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Monthly Archives: February 2013

The Saga of Bartleby, the Healthcare Professional

This is a bit of a rant! I’ve had a bad week, part of a bad month, part of a bad Winter. So, to paraphrase Bette Davis, fasten your seat belts; this’ll be a bumpy ride.

Recent encounters with our healthcare system have me convinced that, like Herman Melville’s Bartleby the Scrivener, the regular and unfailing response of healthcare to our needs is fast becoming, “I would prefer not to.”

Universal Healthcare… Hell Yes!

I am a strong proponent of affordable, accessible, universal health care. In a society as wealthy as ours, there is no excuse not to!

But, unlike those elected bozos in DC and the talking-heads on the network news shows, I readily admit I don’t have the foggiest idea how make that happen.

 

The Healthcare Rock and  Hard Place.

On the one hand, healthcare is not compatible with a free market economy, as some try to claim.

Healthcare is necessary; it’s not discretionary. The healthcare industry has obfuscated its pricing better than the cellphone companies. There is no meaningful competition between providers. Try to price-shop an emergency room visit sometime.

I can certainly live without buying a new car, but I will not survive a serious medical condition. If a car’s too expensive, either I won’t buy it or I’ll try to get a better price elsewhere. If a critical medical treatment is too expensive, either I’ll surrender my life savings or die.

On the other hand, having a huge, self-serving, dispassionate bureaucracy in charge of national healthcare (I mean bigger, more self-serving, and more dispassionate than the bureaucracies that are currently running hospitals and insurance companies), is a horror whose time I hope never comes.

A Microcosm of Institutionally Managed Healthcare System?

But, if that is the potential macrocosm of a national healthcare system, my school may have created its microcosm.

In 2011, we established an on-site clinic for employees and their families. The stated reason for this was to make healthcare accessible for employees and their families, and to reduce healthcare costs. (Sound familiar?)

That’s the theory anyway.

The practice? Here is my saga of trying to deal with this brave, new world.

 

1. Regulating Emergencies.

Last Winter, my wife was having trouble breathing. Although we didn’t know it, she was in the throes of Vitamin D poisoning from an over-dosage a doctor had casually prescribed for her.

She called our Primary Care Physician (remember when they were called “family doctors?) and was told they couldn’t “fit her in” for at least a week, by which time she estimated she would be recovered or in a coma.

We were just about to head for the emergency room, when I remembered the campus clinic. So we called. It went something like this.

“Campus clinic! How can I help you?”

“I was wondering if I could see the doctor. I’m having trouble breathing and I’m having chest pain.”

“Oh! I’m sorry to hear that, but all our appointments are booked for at least the rest of the week.”

“I’m having chest pain. Could you see me as an emergency?”

“Oh! I’m sorry. Both or our emergency slots are booked for today.”

“Wait… you ration emergency appointments?”

“Yes! Of course. If we didn’t, we could be swamped.”

“Wait… you only allow for two emergencies a day?”

You have just entered the healthcare-system-of-the-future twilight zone!

 

2. Make an Appointment… I Dare You.

One weekend earlier this Winter, I was feeling a bit low. I had a few flu-like symptoms… cough, scratchy throat, congestion… but they weren’t going anywhere. So, I decided either I just had a cold, or the flu shot that I had gotten in the Fall was actually working, or cat dander was working its magic on me.

But my wife convinced me I should see a doctor. She was concerned about my spreading whatever-the-hell I had around.

I remembered seeing an email that said clinic appoints had to be made on-line. So I went on the website for the campus clinic. It stated that there was a doctor available on Monday. So I used their on-line application to request an appointment in the afternoon, after my teaching day. The website stated that I would receive a confirmation through email.

Of course, by the time Monday rolled around, no confirming email. But, I was feeling a lot better.

Still, after school, I strolled over to the clinic. There was a woman behind the counter. I know she was a “healthcare professional” because she was wearing pastel, draw-string pajamas with pictures of cutesy cartoon animals. When I entered, she looked up at me with that conventional vacuous, condescending smile of the bureaucratic. And, she was sitting behind a counter. I never had a chance!

The conversation went like this.

“Hi! I’m Ray Gleason. I teach here. I requested an appointment to see the doctor this afternoon on your website, but I never got a confirmation. So, I came by.”

“Oh, the website doesn’t work.”

Silence while I waited for her to expand a bit on that. When I became convinced that she was speaking code for “we don’t check our email,” I continued.

