Navigating without a compass: Lost in US health-care system

When I set out to get routine health check-ups and screenings this year, I expected the process to be tedious, time-consuming, even baffling at times.

Although I’m practiced in the art of Managing My Own Health, I figured that things would be a bit more complicated this time around.

The reason was that early in 2010 my BF and I had moved across the country from Seattle to southern Maryland. While I have the same health insurance, I had to find a new general-care doctor and specialists and facilities for screening tests. And the screening had to be by Preferred Providers in my health insurance, so it would be less expensive or even free.

I needed a plan

Clearly, I had to get organized. First, I’d have to sort out what health-care I needed. Before seeing my doctor for a routine physical in December, I figured that I should talk to him about three things:

*** what vaccines do I need?

*** what screening tests—such as a mammogram—do I need and how often do I need them, and

*** various other health questions, such as why was I suddenly having pain in the thumb on my right hand.

All went well at the doctor’s office. I asked my questions and got answers. I felt good, so prepared, so well organized

Obstacles to getting a simple shot

But in short order I started to encounter obstacles and set-backs, wasted time and energy (mostly my own). One of the first problems was getting what I called a Simple Shingles Shot. What a misnomer that turned out to be. There was nothing simple about it as I later described in excruciating detail.

Planning for a mundane mammogram

There’s been quite a bit of discussion over the past several years about when women should start getting mammograms, how often they should get them, and when they no longer need them. My doctor suggested that I should have one every year.

So a mammogram was the first screening test I scheduled. An administrative assistant (AA) at my doctor’s office—let’s call her Maureen—said I could get one at St. Mary’s Hospital. I called  and made an appointment.

I called the facility in Seattle where I’d had the last mammogram a little over a year ago  to ask that they send the images to St. Mary’s, and I checked before my appointment to make sure that the hospital had received the images. Which they had. Hey, this was looking easy, maybe just a little too easy.

7 things that went wrong when I showed up for a mammogram

*** A receptionist at St. Mary’s Hospital asked me for a copy of the signed referral slip  from my doctor.

*** I didn’t have one, since no one—not my doctor or his AA or anyone at the hospital—had told me that I needed one.

*** The receptionist called my doctor’s office. It wasn’t open yet, so I waited and waited and ….

*** Finally, the receptionist reached my doctor’s office, but he wasn’t in.

*** Maureen was in, but she wouldn’t OK the mammogram. She claimed that there was nothing in my file to show that my doctor and I had discussed my getting a mammogram. (The receptionist at the hospital said that a doctor’s office will usually OK a mammogram.)

*** I drove straight to my doctor’s office to talk to Maureen. She got out my file, rifled through it, and found the part about my doctor and me talking about my getting a mammogram. Had she even looked at it when the hospital called?

*** I said that no one had told me that I needed a referral slip and that I’d driven all the way to St. Mary’s Hospital for nothing. Maureen was unapologetic.

There are only two AA’s in the office, she said. She hinted that they were far too busy to be looking at a patient’s file before answering questions about what was or wasn’t in it.

Huh? Isn’t it part of her job to answer questions from hospitals about a scheduled medical procedure for a patient?

3 things that went right

*** My doctor’s AA gave me a referral slip with my doctor’s signature so that I could get a mammogram at St. Mary’s Hospital.

*** I called the hospital and re-scheduled.

*** I went to Starbucks and got a tall Americano-with-room and a raspberry scone.

Getting health-care shouldn’t be this difficult, should it?  I can’t be the only one having these problems, can I? I’d love to have you share your experience. Rant, if you need to. I’ll understand.

photo by lori_greig

Comments on this entry are closed.

  • Madeleine Kolb 02/24/2011, 8:31 pm

    I’ve been amazed at how acrimonious the debate has been, starting with the Town Meetings before the election. Health-care is not a simple matter, but the problems in the system are not insoluble. It is discouraging to see our representatives in Congress grandstanding and posturing rather than working together.

  • Clar 02/24/2011, 6:22 pm

    Yes, I wish they would work together. Now I think the whole health care issue is put on a back burner while the budget is being discussed. I think we’re all in for worse times. I’m scared of the future.

