An alien in ‘health-care’ land – In the wonderland of United States medicine

I have had some amazing experiences with doctors in the USA and I am eternally grateful to those wonderful human beings and professionals for their healing and life saving efforts as well as contributions to me and mine. As I relate these experiences, I am so grateful that these shining exceptions came into my life and adopted me. The words that follow do not apply to them. I know that they and the members of their staff are outstanding exceptions to what I write below.

I believe that most US citizens and residents are the victims of a systematic scam perpetrated upon them by a large number of insurance and pharmaceutical companies, doctors, other medical professionals and pharmacies working in tandem.

Let me tell you what led me to this belief.

Having spent almost 50 years in another country, being cared for by medical professionals who are members of my family, I am somewhat spoilt, and perhaps innocent about the ways of this ‘brave new world’.

My wife works for an organisation and so we have health ‘benefits’. The fundamental benefit seems to be that we do not have to stand in line to have a sum of approximately $ 75 deducted from every one of her paychecks to receive these ‘benefits’.

My saga begins with problems with my eyes and a pain in my shoulders. I called an individual who is designated as my ‘Primary Care Physician’, let us call him Dr. PCP.

The woman that answered the phone asked me if I was a new patient. I confessed to being one such. Then, I was asked what insurance I was on, rather than what my problem was. I said that my carrier was AvMed. This did not soften her attitude any. She put me on hold several times during the conversation. I was unable to get an appointment with the one supposed to ‘care’ for nearly a week. I could only be seen during the period Monday to Friday. In other words, I had to take off from my working hours to make the appointment. Doctors have yet to learn to work when their patients don’t.

On the appointed day and hour, after spending half an hour looking for the doctor’s office, we called them, only to find that they had moved some time ago to a new location. The receptionist had taken down my insurance information since I was a new patient but had omitted to tell me the new address or offer me directions. Neither the AvMed directory nor website had the new address.   Since I was late for my appointment, I would have to wait for an ‘opening’. The doctor’s office was beautiful, but the reception area was bereft of a TV set, coffee or water fountain. There were several magazines.

I was not deprived of human company however. Plenty of people were waiting to be seen. Periodically a name would be called and a relieved person would spring out of their chair and run for the door for fear of losing their chance.

 A wait of one hour is normal and to be expected in medical establishments, even if you have an appointment, I was told. The time of appointment is the time you are expected to arrive and meet the receptionist. Know well that the doctor will not see you then. Each of my visits to a doctor’s office has taken up at least half a working day.

 A name was announced and I could not recognize it as being mine. Since my name is arguably the most famous human name in world history and was the title of a movie that won several Academy awards, I expect a reasonably close interpretation or rendition of it. I mistakenly expect people to have learnt it during school. When that unintelligible name was called again, I decided that this might just be my opening and if it was not my name, I could always come back and sit down. The chart showed my name and I crawled through my ‘opening’.

No, that young woman was not the doctor. She unsmilingly took my blood pressure, weight, height and pulse. She noted down my symptoms with complete detachment and departed saying, ‘He will be with you shortly’. In the meantime, I found out that the rest room was spic and span and even fragrant.

By and by, the doctor arrived and examined me thoroughly. He promised to refer me to an eye specialist and offered me all possible help. He asked me to exercise my arms to reduce the shoulder pain. He was unhurried, solicitous and charming. I wondered what he had done in life to be punished with staff like this. I informed him that I conduct management training and offered him all my help at no cost. He promised that we would ‘sit down’ some day. Three months later, the opportune day is yet to arrive. Most people do not know that they have a problem till something blows a gasket, I suppose.

I have two kinds of eye problems. Glaucoma and corneal opacity. Because of this dual problem, I need a corneal super-specialist and a glaucoma super-specialist. These doctors see no cases other than ones in their super-specialty.

Armed with advice from the doctors I have mentioned in the first paragraph, I found a corneal super-specialist who was in the AvMed provider directory and website. His business office steadfastly told me that they did not take AvMed. I called AvMed, who asked me to use the magic words ‘Primary Plus’. This whole process took nearly a week. I used the mantra and the doors swung open into a large, mostly tightly run, efficient and friendly organisation. Doctors respond to messages on the same day, are cheerful and uplifting and patiently answer all questions.