“I came by to let you know I’m actually feeling a lot better and I don’t really think I need to see the doctor.”

“There’s no doctor here on Monday. Just the RN,” she stated flatly.

“Really. The website said the doctor was in on Monday and Tuesday.”

Blank stare. So, I continued, “Okay! Well, as long as I’m here, can the nurse see me?”

The response, “The nurse doesn’t see patients when the doctor’s not here.”

Blank stare.

So that the trip was not a complete waste, at least by healthcare bureaucracy standards, I was given a few pounds of forms for my wife and I to fill out in order to “register” for the clinic. “Pajama-woman” also scheduled an appointment for me, when the doctor (who’s office behavior was beginning to seem to me curiously similar to Joseph Heller’s Major Major in Catch 22) was “in,” whatever-the-hell that means.

I was being medically screened to ensure that I was healthy enough to qualify for medical treatment.

 

3. The Last Straw.

Last week I had a major disagreement with my horse, Frankie. I wanted to remain in motion and Frankie wanted to stop. So we compromised. Frankie stumbled suddenly onto his front knees and stopped. I continued in motion until the dirt of the riding hall floor stopped me.

Later that night, my wife finally convinced me that macho indifference was not a constructive response to excruciating pain. The doctor in the emergency room, who was dressed in draw-string pajamas of a primary-color, with no cartoon animals, to establish his precedence in the healthcare food chain over those who wear pastel pajamas, diagnosed a hematoma on my right thigh, but no breaks or fractures. After prescribing Vicodin (Thank God! Thank God! Thank God!) he told me to follow up with my PCP the next week.

So I figure, I’d try to save myself the thirty-dollar copay. I mean all my PCP is going to do is look at my now technicolor leg, make me parrot to him what’s on the emergency room report, which he didn’t read, and ask him to write an order for an MRI, to be sure I have no soft–tissue damage or misplaced bits.

Q. Who went to medical school in this scene?

A. The guy in the draw-string PJ’s… the guy in the backless nightshirt pays the bill.

So earlier this week I called the campus clinic. Of course I got the phone robot.

“Hello! This is the campus clinic. Please leave a message if this is out of our normal operating hours. If this is during our normal operating hours, we may be with a patient. When you hear the tone, please leave your name, telephone number and a brief message. Have a good day… BEEP.”

I had no idea what their “normal operation hours” were, or what made them “normal.” As far as I could see, it was the middle of the work day. I guess I could have gone to their website and check, but I had already broken that code!

I think it was the “have a good day” bit that really got to me, though. If I were having a good day, why the hell would I be calling a medical clinic. I was barely holding on with the help of Vicodin, Naproxen Sodium and a cane.

But, I played it straight. “Hi! This is Ray Gleason. I’m calling as a follow up on an emergency room visit last week. They said I have a hematoma on my right leg but the x-rays showed no fractures. The doctor recommended that I follow up with my PCP and I was hoping I could do that with you guys. Want to make sure all the bits are still attached… ha… ha… my mobile number is 574-555-1212. Thank you!”

Of course I didn’t hear back. They don’t check voicemail either.

So, this morning I called again. It went like this.

“Good Morniing! Campus Cliniiic,” the now familiar voice of “Gate-Keeper Woman” sung over the phone wires. I could envision draw-string pj’s… light pastels… cartoon animals…

“Hi! This is Dr. Gleason. I called earlier this week…”

“Oh, yes. We were going to call you back!”

Yeah… right… I mentally completed her thought, when hell froze over. And, who the hell is “we” in this conversation?

“I called to see if I could follow up…” I tried to continue.

“What seems to be the problem?”

Oh yeah… you listened to my message… sure.

“I had a horseback riding accident…”

“When was that?”

“Huh… It was last week… Thursday…”

“Where did it happen?”

“…the riding hall… the doctors in the emergency room…”

“Where was that? Plymouth?”

“Yes, St. Joe’s… the doctor said…”

“Were you working at the time?”

“The time of what?”

“When you had the accident. Were you working?”

“Don’t know how to answer that… I’m a salaried employee…”

“…because if you were working, and it had to do with your work…”

“…I was on a horse and…”

“…you need to go to the campus health center, because they need to…”

“…but the accident was last week…”

“…there may be workman’s comp issues…”

“…no …not a workman’s comp issue… the equine sciences department is taking care of all the paper work for the accident report… I just need to see…”

“…we don’t handle workman’s comp issues here… the campus health center has to…”

“…no… no workman’s comp…”

“…the school needs the paper work for…”

“STOP!”