  • Madeleine Kolb 02/23/2011, 8:19 pm

    Clar, It’s fascinating to me how the administration’s health care reform proposals were attacked as “socialized medicine,” as if that’s completely unthinkable. But from what I’ve read, the health care systems in France, Canada and the UK work quite well. They’re simpler, and people know the cost of procedures up-front.

    Some tweaking may be needed to the legislation which was passed, but many congressmen who talk about “repeal and replace” seem to want to stop at “repeal.”

  • Clar 02/23/2011, 6:18 pm

    Thank you for this post. I found you through the Alist blog club but feel compelled to comment. I think the only way out of this mess is to adopt a health plan like France, Canada or the United King dom has. I think we need to think of others while we rethink our health plan. If we have this much trouble with insurance how are those without faring? I think OBAMA had a good idea that just needs some tweaking to make it better. Wasn’t his plan going to help the deficit in the long run?

  • Madeleine Kolb 02/11/2011, 10:15 am

    Emilie, I’ve read of this trend, and it’s disheartening. I’ve discussed with my doctor the matter of decreasing payments for doctors who treat patients with Medicare.It’s a real dilemma and seems perverse that–as the population is aging–we as a country cut payments to doctors who treat aging patients.

    My doctor’s take is that doctors who specialize in geriatrics are not considered specialists–like surgeons. All they do is diagnose and treat patients who may have several chronic conditions and try to keep them as healthy as possible. So they shouldn’t be compensated as a surgeon or other specialist would be.

    This problem is likely to get much worse as the population over 60 or so gets larger and larger. One approach which could help would be for the government to pay medical school tuition for students who commit to some period of time practising geriatrics.

    But meanwhile, we’re living with the ungainly, ridiculously complex and expensive sytem we have now. I don’t see an easy answer.

  • Emilie 02/10/2011, 6:30 pm

    Well, here’s an example of what is allegedly being touted as a solution. Our doctor of 16 years just decided to go with a “boutique” type practice via MDVIP. What this means is that he is dropping his patient load to only 600 patients and for the privilege of being one of those 600 special people you pay $1800.00 per person, per year. For my husband and I that amounts to 3600.00 per year. We already are paying for Medicare, a supplemental and part D . We are retired, trying to live on what we have coming in, and we simply can ‘t afford to pay an additional $300 a month for medical. We are an example of the middle class which is slowly sinking into decline, facing ever increasing costs to manage the daily necessities. In speaking with our doctor he alleges by going with concierge medical we will receive numerous perks including better, more personalized care, shorter wait time in the office also that medical care and or advice will be available to us round the clock. He has also said that this is a system for people who place their priority on good health and the only solution for us is to take a look at this new system for health care or face what is out there. I find this also an unsatisfactory solution because it leaves the “promise” of more personalized health care for those who can afford it while those who can’t pay are left behind. The next problem is finding a new doctor who will accept Medicare patients since more and more are no longer doing so.

  • Madeleine Kolb 02/08/2011, 7:44 pm

    There are so many problems, a big one being communication between doctor and patient (or patient and doctor’s office as in my experience). It’s maddening that all the current political posturing and game-playing about health-care doesn’t begin to address some of the day-to-day difficulties we encounter when we try to wend our way through the system.

  • Lynne Spreen 02/08/2011, 12:39 pm

    Doc #1: Per CT scan, your ovaries look questionable. They need to come out. Also, CT scan says “uterus normal for 56-yr-old.” You don’t have a uterus, do you?
    Me: No.
    Doc #1: Are you sure?
    I went for a second opinion.
    Doc #2: You don’t need them out.
    Me: Even though two of my aunts died of ovarian cancer? And I researched OC –
    Doc #2: People “read the Internet”, and get all worried. There’s nothing wrong with your ovaries.
    Okay, I’m thinking, if Doc #2 was my regular doc, insurance wouldn’t cover the surgery. So I paid him cash and got the surgery as per Doc #1. Outcome: Ovaries were pre-cancerous.
    Best health care in the freakin’ world, right? PS Both docs work in middle-to-affluent communities, out of respected hospital groups. But that’s beside the point, isn’t it.