Navigating the health care system
Well, this morning I'm full of complaints, so reader beware.
You know, when people complain about wait lists in Canada it really gets my proverbial panties in a knot. That's not because there aren't wait lists in Canada -- there are. That's not because I don't think things could be improved over there -- they could.
It's this idea that our health care system is so flawless, that we can just go into the doctor here and set up surgery. And that couldn't be further from the truth if you have anything out of the ordinary.
I have to have complex and unusual surgery on my femur (thigh bone). I found this out August 31st. I've been trying to arrange surgery since then, and I've gotten almost nowhere. First, trying to even figure out which surgeons specialize in what I need is a nightmare. I need a pediatric orthopedic surgeon. That shouldn't be too hard, right? Try finding a pediatric surgeon that will still operate on someone over 18!
Next, in the extremely slow communication world of over-worked nurses, it takes a week emailing back and forth to even approach answers to my questions.
What's this? Finally a doctor in KC who might be able to see me?! Oh, yes, he can help you but his next availabe appointment is February 16th!
Okay great.
I need to have this surgery, which I fully expected to have by now, and I'm just finding that any type of plans I make keep being smashed to pieces before my eyes. It's been such a frustrating ordeal, not in the least because I'm just sitting around, waiting for news, unable to plan what the next however many months of my life are going to be like. I don't think I've ever been so frustrated in my life, and all I can do is wait. And the waiting is hell.
23 Comments:
Sounds horrid, but why do you need a pediatric surgeon?
I have great health insurance. I consider myself lucky.
I have Rheumatoid Arthritis. It sucks but I have it mostly under control. However, on occasion I have had one of my medications suddenly stop working and the onset of pain is unbelievable and debilitating. I am a stay-at-home-dad to 20 month old twins, so staying functional is essential.
Last time this happened, I immediately called my rheumatologist (whom I've been seeing for more than 6 years now) and explained the situation. Best I could get was an appointment in 8 weeks. I had to call everyday and hope for a cancellation.
Trying to get into see a different Rheumatologist would've been at least 3 month wait.
Yup, I love encountering those that point out waiting lists in other countries.
The trick is to be a longtime personal friend of a pediatric surgeon. That way he/she can squeeze you in as a personal favor.
So your task - travel back in time 5 years, find such a surgeon, treat him/her to coffee, chat, develop a close friendship and you'll be fine.
I mean really, what's so hard about that?
I saw your article on MyBlah, and I am curious, because I've experienced health-care in both Canada and the US... and I am intrigued by your situation.
Is it an insurance issue? Is it your HMO that's the problem and their designated doctors lists?
A pediatric surgeon may be necessary because of his or her familiarity with osteosarcoma, a bone cancer that is usually seen in children.
good luck!
If you can get to St. Louis, try Douglas McDonald MD, tumor orthopedic surgeon at Washington University (at least I think he is still there). He used to work at my institution, Saint Louis University, and he is a first-rate surgeon. Full-time tumor orthopedists are few and far between - most do other ortho procedures to fill in.
Nancy Phillips
I need a pediatric orthopedic surgeon because the damage to my bones was done in childhood, and ped. ortho's have way more experience with this procedure than adult ones. Fortunately, it was not cancer, or anything nearly as bad -- I had rickets (google it).
The issue is not an insurance issue, it's more of a living-in-Kansas issue, and a lack of specialists who can deal with my situation.
Our medical system sucks. One time, all I needed was a basic orthopedic surgeon for a basic elbow problem, but my health insurance sucked and didn't have many providers, though I lived in a big city. And so the clinic I was at called around and finally got me an appointment for the following week. I did everything I was told, but two months later found out that while the orthopedic clinic was covered under my insurance, that specific doctor wasn't; though no one at the clinic knew that. And so I was expected to pay for the whole thing, though my only mistake was in trusting that they knew what they were doing.
Luckily, I had decided against the operation and so the bill was a measily $220; which an insurance phone rep had promised to pay (it was partially their mistake that I was there), but then refused to pay until I harrassed them for two whole years.
They kept telling me that they would research it and for me to call back the next month, but when I'd call back, they wouldn't know anything either, and we'd start all over again. And somehow, all my letters kept getting lost, though each phone rep insisted that the letters couldn't get lost, and that I must have sent it to the wrong place. They also insisted that they didn't make mistakes; as did the ortho clinic. And the whole time, I was being harrassed by the clinic. They even sent me to a collections guy, who I finally paid.
