS!!!”

I smiled as I said, “Yeah, well, I’m one of them. So you can protect me, too, because I’m staying right here until I see GIJoe.”

Lourdes then instructed the person behind the counter to make a call. I didn’t know to whom or what it was about, but my suspicions were confirmed when about 30 seconds later a large young man in green scrubs arrived on the scene. One look at him in this situation evoked memories of the big bouncer in “Hardcore Pawn” — both in size and demeanor. ????? ??? ???? I’ll call him Big Bad Juan the Bellydoc Bouncer.

“This is him!” exclaimed Lourdes ungrammatically. “This is the patient who won’t leave.”

“I need to see the doc for only a minute to straighten out a scheduling issue,” I explained to Juan.

Juan turned to Lourdes. “It’s OK. He can stand here.” He walked away.

She wheeled around and no doubt cursed in Spanish under her breath. I thought I vaguely heard mierda.

While this was happening, the other young woman was alerting the doc that there was a maniac just outside the examining room waiting to carve up the entire staff with a scalpel.

In about a minute, GIJoe exited one of the exam rooms. He asked, “How can I help you?”

I explained that the scheduler had thumped the rulebook to perform her clerical intervention in opposition to our mutual agreement regarding scheduling the procedure next week.

“Let’s go out there,” said the doc. He pulled up a chair next to the scheduler in question. “Let me see his chart.”

“Actually, I was helping someone else,” María haughtily stated, in a final attempt to preserve her clerical dignity — a last gasp at a possible triumph over the unruly and undesirably disobedient patient, who should have known his place but obviously didn’t. Perhaps she thought GIJoe would take her side and throw me the hell out of there. He didn’t.

GIJoe grabbed my chart, pulled out his cell phone, called my internist’s office, asked for them to fax over authorization for me to do the procedure, and concluded the transaction telling María, “Put him in Thursday.”

She briefly objected, saying that I had those cardiac tests and she was instructed that the anesthesiologist had to review them, etc., etc., etc.

GIJoe responded, “He passed them! Schedule him Thursday.” I thanked him as he left, and he returned the thanks.

Meanwhile, back at María, nary a word was spoken as she was all asses and elbows shuffling my papers, occasionally thrusting one at me for a signature. As I sat there waiting, I observed a certificate on María’s partition declaring that of the entire clerical staff that interfaces with the public, she had received the most favorable patients’ comments for the month of January. Wondering what might have happened to her brain since then led me to the conclusion that everyone else was either sick or on vacation in January. Finally, she read me the instructions. I thanked her and left, arriving at my meeting at 5:50 pm, 50 minutes late. End of story.

It could have gone down differently if the clerical worker had merely listened; however, her statement  that “patients say things” indicates to me that she has no intention of hearing what we have to say. I’m not suggesting that she should be empowered to make crucial decisions based on patients’ say-so — that would be an insane amount of authority for a low-level clerical worker to wield.  On the other hand, if the patient tells her that the doctor said something, she could get off her ass and check with the doc to verify the patient’s claim. What she definitely shouldn’t be doing is arguing with patients. The rule book provides no authority to escalate a customer request into a brouhaha — at least I hope to hell it doesn’t — or to contravene a doctor’s orders, even if such orders are expressed through a patient. The patient — the customer — must be given the benefit of the doubt and the story checked out. Chances are, he or she didn’t make it up.

Patients “say things.” Harrumph! What a screwed-up attitude!

We don’t have to take crap from these low-level people. The vagaries of the third-party payer system into which health care has evolved has created a disconnect along the lines of “just who’s the customer, anyway?” For many medical clerks and administrators, insurance companies are the true customer, while patients are merely transportation devices for the all-important insurance card — necessary, semi-sentient, evil humanoids who serve only to create clerical hardships and distract the drones from their paper-pushing raison d’être.

Don’t assume that a single-payer system will make things better. Screw Obamacare, which is designed to trend us toward that direction. Already, we’re seeing medical decisions being wrested from us at the behest of the government through the best control mechanism they have available to them: the purse strings. Do you really want to inject the IRS into this whole health care fiasco? That’s what’s happening right now, as I write this. Think of it: a million more rule book empowered clerks coming between you and your medical care. However, unlike your typical medical office jerks, these superclerks are armed and dangerous, and when they say “No!” they can bring hell and eternal damnation upon us if we talk back. Just what we don’t need!

(Yeah, I’m sure there will be an appeals process, Mr. Wise Guy. But have you ever tried to appeal anything with the Feds and gotten anywhere? Hmmmmm? I didn’t think so. This turkey has appealed decisions both with Medicare and the IRS, getting nowhere in each case, so shaddup with your idealistic theorizing. In practice, it doesn’t work. The government will always go for the throat and grab your wallet while the stranglehold is in progress.)

Distinguish yourself from the vast unwashed herd who allow themselves to be controlled by clerks. You can do better for yourself, and if enough of us take the initiative, we all will be better off!

******

So a guy walks into the Bureau of Vital Statistics, wanting a copy of his birth certificate. The clerk behind the window asked for his name and date of birth. After a long absence, the clerk reappeared.

“I looked under the name you gave, but I couldn’t find it. ?????? ??????? Give me the name of the hospital and your mother’s name.”

The guy gave him the information and proceeded to wait. Another long wait ensued before the clerk emerged from the bowels.

“I found your record, sir, but your father and mother were not married at the time you were born. That makes you a technical bastard.”

Smoke came out of the guy’s ears as he pounded his fist on the counter and said, “That’s what I concluded about you 20 minutes ago!”