(Un) Managed Care: A Trip To The Doctors.

Tuesday, January 17, 2006

So I had to go to the doctor yesterday…well, not exactly the doctor, but the Physicians Assistant. I had a sore throat, you see, and that doesn’t actually rate a doctor. I call the office, go through the sixteen voice prompts and after only twenty minutes ( Luckily, I love to listen to Boy George’s ‘Do You Really Want To Hurt Me’ through my phone over and over again.) get through to an actual human being.

“Good morning. Judy speaking. How can I help you?”

“Oh, hi Judy. It’s Chuck Terzella. We’ve spoken before.”

“No sir, we haven’t. We all just use the name Judy. It’s easier that way.”

“I see. Well anyway, I have a sore throat and need to see someone.”

“Let me see”, I hear computer keys clacking, “….I can give you an appointment in the early part of February, the end of the first week. That’s only three weeks away.”

“Um, can you do January at all? My throat really hurts. Plus, our insurance changes on the 1st and I’d like to see him before that.”

That got her attention. Suddenly it was a true medical emergency.

“An insurance change?,” she asked anxiously, “Why didn’t you say so? In that case I can put you in on the 28th of January. Your appointment is at 1:00. He doesn’t have anything else scheduled until 1:15, so you’ll have plenty of extra time if something goes over.”

“Uh, well, that’s great.” I said, checking my pulse and wondering if I should go out and get my own EKG machine, CT scanner and home surgery kit, just in case.

She became a bit more concerned and solicitous. “I hope you’re okay. I mean, changing your insurance can be very painful and if you’re not careful, deadly. Are you sure you know what your doing?” I assured her I did, and we parted on friendly terms.

But the sore throat just got worse. Yesterday morning, having gotten fed up with pain on swallowing every time I got fed, I called back. A gruff male voice answered, “Judy speaking.”

“Look uh, Judy, I really hate to bother the doctor with illness and all, but this sore throat has gotten out of hand. Is there a way I can see the doctor before my scheduled appointment?”
“No he’s booked solid, but I can give you a slot with his PA. She’s the one who sees people who are actually sick anyway. The Doctor is there more for the long term stuff and to write out referrals to other doctors.”
“Of course. Your health insurance company won’t let you see a specialist without a referral from your GP first.”
“So, if I had, say, a severe massive brain swelling…”
“Oh, then I’d get you right in to the PA, who’d get you an emergency slot with the doctor within days, who’d refer you to a specialist, who’d send you to the hospital. Takes a little less than a week or two, at the most.”
“Wow, that’s fast.” I marveled.
“Yes,” he answered proudly, “The United States healthcare system is the best in the world…that’s why we can’t let you take advantage of it easily.”
“I can see that now. So about my sore throat…”
“You can come in today at 1:45 to see the PA. She’s got a five minute opening then.”

Armed with a book, three crossword puzzles, a ham sandwich and a bedroll in case there’s a small wait, I arrive fifteen minutes early. (Once, in 1983, I actually got into a doctors appointment early when the patient before me died of a lingering illness a week before their emergency appointment, leaving the time before me open. Hope springs eternal.) To my surprise, my 1:45 appointment actually begins promptly at 2:30…record time. I go in.

In the hallway, the nurse directs me, “Step on the scale please.”
“Sure, just let me get my coat and boots off.”
“Why”, She seems honestly confused.
“So you can get an accurate weight.”
“Oh, that’s alright. We deduct two pounds for clothing.”

I step on the scale.
She frowns, concerned. “You’ve gained a lot of weight since your visit last summer.”
“Last summer I was wearing shorts, sandals and a tee shirt. These boots alone weigh five pounds. On my scale at home I’m actually ten pounds less than I was then.”

“Are you a doctor?”, she asks pointedly.
“Uh, no…”
“I see. Please step into exam room 87. Take off all your clothes and put on the gown you’ll find on the exam table. The PA will see you shortly.”
“Take my clothes off? Why? I have a sore throat. My necks already naked.”
“Are you a doctor?”, she asks again.
“Oh, yeah, right. I forgot.”
“Please remember next time. We’re very busy.”

I go into room 87, strip, eat the ham sandwich and do the Syracuse Post Standards Monday Monster Crossword. Completely. Suddenly, an hour later, the nurse comes in.
“I need to take your blood pressure and pulse. Put this thermometer under your tongue.”
“What are they?” I ask when she’s finished.
“Your BP is 126 over 83 and your pulse is 68 beats per minute. Not bad, considering you’ve put on a lot of weight since your last visit.”
“I weigh 170 pounds and I’m nearly six feet tall.”
“No, you weigh 195 pounds. We just weighed you.”
“You weighed me with all my winter clothes on!”
“Are you a Doctor?” she asks, pointedly

A short time later the PA comes in.
“Hello, Mr. Terzella, and how are we today? It says here on the chart that we have a sore throat.”
“You too?”, I ask. “I guess it’s going around, huh? And why is your medical information on my chart?”
She stares at me. Hard. “Open you mouth and say ahhh.”
I do so and she jabs a piece of wood into my tongue. “Owww!”, I say.
“No, ahhh.”
“That’s right, ahhh. Oh my, your throat must be very sore. It’s all red and inflamed.”
“I already knew that!”
“Oh, are you a doctor?”
“No, we’ve covered that. What wrong with my throat?”
“I just told you, it’s all red and inflamed and sore. You have a sore throat.”

“You don’t understand,” I tell her desperately, “I have to have something that sounds worse than a sore throat. My wife won’t give me any sympathy for a sore throat. I need an obtuse medical term that sounds much worse than it actually is in order to get the rest of the day in bed.”

“I see.” she smiles, “it’s like what we have to tell the insurance companies. They hate to pay for sore throats too. Tell her you have Pharyngitis.”
I panic. “Oh, my God! Pharyngitis? Is it serious?”
“It’s a bloody sore throat! I thought we were on the same page here, Mr. Terzella.”
“Oh, sorry. I get excited sometimes.”
“Yes, well, we can give you something for that. Maybe your excessive weight gain is due to stress eating. In the meantime, here’s a prescription for some antibiotics. You can put your clothes back on. I have to say, though, you’re lucky. You carry all that extra weight very well. You don’t look a pound over 170.”