And even after the insurer paid, the clinic insisted for four more months that they hadn't been, and wouldn't reimburse me (for some reason,the insurer refused to reimburse me directly). And the clinic eventually ripped me off for the $40 that they had paid the collections people to collect my money. So basically, I paid a collections guy to harrass me for money that I didn't really owe. And the whole time, both the insurance company and the ortho clinic acted as if I was some jerk trying to rip them off; rather than acknowledging that they had ripped me off. I never got an apology from anyone.
And to top it all, I still have the bone chip in my elbow! But I'd rather have the bone chip than the large bills I would have gotten, had I elected for the surgery.
Thank god I've never had any serious medical problems. Especially as I can't afford insurance anymore. I haven't seen a doctor or dentist in years. We need a better system.
Thanks Nancy,
I actually saw an oncologist who specialized in bone cancer here, and he said he just didn't have the expertise in the procedure.
I'm definitely looking into Docs in St. Louis, though, so if you know anyone who does pediatric orthopedics, or has expertise on straightening and rotating the femur, and can see patients over 21, I'd love the rec!
You know, unless you have some evidence that it's a snap to line up a Canadian pediatric surgeon to operate on an adult rickets patient, your little anecdote means pretty much nothing in terms of comparing the US and Canadian systems.
The point is that she is disproving the contention implicit in the criticism of the Canadian system for having "waiting lists", that is, that health care in the US system is plentiful and easy to get on demand. We as a nation cope with an increasingly dysfunctional and inefficient medical payments system, and when people suggest the single payer alternative, the boogie-man of "waiting lists" is raised up. But we effectively have some waiting lists now, they just aren't rational.
And, as a recent cancer survivor, I'm here to say that we really, really need to fix our medical payments system.
Anonymous, what Paul said.
To second Paul, let me quote from a relatively recent international survey of patients:
The majority of adults in New Zealand and Australia said that they received appointments the same day the last time they were sick and needed medical attention. In contrast, only one-third or less of Canadian or U.S. adults reported such rapid access. Canadian and U.S. adults also reported long waits, with 20–25 percent waiting at least six days to get an appointment when sick, a waiting time rare in Australia or New Zealand.
Difficulty in getting care nights, weekends, or holidays was of significant concern in all five countries. Although problems were most widespread in the United States, majorities of adults in Australia and Canada also said that after-hours access was difficult.
-- from Health Affairs (October 2004 Web Exclusive)
For my part, I have to say we have gotten in to see nurse-practitioners in the States pretty quickly, although doctor appointments have to be made two months in advance in most cases.
That's not to say that we were treated by the NPs, though; The NPs either I or Sarah have seen for various reasons have told us we were not really experiencing the symptoms we complained about, and gotten us out of the doctor's office as quickly as possible. This might be read as efficiency, but it looks to me like another way to put off treatment.
If you can't find a surgeon readily in the States, consider Europe. I googled for "chirurgie orthopedique pediatrique" and got lots of links to promising-looking hospitals and clinics in France and Belgium. In France at any rate, you can usually consult a specialist (including full university professors) as a private patient. You would have to negotiate the surgery and hospitalisation charges both ends.
Good luck.
James
Another issue for people with long-term medical conditions: Since insurance, for reasons I don't completely understand but that may have made sense as part of the New Deal, generally comes through your employer in the States and job security has become a fond, if distant memory, every single time you change jobs you are in for a fight. Even if you document prior coverage, you have to go toe to toe with them all over again to get any non-generic medications approved for coverage, any "non-routine" medical treatments, etc. I debated getting a copy of my doctor's records and burning them to CD, so I could just mail them to a new insurance company, but was fortunately sat down and told not only why they wouldn't accept that, but why that would be a colossally stupid thing to do in terms of what would happen to my future coverage, with every little ache and complaint documented and in the hands of people whose task it was to figure out reasons Not To Spend Money.
I recently saw a nurse practitioner, and SHE was complaining that she couldn't manage to reschedule an appointment; she finally gave up and simply canceled, without rescheduling. And she has coverage under what is considered to be the best HMO in our area. This is someone who is plugged into the health care system!
As for me, a couple of weeks ago I received a letter saying an appointment had been canceled, and to call to reschedule. To get an appointment under my plan, you have to call at either 7:00 or 9:00 in the morning. You wait on hold for about 45 minutes, and then there is at least a fifty percent chance they'll tell you you've called at the wrong time; if you've called at the right time, there is a 90 percent chance that there are no appointments for the next day; and they won't make appointments further in advance. I guess I'll wait until I have an emergency, and go to the emergency room. When you're seen at the emergency room, they give you a follow-up appointment without your having to schedule it. How efficient is that?
Nancy Irving
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