I Ain’t Broke, Broken, or Borked

A week ago, I went to a new doctor. This doctor is part of the UTMB teaching facility. My goal in going to this new doctor was two fold: 1) find a new doctor who could treat me and dcoordinate my care for me between all the specialist, one who would look at all their reports, all their medications, all their recommendations and make sure none of it conflicted with anything else. Why? Because I had a PA who gave me a BP medication that interacted with, in a bad way, my metabolism and absorption and conversion of T3 Cytomel, given to me by another doctor, and it took a cardiologist (a third doctor) to tell us that this wasn’t good and take me off the medication. A primary care doctor who is supposed to be coordinating my care should have caught that. 2) I wanted/needed to get into the UTMB system.

UTMB: University of Texas Medical Branch

UTMB is the county-funded indigent care clinics and hospital in the area. That’s not why I want to go to them. UTMB is a teaching hospital. That is a big part of why I DO want to go to them. Teaching hospitals have a long tradition of doing research and being ‘up’ on the more current medical trends and information. Students are eager to impress, so they try harder, I think, and at the very least, they are researching things from a different perspective than a doctor’s practice. The hope, the goal, of being in the UTMB system would be that the doctors will take a more active role in looking for what is wrong and might even consider some less-than-conventional-treatment modalities that might be beneficial.

In other words, maybe they can freakin’ diagnose and fix me.

We’ll see.

So I tried to make an appointment online with the two doctors that my new doctor referred me to. I get an email back that says, and I’m quoting here: ”

Good Day ,

 We have received your on-line request for an appointment. You did not indicate that you had insurance and unfortunately we are not able to complete this request. Attached is a letter explaining the process in order to be seen.  If you have insurance that was not included on your initial submission, please do not respond to this request.  You may call our UTMB Access Center at 409-772-2222 or 1-800-917-8906. Representatives are available 24/7, 7 days a week to assist you. 

Well, we tried to call that 24/7 hotline, and apparently, there are 8 hours in a day, not 7, and we called during the one hour when representatives simply were not available. It just rang and rang and rang. Not even a voice recording. It was like the Twilight Zone of medical listener on hold, “You know you want to talk to us, but we’re just going to let it ring and ring and ring…” *cackle, snort, cackle, laugh*

But wait, it gets better. The ‘attached letter’ on how to handle this ‘process’ said: ”

We have received a self‐referral request for one or more appointments to a UTMB clinic. We are unable
to schedule a clinic visit for you at this time without a referral submitted on your behalf by a physician.

In order to be seen at UTMB for new service, you must first be referred by a physician and then
accepted by that service area. Please have your physician fax a referral to Financial Counseling at 409‐
747‐9900 to be processed.

If you do not have a physician, please contact your county health department for more information
regarding resources that may be available to you.

Translation: If you don’t have insurance, we assume you’re not going to pay, so a doctor who has been seeing you has to refer you so we can make sure you’re legit, and if you don’t have a doctor, you have to go to the financial counseling office to prove you can and will pay your bill. And probably sign your life away. Why assume that just because I want to get into the fabulous UTMB system that it means I can’t afford to pay my bills? I don’t have a single unpaid medical bill and we always pay our debts at the time of service. Why do I have to go to financial counseling? It’s crazy and it pisses me off.

So instead of being able to push the appointment up sooner by doing it myself, I have to wait until the offices call me with the referral appointment. This could take days or weeks, and then it might be weeks before I get in too. Perhaps a month or longer, which is often the case with new patients at specialists. I can get in much faster at a different pulmonologist, but he’s not part of the UT system, so that defeats my purpose. It’s all so convoluted, but it boils down to this: Healthcare isn’t about caring for health… it’s all about making money.

When the doctors start making 15-minute slots for patients, and then charging them hundreds of bucks for that 15 minutes, then they never look at the chart again unless the patient is in the office, how the hell do they intend to ever treat anyone and get answers? Sure, a quick cold or the flu, maybe  a rash or a cut or scrape can be handled in 15 minutes, but what if that rash is part of something bigger and the doc, who only has 15 minutes or less, just prescribes a cream and walks away?

Where is coordination of care? Where is the doctor who pores over medical books and seeks diagnoses and treatment protocols for the patient instead of throwing a pill at them. Here, take a sample pack of X. You’ll never be able to afford it at the pharmacy and no insurance doesn’t cover this medication, but take the sample pack anyway… you’ll love it.

Pfffttttt…..

I’ve waited this long. I guess I can wait a little longer to see the specialists. It’s just time. Time is all it is. I just hate feeling like I’m running out of time and no one seems to care.

SENT HOME TO WHAT?

In my head, when I first started to think about what had happened at the doctor’s office last time, I said to myself, “She’s just sending me home to die…”

I hate that I thought that way. I hate that my mind even let that enter it for a moment. But the truth is, I’ve thought it a lot. Stay tuned to the next blog post – I’ll link here and put it on FB and all, but it’s really an important one. I just needed to vent my spleen (which, by the way, the CT scan says is enlarged!) so that I could get this anger out of the way and write the blog post I really want and need to write.

