Wednesday, September 29, 2010

Dr. Goldman, You're Fired!

Dr Goldman, my all-in-one primary care doctor of the last nine years, is fired. Here is the list of infractions over the last three months:
1. Flagging low blood sugar during my recent well check
2. Flagging high cholesterol during my recent well check
3. Telling me I am healthy as is and don't need to lose weight (I LOVE her for that, but it is bad advice)
4. Insisting I come in for an office visit for what I was pretty sure was a cold by telling me I might have pneumonia
Having an auto referral system that prevented a local urgent care clinic from getting a live time referral and therefore prevented me from getting what ended up being a strep-free throat culture closer to home.

This is not a story of customer service outrage, but rather a reflection on the messed up state of health care services in America. It took me 5.25 hours, a 1/4 tank of gas, and either visits to or communication with five separate medical practices to get a throat culture today. Let's review:
Step One: At 10:30 this morning, concerned about my fever seeming unabated I called my primary care doctor, who insisted I come in to the office for a throat culture.
Step Two: At 12:22 PM BMG checks in while on his lunch hour to see how I am doing. Hearing that I didn't feel well enough to make the 2-hour round trip drive, he suggests I might be able to get a throat culture closer to home.
Step Three: At 12:37 PM I call my primary care provider only to learn the entire office is shut down for an hour while they take lunch.
Step Four: At 1:06 PM, I call my primary care provider to ask if I can get a throat culture closer to home, like, for example, at the urgent care center at South Shore Hospital. They say, "Sure, you can do that."
Step Five: I hop into the car and drive to South Shore Hospital. Arriving at approximately 1:45 PM, I park, head to the concierge and ask for directions to the urgent care clinic. That's when I'm told they South Shore Hospital doesn't have an urgent care center. "I'm told they are concerned about competition with CVS," says the nice man at the hospital concierge desk.
Step Six: At 1:56 PM I call BMG who helps me find another medical practice in the area with "Urgent Care" in the practice name.
Step Seven: At 1:59 PM I call the new practice only to learn they don't provide urgent care services to anyone other than their patients. They give me the name of ANOTHER nearby medical practice.
Step Eight: At 2:02 PM I call what is now the fourth doctor's office I've talked with today, explain my need. They say "Sure you can come in."
Step Nine: At 2:22 I arrive at the fourth practice. It is sketchy inside, but I'm desperate. I explain my situation and they ask me if I'm in the market for a new doctor. I look at them and say, "I'd like to take care of my immediate need for a throat culture before I answer that question." The receptionist insists they can't see me without a referral from my doctor. I give them my doctor's phone number. They call and claim the phone just "rings and rings."
Step Ten: At 2:26 I call my primary care provider from my cell phone, and go through the voice activated referral line and submit a referral request. I hang up and tell the sketchy practice the referral has been requested. They say they won't see me if they can't talk to my doctor's office directly. My doctor's office won't talk with them directly and apparently the sketchy practice can't make a phone call.
Step Eleven: At 2:29 PM I leave in a sweaty huff and call BMG and tell him I'm giving up.
Step Twelve: Concerned about my apparent lack of concern for my health he (a) tells me again my doctor sucks and I need a new one, and (b) realizing that isn't helpful in the moment (after I scream, "That doesn't help me right now"), he finds a CVS 1-Minute Clinic a short 8 miles from home.
Step Thirteen: I drive back towards home to the CVS clinic. The medical provider administers a rapid strep test, affirms I don't have strep, and sends me home at 3:15 PM with an order to drink fluids and get plenty of rest.


What if I didn't have a car? Or a cell phone? Or someone who could help me with web research during my muddled state? What if I were toting kids around with me on this stupid odyssey?

It is no wonder to me that America's health status relative to the cost per capita spent on health services is lowest among industrialized, shoot, even developing, nations. If I was more than a little sick, had kids, or was using public transportation I would have stopped at Step Five and gone directly to the emergency room. As it was I had resources, including a degree in public health, that led me to make the choices I made today (for better or for worse).

And it is with these resources that I'm going to find a new all-in-one primary care provider who can see me with minimal travel hassles the next time I'm too sick to drive to work.

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