Why is so much of the health care system set up for consumer failure?
My doctor referred me to see another doctor. She made an e-referral, "shared" my e- Medical records, and told me all I had to do was set up an appointment. Technology is great, I thought happily. I had no idea that I was about to enter the scheduling Twilight Zone.
Consider this sentence in a message left on my voice-mail hours after I initially called to set up an appointment:
"Then we'll mail you a questionnaire and when you fill it out and mail it back we will review it and then call you to make an appointment. So call back and let me know if I should send it."
First of all, you'll mail a what? I'm not taking the Pepsi Challenge. I'm going to see a doctor. Second of all, I had already called and left a message in the "scheduling" box. Which I was only allowed to do after I did an intake over the phone with someone from Registration. Clearly, I want an appointment. Send the questionnaire if that's a real thing. Why do I need to call back a third time?
Surely I had misunderstood the voice-mail.
The next day when I called I was told the questionnaire had not even been sent to me yet since they had not heard from me. I asked why I needed to fill out a questionnaire and was told "so we can determine which practitioner you should see." At this point I reiterated that my doctor had submitted a referral for a specific doctor in their practice. "That is the practitioner I should see," I pointed out. The secretary told me I still needed to answer the questions and mail it back. There is no way to fill out the form online. I need to receive it, fill it out, mail it back, and wait for it to be reviewed before I can schedule an appointment.
This is insanity to me. In an age where robots perform surgeries, where computers can play Jeopardy, and where I can have ice cream delivered to my door UNTIL 4AM and pay for it with a credit card, why am I watching my mailbox? Don't they know I am rarely home? That I have two jobs? That I just ran out of stamps? Am I being referred to see Dr. Quinn, Medicine Woman? *
As I stood in the hallway at work, trying to let the anger go, it made me think of my patients.
- If I can barely navigate this ridiculous back and forth of voice mails, phone calls and paperwork, how hard must it be for someone without a home? A phone? A voice mailbox? A mail box? Even if a homeless man or woman has a mailing address (and many do), often it is not accessible to them 24/7.
- Add on the fact that seeking help for anything other than acute injury is not going to be a priority for someone on the street, and you have a real barrier to compliance for appointments related to chronic life threatening problems such as diabetes, cancer and AIDs.
- Forget appointments to screen for early signs of disease, such as yearly pap smears for females or colonoscopies for people over the age of 50.
- Plus, when I finally get an appointment I am likely to write it down somewhere, be able to take a (paid) day off from my job and I will drive my car to see the doctor. A homeless man or woman is likely to forget the appointment, or just blow it off due to lack of transportation or the need to be somewhere else at that time (taking care of an infant, standing in line for a bed or food) or in some sad cases, abusing substances to mask physical or emotional pain).
That's why Healthcare For the Homeless programs are so important nation-wide. It's not about cheaper access to services or free care. It's about access to services at all. It's about organizations that can offer rides to the disabled war veterans to get to appointments, or who will help an illiterate woman fill out pages and pages of complicated forms in order to get social security benefits. It's about teams of people who will meet with folks who have been through too much trauma to deal with the type of rejection sometimes faced by patients waiting for care. Just think, I've had to call this woman's office three times so far since my PCP made the referral for me. People with mental health issues, social phobias and histories of being abused probably would not have made the second call, if they made the first one at all.
So as I continue to try to get in touch with Dr. Mike** I am thankful for the structures in place in my life that I often take for granted that will assist in me eventually getting an appointment. And I vow, not for the first time, to do my best every day to address every patient issue that I can, or to put the patient in direct touch with someone who can help them. It can't always happen. Things get busy. Patients get blown off. Especially ones with minor complaints. We triage, we prioritize. But I can try my best.
Because unless I create the care I wish to receive, the system is going to stay broken.
In the meantime, Nurse Sassy Lionheart suggested I just get on my horse and gallop the questionnaire back to the office. You know, to speed things up.
* Gosh I hope so. And I hope Sully is there. mmmm.. Joe Lando circa 1996.. That helps. No more anger. Only wild and free "courtship feelings." ****
** Not her real name, obv, but I am assuming she, like the real Dr. Mike, will be bold, outspoken and have all kind of new ideas she learned at the Women's Medical College of Pennsylvania.***
*** If not, this was so not worth it.
**** No disrespect, of course, to Joe Lando's current wife and children. I am glad it worked out for you all.