Love and stuff,
Michy

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6 comments to I Ain’t Broke, Broken, or Borked

  • Cin  says:

    Michy, I sooo get this. Last year, when I had a cough for literally 5 months, I had a referral to the local pulmonologist. It took, wait for it, 6 weeks to get the appointment. By the time I got in, most of the lung issues had cleared up. He looked at my lung x-rays and heard the lingering noise and was able to guess that yes, I’d had H1N1 that settled in my lungs and that resulted in a lung infection usually seen in children. My primary care doc, who is actually a PA, had been treating the symptoms and she’s the one who initially thought it was H1N1, but I never had the flu-like symptoms people expect, or the high fever.

    I could have gotten into another pulmonologist faster, but this was the one that accepts the reduced-cost medical program I have (not insurance, just sliding scale fee). I’m not sure that it wouldn’t have been cheaper to just go to the out of network doctor as in those 5 months I spent hundreds of dollars on inhalers and other medications that were treating symptoms but doing nothing for the root viral infection — and some, like the $200 antibiotics were completely worthless.

    Here’s hoping for rapid referrals. I know when I used to do them, we could sometimes push the specialists to see patients sooner, but often the primary doc had no control over the referral timing 🙁

    • admin  says:

      Yup, that’s it exactly. I asked one time, “What do I do then if something comes up between now and then?” Answer: Go to the ER.

      Well, the ER is expensive, and they rarely treat anything. Their philosophy is ‘stabilize and refer’. So unless you’re deathly ill, in need of ICU type treatment, going to the ER is only going to cost you an arm and a leg and maybe an appendix or tonsil or two, but it’s not going to really DO anything for you but drain your money.

      For a chronic condition patient, having to wait a few weeks to a few months to get an appointment means having to wait in agony, pain, suffering, misery. There’s no guarantee the doc can change that, but I do know the doc can’t change it if they don’t see you at all. For an acute condition, it’s usually gone by the time you can get in with the doc, so people go anyway, just because it took so damned long to get the appointment that you don’t want to give it up, but there’s nothing the doc can do at that point. Crazy.

      And like you said, happened to me with the cellulitis back in 2008, lots of drugs and treatment from other means that weren’t necessary that you could have both felt better and saved money if the doc could have just gotten you int he office.

      It’s really f’ed up. It really is.

      That’s why I did love this new doc I went to, even if she is referring me and all that. She spent two hours with me. She only books 15 patients per day, maximum, but she leaves room in the schedule for a few walk-ins for emergencies and told me that we could come in emergency if we ever needed to – we wouldn’t even need to call to do it. She spent time with me… she didn’t get everything. She still doesn’t know/believe all my history yet, but she will learn and see that I know what I’m talking about – and I trust she will likely talk to my other docs. Heck, she called the cardiologist from her office right there in front of me to prescribe the metoprolol. That impressed me. The cardiologist was another one who spent plenty of time with me and actually listened – he’s the one who referred me to this new doc.

      So I am finally finding docs who are trying… and both the cardiologist and the new doc recommended the SAME two docs I’m being referred to (pulmonologist and endocronologist), so that’s optimistic that they both like the same docs. It’s very possible I’m about to have a real medical TEAM that will coordinate things for me.

      Can ya tell I took prednisone in higher dosages today? talk talk talk talk talk…

      Anyway, thanks for sharing your story too… the healthcare system does really need to be overhauled somehow. I just don’t see any way to do it without a lot more government regulation, and that in and of itself would cause some interesting problems.

      Anyway, luv ya, Cindy… it means a lot to me that you almost always comment on my blogs. Thank you for that. I love comments. I really am a comment whore, but more than that, it’s good because your comments always show that you’ve read what I said and that you get it… it’s nice to be understood and validated in that way, so thank you for that.

      Love and stuff,
      Michy

  • Michael  says:

    Hi Michy,

    Incredible. But sadly very believable. You said it perfectly, although I’ll modify it some: Modern American healthcare is not about health, it’s about money. And we often don’t think about it or realize it, but doctors have a herd mentality just like any other group. So they’ll always play it safe (even at the cost of your life), and do what all the other doctors do. It’s worse than that: Insurance and pharmas also reinforce what they can/can’t do. Malpractice suits are a constant worry. So add lawyers to the list. I could go on, but it’s all depressing stats. You’re hostage to a dysfunctional system. Here’s a couple of links if you’re interested. Maybe you already know, being so intimately involved with it all:
    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/graphs.html
    If you click on the various tabs in the chart, you’ll see we pay more for the privilege of healthcare in this country—but live less longer. Sadly, it’s worse than even this: we are actually dead last in all major developed countries.

    http://www.commondreams.org/archive/2007/05/15/1198 has a bit of an agenda, but I find their facts to be pretty close to others I’ve read on this.

    http://www.reuters.com/article/2010/06/23/us-usa-healthcare-last-idUSTRE65M0SU20100623 – more confirmation we’re dead last.

