Friday, February 16, 2007

Phun with Physicians!

It's been almost three years since my last eye exam, and my old guy eyes aren't getting any younger, so I decided it was time to get my scrip updated so I can get a new pair of eyeglasses. Simple process, right? No, not exactly. Let me start right out by saying I have some issues with health care in America. My mom had a prolonged illness and passed away several years back, so when I say I have more than a passing acquaintance with hospitals and health care providers, I really mean it. Still, I don't currently have any real health problems, so my interactions with doctors aren't too frequent. Having thus set the stage, let's raise the curtain of this production.

I belong to an HMO, so I have to get a referral from my primary care physician to see the Ophthalmologist. So I dutifully call the G.P.'s office to ask for a referral. This on Monday. Silly me, of course I get voice mail! Having left a message with my name, phone number and request, I figure that it generally takes a while to get an appointment, so I call the eye doctor's office to set that up. Turns out it was my lucky day - they had an opening first thing Thursday morning. If I couldn't make that, they had openings in April. Sheesh. OK, so I take the one on Thursday. Tuesday comes, and no call from my primary doc's office. I try calling, and do get through, but it's not Bonnie, the usual receptionist - I can tell right away because she didn't put me on hold. She tells me that I'll have to wait until tomorrow to talk to Bonnie. I tell the nice lady that I have an appointment on Thursday, so I really need to get the referral by the next day. She tells me that I'll have to wait for Bonnie, and assures me that it isn't that much of a deal any more - the referrals are now electronic and I don't absolutely have to have it before my appointment, it can be within a few days.

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Having had more than enough fun with the rapidly mutating stories that you can get from health care professionals, I of course called the eye doctor's office for confirmation. Color me surprised - they had a slightly different take. I could show up without having the referral in hand, but I would have to sign a waiver, and they would need the referral within 48 hours of the visit. OK, so it seems safe enough, the referral is in the works.

Wednesday we had snow. No referral for me. OK, so on to plan B.

I show up early as requested at the eye doc's Thursday morning - been so long that I've gotta fill out the forms all over again, don't ya know? So the usual eye chart, eye drops, bright lights, yadda yadda. Then we get to the part about the long time since my last visit. Tisk tisk. Well, the doc has concerns about my eyes - I have an enlarged optic nerve or some such that can be a sign of glaucoma, although they have tested me for glaucoma in the past and I don't have any other symptoms, thank the Flying Spaghetti Monster. I remember all that glaucoma stuff they put me through 4 years ago - not fun, and involving several additional visits, including an extra one when the doc rescheduled on me the day when the medical photographer took pics of my retinas. (Please pay the additional co-pay on your way out, thanks!)

Interesting thing about the enlarged optic nerve, though. The next time I went in for an exam, they had a new electronic gizmo. It allows the doc to examine your retinas without using the drops to dilate your pupils. However, the HMO won't pay for it, so you have to pay an additional $35 out of pocket. But you do get to have the digital pics of your retinas saved to your file, so they can always look at the pics to see if there is any change. Well, I gave it a shot. They were very proud of their new, toy, and made a big show of the glorious images on the computer screen showing my "perfectly normal retinas!" Uh, last visit I had an enlarged optic nerve, which entailed extra visits. Did I get better? Later, I googled the name of the gizmo and found the manufacturer's web site, expounding the virtues of the machine - as a profit center for your practice. Huh.

The physician trade has been in an interesting squeeze of late. Insurers are requiring ever more paperwork, and putting downward pressure on what docs will be paid for what they do. Meanwhile, the additional paperwork has caused the doctors' staffs to devote an increasing amount of time to doing said paperwork, thereby increasing overhead. So doctors have been looking at alternate ways to increase revenue, and those have given me an unsettled feeling more than once. I didn't go to the G.P. to buy vitamins, or the eye doc to buy wrinkle cream, so I'm somewhat put off when they pitch me for it. And my G.P. has never met a prescription he didn't like - we call him doctor pusher because of his fondness of sending you away with at least three scrips and a handfull of sample after every visit. Hell, the pharmacy once refused to fill one of his scrips because it was too many pills! I keep wondering if he's on some crazy incentive plan.

Meanwhile, back to the eye doc and my enlarged whatchamacallit. She wants me to come back in a year for an exam with their specialist to make sure that I'm still not at risk for glaucoma and to take more pics of my eyes. OK, but didn't you get enough already with the $35 gizmo. Oh no, that doesn't take the right kind of pictures - but they do have a new machine, made in Germany, that does take the right kind of pics. I wonder what I'll find on the manufacturers web site if I google it?

I put on my shades, squint my way into work, and get on the phone to Bonnie. She tells me that she'll get me the referral, but that it's hard copy, not electronic. Huh, where did I ever get the idea that it was electronic? So she'll put it in an envelope in a drop box outside the office and I can pick it up on my way home from work. I swing by after work and pick it up, and what do you know? There's other stuff in there. First, a note telling me about the new 5 day notice policy on referrals. Oopsy. Second, forms for some blood tests and a note telling me that since it's been two years since my last visit, I'll need to get the tests done and schedule a follow up visit with the doc, or they will have to archive my files and they won't be able to give me any more referrals. Huh.

So here's the bottom line out of this long meandering tale - is this stuff all for my benefit, or theirs? I'd like to think that the doctors only concern is the well being of their patients, but I am very uncomfortable with some of the stuff that they do. I mean, come on! Wrinkle cream? Thinly veiled blackmail so I'll schedule a visit? (Please pay the additional co-pay on your way out, thanks!) This is all just more symptoms of our screwed up health care system. It's really time for change. Long past time.


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