Tuesday, May 22, 2012

A Broken System

I don't have a lot of dealing with the human health care system.  I tend to be a pretty healthy person overall (knock on wood), which is good because I have a massive case of White Coat Syndrome and a deathly fear of needles.  But last week I realized that it had been 3 years since my last rabies titer, and I'm actually supposed to get that checked every 2 years.  And so the journey began.

My first phone call was to the health department to set up an appointment to get the blood draw, which is where my boss had helpfully informed me was the best route to go for this procedure.  Leaves most of the health care system completely out of the equation.  I was informed that because their office was shutting down, they didn't do that anymore, and I would have to go to my PCP.

I don't have a PCP.  I got by with college health clinics for 8 years, and before that one of those one-stop "quick" care places did what I needed.  So I went to the insurance website and found a local doctor's office that was in-network.  Called them, asked if they could do the blood draw, and was assured that it would be no problem.  They worked me in the next day, which I thought was awesome.

Arrived at the clinic 15 minutes before my scheduled appointment time since I was going to be a new patient and anticipated some paperwork.  20 minutes later (5 minutes past my scheduled appointment time) I was called to the window and requested to present my ID, insurance card, and $30 co-pay.  The thing is... I was the only patient in the clinic.  I had the first appointment after their 2 hour lunch break (per the sign on the door).  And all the nurses and doctors were standing in plain view of me during this time, gossiping about other patients.

I thought it was a bit odd that I wasn't given any sort of form to fill out about my health history, but to each clinic their own.  I guess.  I was taken back to a room by a nurse and informed that the doctor would be right in to see me.  25 minutes later, I was still sitting alone in the room.  After another 5 minutes a PA came in to see me.  She asked why I was there, and then took the briefest medical history in history.  She told me a nurse would be right in to draw my blood.  20 minutes later the nurse came in and said that they could not pull the blood for the rabies titer at their office and that I would have to take a lab form to the local hospital.  Fine.

I went to the hospital outpatient lab.  The hours on the door said 7am - 6pm.  I got there at 3pm and was told that they did not draw blood after 2pm.  Um, what?  They told me that I would have to to to their off-site outpatient lab, but were unable to give me an address or any directions, just that "it's near the Rosehill Plaza."  I kid you not.  I was able to keep myself from smashing my fist through the wall, but unable to keep myself from crushing my lab request form into a tiny little ball and storming out, slamming the door behind me. 

Thanks to Google, I figured out where I need to go, so off I went.  At my next stop, I learned a very important lesson.  If you walk into a medical facility like you own the place, march up to reception desk, throw your re-flattened form down, and say, "Ma'am, I sure hope you're able to help me because no one else in your health care system seems to be able to," you go right to the front of the line.  Seriously.  They took me straight to a desk, with a very helpful young lady running the computer, and sent a person from the actual lab to personally find out if the test could be run.

I would like to take this opportunity to send many thanks to Casey, who handled the intake paperwork correctly, efficiently, and with a smile... in the face of an obviously upset person.  I send a million billion thanks to Jessica (my phlebotomist) who, seeing a terrified person, managed to get the necessary blood with a teeny tiny butterfly needle on the very first try, and then gave me a moment to regulate my blood pressure before asking me to get up and walk. 

After this, I was fairly certain that there was little to no hope for the human health care system, but a phone call this morning confirmed it.  I got a call from the initial doctor's office asking me, "Um, did we give you a green form to fill out with your medical history when you came to see us?  No?  Um, could you come by and do that?  Or I could mail it to you if you promise to mail it back?  Um... I'll do whichever is easiest for you, but I really need you to fill out this form."

I still can't believe the steps it took to get a blood test.  If I knew where to send it, (and didn't have that hardcore fear of needles thing going on), I could have drawn the blood on my own.  Seriously, I have the equipment.  There was just so much failure of the system... throughout the whole process.  Maybe I'm just naive.  One of the good things about my job is that I'm not limited by a government-based system when it comes to dealing with my patients, but still.  When someone makes an appointment with me, I know to check and be sure that 1) have the proper equipment/information, 2) that I know where to send any samples, and 3) that I will actually be willing/able to do the freakin' procedure!  I'm not even going to touch the blatant HIPPA violations, the complete lack of medical history for a new patient, or being charged a co-pay for being ignored, handed a generic piece of paper, and sent to the wrong location for follow-up.

Oh, and in case you were wondering, I still haven't gotten the results of the blood test despite being told that they results would be reported in 2-3 days.  I don't have the time (and definitely not the patience) to track it down.  I guess if I'm exposed to a potentially rabid animal, I'll remember to wear gloves, and keep my fingers crossed that the owner is willing to submit it for testing if it dies.  And if they're not, I'll just keep playing Russian roulette with not getting post-exposure vaccines.

Monday, May 7, 2012

Beyond Help

6 p.m. Friday
Dr. D: Hello, what's going on this evening?
Client: I have a baby goat with scours and I've already treated him.
Dr. D: Good job.

3 p.m. Saturday
Dr. D.: Hello, what's going on this afternoon?
Client: My alpaca fell over and had a seizure!
Dr. D: Ok, I'll started heading your way, try to keep him from smacking his head on the ground.
Client: Well he's not doing it now... this happened around 9 a.m.
Dr. D: What's he doing now?
Client: Eating.
Dr. D: Call me back if he has another seizure.

9 p.m. Saturday
Dr. D: Hello, what's going on this evening?
Client: I have sick kittens.  They are sick and I need medicine.
Dr. D: You know I only work on large animals, right?

7 a.m. Sunday
Dr. D: Hello, what's going on this morning?
Client: I'm leaving for a show in less than an hour, and lost my Coggins, so I need you to fax me a copy, right now.
Dr. D:  Well, I will call the office [at my boss's house] and see if someone is there to fax you a copy, but I'm not sure if anyone is home.
Client: Then you'll just have to drive over there and fax it yourself, won't you?
Dr. D: I live 30 minutes from the office and I'm not even out of bed and showered yet.  I can guarantee it won't happen in less than an hour.

10 a.m. Saturday
Dr. D: Hello, what's going on this morning?
Client: I have a heifer having trouble calving.
Dr. D: Alright, I'm on my way, go ahead and get her caught up, preferably in a chute.
Client: I don't think that's possible, she's down out in the field.
Dr. D: Can't get up down?
Client: No, she gets up and runs away when you walk over to her.
Dr. D: I don't think it's possible for me to pull a calf without touching the cow.

11 a.m. Sunday
Dr. D: Hello, what's going on this morning?
Client: I think my horse's hoof is going to fall off.
Dr. D: What makes you think that?
Client: Because of the way it looks.  He's fine otherwise.
Dr. D: I think it's highly unlikely, but I can come take a look.
Client: But I'm not there, and I won't be back until Tuesday.
Dr. D: Call me on Tuesday.

6 p.m. Sunday
Dr. D: Hello, what's going on this evening?
Client: I have a calf with scours, and I've already treated him.
Dr. D: Good job.