    I’ll stop here: more facts and figures just equals more depression. Sorry.

    But I can relate. I’ll skip my own personal experiences with the healthcare system. Suffice to say – I can relate very well!

    • admin  says:

      Oh, Michael, don’t ever apologize for giving me links to information. I eat this stuff up and love to read, read, read and learn. I appreciate these links.

      You’re right, of course, that it’s not exactly entirely the doctors’ faults. I do get that, and in my frustration, sometimes I forget it temporarily and rail at the wrong end of things.

      Insurance sucks right now. It’s that simple. But without it, you’re nearly hopeless in the healthcare system. I’ve had doctors literally refuse to make an appointment for because I was self pay. Why? Because they told me a little-known secret about the Hippocratic oath. Ready for this?

      Continuity of care.

      Three little words that mean soooo much and most people don’t know them. A doctor cannot, by law, refuse to see you do to an inability to pay, provided you already have a relationship with that doctor. In other words, you go to a doc for months, doing good, maybe have a chronic disease, end up losing your job, lose your insurance, but still have the chronic disease – but now you can’t pay for your medical care – the doctor CANNOT by law and by his license drop you as a patient. He must treat you, regardless of your ability to pay.

      Now, he can drop you for failure to comply – meaning he gives you instructions and you don’t follow, or you don’t take your meds like you should, or you miss your appointments you’ve scheduled, etc. They FIND ways to drop patients like this legitimately, but in the meantime, many docs simply refuse to take on a cash paying, self paying patient for that very reason. This is likely why UTMB won’t schedule my appointment.

      But what I hated about it was the have to be ‘accepted by the service’ part. The doctors are not supposed to accept me as a patient. I am hiring them as my doctor. I am the employer, so to speak, and *I* decide if I will accept THEM as my doctor. I can spend my money elsewhere, and they should SHOULD treat me accordingly. In any other business, they would.

      The difference here is, any other business isn’t life and death. And the medical business is the only business in which it’s in the ‘businessman’s’ best interest NOT to be good. I mean, if the doc gets you well, he can’t keep getting money, now, can he? So keeping you sick, making you come back in for follow up appointments, etc, pad his wallet, while you stay sick. Do doctors DO this? I don’t know… but yeah, I think maybe some of them might. At the very least, perhaps they schedule more appointments than necessary for proper treatment.

      And you’re right too – don’t even get me started on the pharmas… wow.

      Depressing? Yeah, it is. But it’s also a bit energizing in a way. Gets my blood rolling and sparks the advocate in me some. Motivating, I’m thinking.

      I am so sorry that you can relate. (HUGS TO YOU)…I hope that you’re conditions and situations can improve and you’ll find better luck in your healthcare quests as well. I’m optimistic right now, but man, it took me YEARS to get to this point of finally finding a medical team, and I”m not sure we’re there yet.

      Feel free to share any time you want, Michael. We’re all in this together, and sometimes it helps, as I said earlier, to vent a spleen to people who sort of ‘get it’.

      Thanks for the comment and now I’m off to read those links you gave me.

      Thanks!

      Love and stuff,
      Mich

  • Christine Senter  says:

    It breaks my heart to know you’re going through this, but unfortunately it’s happening all over the country.

    Years ago, the VA had my dad on so many meds that no one was sure what he was taking. My sister is a CNA and started looking at his prescriptions and discovered that one doctor had put him on meds to thin his blood and another had put him on a script to thicken his blood. Even though they both worked in the same VA hospital, neither had taken the time to really read his charts to see what all he was taking.

    I pray you find relief and get to feeling better soon. I hope you get the medical help you need, and I want you to know that we’re all out here pulling for ya. Oh yea, and I hope you “accidentally” trip the next dr. that barely looks at your or your chart. LOL

    • admin  says:

      See, isn’t that just crazy, Christine? It’s ridiculous that people are put at such risk. I don’t understand how doctors can do this. I mean, I know there are good docs out there – I know it – so I don’t want to slam the entire profession, but more often than not, it’s the horror stories you hear about things like your father.

      And how those things can kill people… or worse. And yes, there ARE things worse than dying, in my mind.

      It breaks my heart too, for me and for everyone else who has to suffer… but it galvanizes me and triggers my advocacy too. I want to affect change. I have a non-fiction book I’ve been working on for years, and I’m considering giving it away to anyone who wants a copy of it (probably digital) so they can navigate the system that I’ve been navigating, learn the ins and outs. I just can’t finish it yet, ’cause I’m not done learning some of what I need to learn. I’d like the book to have a ‘happy ending’ so to speak.

      Thank you… I hope I get the help I need too, but it will not be thanks to a doctor. It will be thanks to myself, my family and all my friends, like you and everyone here online, who keeps me going when I want to give up. Who encourages and supports me emotionally, financially, physically when I’m not able to be what I need to be for myself.

      You guys all rock… seriously. Thank you for commenting!

      Love and stuff,
      Michy

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