Tuesday, July 8, 2014

Does getting medical care really have to be this hard?

["Can't you please just fit
me in somewhere?"
18th-c. engraving]
If you're my friend (or have read my blog), you know I'm (a) grateful for American medical specialists who have taken excellent care of my heart problems and (b) frustrated by the American medical system in general. It should not be so difficult to get good medical care.

Here's my story this week.

Late Wednesday afternoon I apparently had a TIA. It lasted less than 10 minutes, but TIAs shouldn't be ignored: they can mean a stroke is waiting to happen. To be safe, I went to the ER. They tested me and advised me to see my primary care physician or cardiologist early this week for follow-up tests.

Ideally follow-up tests for TIAs are done within 48 hours, but this was the Fourth of July weekend and my risk factors are low. I decided to call for an appointment after the weekend when medical offices reopened.

Monday, however, I learned that my primary care physician is on vacation. The PCP's triage nurse faxed my cardiologist's office an order for an echocardiogram, but they couldn't do it for two weeks or so. (If they did it earlier than six days from now, they told me, I'd have to sign a waiver saying I'd pay for the whole thing myself if my insurance company wouldn't. I have no idea what Medicare thinks about echocardiograms, so I demurred.)

Actually, though, my discharge instructions say that I need more than an echo. I also need a "an outpatient stroke workup including a carotid ultrasound ... and possibly additional testing." Because I don't have a physician's order for any of that, I need to see a doctor before getting the tests done.

So I called the cardiologist's office directly and learned he too is on vacation, and besides, he doesn't have any openings until September.

Next I called the hospital whose ER I visited, and they referred me to their cardiology team. Unfortunately the lady who answered the phone interrupted me (so I'm not sure if she knew what I was looking for) and connected me to a cardiologist's voice mail box. I hung up.

Next try: a different cardiology group. They neither answered their phone (after 15 rings) nor offered voice mail.

So I called the Johns Hopkins Heart and Vascular Institute. The man who took my call thought he could get me in to see a doctor 45 minutes from my home on Wednesday or Thursday, but before I could make the appointment, the call dropped.

I called right back, and the woman who took my call said the first available opening was a week from today, which is nearly two weeks after the TIA, also 45 minutes away. ("These appointments fill up fast," she explained.") I took it.

 I'm probably fine. It's very unlikely that any further problems will develop in the next week (or however long it takes to get the tests done after I see the doctor). If they do, of course, they could be major, and they could affect the rest of my life. But I'll just have to take my chances. What else can I do?

The American health care system is excellent - if you can figure out how to work it, and if you don't mind waiting, and if you aren't scared that you might get an enormous bill after the work is done.


Lileonie said...

Today is August 19. Is there going to be a moment between and betwixt your beautifying your soon-to-be lovely home to let us know what the medical tests showed?

LaVonne Neff said...

Ha! I was thinking just this morning that if I didn't write something soon, my blog would need hospice care. But to answer your question: I have beautiful carotids (said the tech), and my heart appears to be in good shape (according to the echocardiogram). I decided to skip the eye exam. My primary care physician thinks the episode might have been an atypical migraine. As for the house, hvac last week (you don't want to know). Painter and electrician this week. Contractor again next week. Kitchen cabinets the week after that. Kitchen counters a week later. And maybe other weeks and other workers. This was supposed to be a minor alteration...