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KOK Edit: your favorite copyeditor since 1984(SM) KOK Edit: your favorite copyeditor since 1984(SM) Katharine O'Moore Klopf

Friday, February 27, 2009

A Soap Opera: As the HMO Turns

Here's the latest episode in the soap opera that life around here has become:

You probably remember that Ed has been working part time for a grocery-delivery service because the awful economy has meant that his cabinetmaking clients aren't spending much money. On February 6, while checking out the back of a different kind of truck that he was to be driving that night for the deliveries, he gashed his forehead severely. He went to the local hospital's emergency department for stitches. The physician had him undergo a head computed tomography (CT) scan just in case there were internal injuries. There weren't, but the scan turned up a brain colloid cyst. These cysts are always benign, never malignant. But they are always located just where, if they are large enough, they can block the flow of cerebral spinal fluid, which can result in odd symptoms and even unexpected death because of high intracranial pressure.

Of course we were scared. We tried hard to get Ed's primary-care physician's office to get Ed a referral to a neurosurgeon, which is what the hospital suggested we do. (We couldn't just go back to the hospital and request to be seen by the physicians who treated Ed the night he injured his forehead, because that first visit to the emergency department was a worker's comp issue, whereas this brain tumor is not.)

But as I just now wrote only somewhat coherently to update a friend:

Grrr! Ed's physician's front office is incompetent! The doc looked at Ed's brain CT scan film yesterday, before Ed's appointment with him today, and saw the colloid brain cyst that the hospital emergency-department radiologist spotted 3 weeks ago. Today, the staff can't find the film! Idiots!

Ed was just now at the doc's office now for his postponed physical exam. These staff members are the same idiots who refused our request for a referral from the doc to a neurosurgeon before the originally scheduled exam date of February 18, which they rescheduled for today and said no referral before today, even though I told them it was regarding a brain tumor. If Ed were dying, would they have moved any faster? I doubt it. This is a #(*^$@ HMO.

So now Ed's doc has to call up the hospital to order another set of CT scan films stat, so that he can look at them with a neurologist. He told Ed (who called me during a break during his physical exam) that the cyst is "only" 3 mm and should probably just be watched at this point—no brain surgery to remove it for now—with Ed getting a new MRI scan once a year. But I want to hear this from a neurologist, dammit! The HMO is supposed to call Ed within a couple of days with arrangements for him to schlep halfway across Long Island (sigh—the local HMO practice facility doesn't have a magnetic resonance imaging [MRI] scanner or a CT scanner) to get a series of baseline MRI scans with (radioactive) contrast dye so that it can have plenty of info to compare against future annual MRIs.

I told Ed that if he didn't emphasize to his physician that a member of his front-office staff caused us lots of mental anguish by making us wait for 3 weeks for this appointment, despite my telling her about the brain tumor, that I was going to get on the phone and raise hell. The dimwitted staff member should have at least performed triage by putting me on hold for 30 seconds, telling the doctor about the situation, and then getting Ed in for an appointment before other patients with less scary ailments. Luckily for that staff member, Ed did what I asked, and the doc says that he'll get to the bottom of the situation. You don't let your patients sit around for 3 weeks in an agonizing knowledge vacuum. You just don't.

Anyway ... no brain surgery for Ed as of right now. Thank goodness.


Unknown said...

How frustrating! I'm so glad he finally has an opinion, though.

libhom said...

We desperately need single payer healthcare. The HMOs and insurance companies need to be driven out of healthcare for once and for all.

Katharine O'Moore-Klopf said...

You're absolutely right, LibHom. I can't wait for the day that happens.

A friend of mine in India was shocked when he read about how poorly Ed's situation has been handled. My friend thought that surely, in the great United States, health care was much better. Not.

Karoli said...

Whether single payer or simply system reform (and I'm not sure yet which is best), we need situations like this to stop. There is really no excuse for such disorganization, and it costs all of us money, while your husband stresses alongside you.

Grrrr, stories like this drive me batty!

Funny about Money said...

Yeah, well...yes, you DO sit around for weeks worrying that your tumor is growing to inoperability. That's pretty much par for the course these days.

Single-payer or no, I'm afraid only the most wealthy Americans will have access to decent medical care -- or to any medical care. The Mayo, where my doctor practices, no longer will accept Medicare patients. If you've been a longstanding patient (and that means you have to go in at least once a year, whether or not you have any reason to do so) and then you go on to Medicare, they'll let you stay. For the time being. Nothing to stop them from changing that policy, of course.

When I had appendicitis, I could not get treatment at all -- not even triage -- at the ER of one of the largest medical centers in the Southwest. It was a horrendous Third-World scene there. After I had waited over four hours, outside on a concrete bench in the middle of the night in the cold (it was December), in excruciating pain with noplace to sit down, I finally called a friend and had her drive me home, figuring if I was going to die I'd rather do it in my own bed. The next morning her husband drove me to the Mayo, where they instantly slapped me into surgery.

While at this ER, I sat next to a young woman who was miscarrying. She also had been there for over four hours with exactly zero medical care.

My mother died hideously at the hands of HMO doctors. My father and I had no time to be with her as she lay on her deathbed, because we spent almost every waking hour fighting with bureaucrats. Nothing, and I mean NOTHING, is an uglier combination than bureaucracy and arrogant doctors. I try to stay out of HMOs, but it's not easy, given the cost of medical insurance. And sometimes it seems futile, since the access you can get with even the best plan isn't much better.

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