A laser surgery was the best alternative and the insurance company promptly refused to pay for it. After an alternative surgery costing four times more was proposed to them, they asked the doctor’s office to send the bill to them. The business office did not call me back with this news the same day and I could not schedule myself for the surgery which takes place only twice a month, thereby wasting a precious three weeks.

Whether the bill will be paid or not, remains to be seen. Three weeks after the surgery, they sent my wife a document wherein she was to certify that I was not covered by any other insurance.

I did undergo the surgery. More time was spent on signing documents, than the surgery itself. I signed away most of my rights. For example, legal problems with this doctor will go for arbitration and not a jury trial (Juries consist of patients!). If I die on the operating chair, my living will, if any, will be ignored and I will be resuscitated or put on a life-support system and dropped off at the nearest hospital. I do not know whether Dr. PCP will be there signing referrals.

Irrelevant as this may be, I am slowly recovering from the surgery which was quick and painless.

One of the ‘drugs’ I use is Muro 128 ointment, manufactured by Bausch and Lomb. The tube contains 3.5 grams of medication and costs nearly $20. Its 3.5 grams include inactive ingredients: water, lanolin, petroleum jelly and mineral oil. The active ingredient is 0.1525 grams of Sodium Chloride. Also knows as common salt. Talk about profiteering.

Pharmaceutical companies here must make incredible profits, since their profit margins are unchecked. So do retailers or pharmacies, since they can sell any medicines at any price they like. The same medicines are available in many other countries at a small fraction of the cost.

After much research, I have concluded that there is no board certified Glaucoma super-specialist accepting AvMed or Primary Plus in the Tampa Bay area. In private conversations, other doctors have told me that this insurance company is notoriously slow in making payments and they prefer not to work with them.

Did you forget that I have pain in my shoulders and arms?

A friendly doctor and her spouse, a one-time orthopedic surgeon (Yes, two of the first paragraph doctors), suggested that I had probably developed rotator cuff tendonitis, but that I needed to undergo an MRI to rule out anything else.

 Dr. PCP being the funnel, I called and asked for a referral and got one for a plain, vanilla flavored X-ray! A note on the referral said, ‘An X-ray is needed before I can order an MRI’. Another wasted half a day. Two days later, I was told that the X-ray was negative but Dr. PCP would need to send me to an orthopedic surgeon since only he could ask for an MRI. Wonder why that was not done in the first place?

The shoulder pain continued.

This new worthy is a Dr. Richard Gray. I called immediately to schedule an appointment, It was almost 5.00 PM. I was asked to hold, she hung up the phone on me and when I called right back, I got the answering service.

The shoulder pain continued.

I called again the next day and found out that this able professional only worked twice a week in our town. I was offered a date and I requested that I be given a moment to check my schedule. I was promptly cut off. Now, the foregoing saga may have given you the impression that all I do, all day, all through my life, is seek health-care. I am sorry but I do pursue a profession to put bread on the table and sometimes it calls for travel. For the next two weeks I could not give Dr. Gray an appointment. So, I called back and got my appointment on a day two weeks later. This receptionist was trained in the same school as Dr. PCP’s rece[tionist. She got all my insurance data but left it to me to discover where they were located. When I asked, she gave me the street address but when I asked for the nearest intersection or some landmark, she hung up.

Three months into the pain, I managed to meet the doctor. But he did not take care of the pain and fortunately for me I came back to India and after 8 weeks of physiotherapy, I am as good as new.

 I, at least, am not surprised that there are so many lawsuits and so many judges and juries willing to award millions of dollars in damages against the health-care profession. I know that I would, if a half decent case were to be presented to me.

Perhaps most patients do not have similar experiences and I am unfortunate in having them.

For the sake of all US citizens, who are decent and hard working people, I sincerely hope so.

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~ by parimalgandhi on 03/06/2009.

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