This of course such self-exertion in the face of someone sitting behind a counter is an immediate bar-to-service in the wonderful world of bureaucracy.

“Excuse me?” Voice dripping with righteous “I-am-a healthcare-professional-draped–in-pastel-draw-string-pajamas-and-sitting-behind–a-counter” indignation.

“Twice I’ve said no workman’s comp! It’s not an issue. I just need to follow up with a physician.”

“Have you filled out your screening forms?”

“Yes! I turned them in right before Christmas break.”

“Has the doctor interviewed you yet.”

“No. You scheduled me for March. You said that’s the earliest…”

“If the doctor hasn’t seen you, WE cannot give you an appointment!”

“Wait a minute! You just said that because the doctor hasn’t seen me, the doctor won’t see me.”

CLICK!

 

“Ah Bartleby! Ah humanity!”

The Grunt Speaks: The Distinguished Warfare Medal

On Wednesday, 13 February, Defense Secretary Leon Panetta announced the new Distinguished Warfare Medal (DWM), which will be awarded to individuals for “extraordinary achievement” related to a military operation that occurred after Sept. 11, 2001. Why did an innocuous announcement, and one that seems to seek to recognize the achievements of service members, cause such a crap-storm with veterans and veterans’ groups?

No sooner had the ink dried on the announcement, than my colleague at school, “The Major,” walked into my classroom and denounced the whole thing as a complete boondoggle orchestrated by that madhouse on the Potomac! “The Major” and I are “old school,” from the old “black-boot” army. We’re veterans of Vietnam-era light infantry operations, in the boonies, up close, personal.

What really stuck in The Major’s craw, I believe, was that the DWM ranked higher than the Bronze Star and the Purple Heart, awards that we both hold and awards that a soldier has to get “up close and personal” with the enemy to earn. The Major suggested that next the DOD would start handing out Purple Hearts and GI Insurance for guys whose avatars were “WIA”or “KIA” in cyber war games.

One issue is that the DWM is characterized as a “combat medal,” but it doesn’t require the recipient risk his or her life. In fact the soldier doesn’t have to be in the hemisphere as the “enemy.”

This seems to be in response to the changing concept of “combat” from the dirt, smoke and blood of a physical battle field, to fighting for dominance in cyber space and the ability to apply combat force by the use of missiles and drones, while the operator is hundreds of miles away operating from a high-tech console, seated in a comfortable chair in an air-conditioned facility, surrounded by the sounds of elevator music, wondering what’s going to be served for dinner at home or at the club after quitting time at five.

An essential question is whether the “cyber / drone” scenario is “combat.”

I believe the answer is yes. It’s offensive and defensive operations in support of a military mission, in which a soldier may have to apply deadly force against an enemy in order to achieve the assigned mission. Dirty or clean, dangerous or not, that’s “combat,” folks.

A second consideration is whether such combat poses any danger to the soldier / operator. How much “valor” is required in blocking a cyber-attack? Does the operator of a flying drone put his or her life on the line like an infantryman assaulting an enemy held position, or patrolling an area where there is a danger of ambush or IED attack?

The answer to that is no! As my colleague, “The Major,” quipped, if a drone operator falls out of the chair or gets a paper cut, what next? A Purple Heart?

Before I go any further, let me put a stake in the ground on one thing. I support any deserved recognition of the service of soldiers. Those who dedicate their lives, or a few years of it, to the service of their country and to the safety and welfare of its citizens deserve to be recognized.

Now back to the DWM issue.

First, I cannot support the DWM being a higher ranked award than the Purple Heart. Literally, a soldier has to be injured by enemy action to be awarded the Purple Heart. I’m with The Major on this. By sacrifice and valor required, the Purple Heart ranks higher than the DWM.

Second, what about the Bronze Star Medal (BSM)?  This is a bit more complicated because the BSM is really two different awards, one for service, the other for valor.

The BSM for service is an Army Commendation Medal on steroids. It’s the army’s way of saying “thanks a lot,” usually to officers and senior NCO’s. Its award does not necessitate valor, or even combat. Most officers who served a basic combat tour in Nam, twelve months in country, got one of these, regardless of assignment. So, subordinating the DWM to the BSM for service doesn’t ruffle my feathers one little bit.

The BSM with a “V” Device, for valor, is a different story. This meant valor in combat, something “above and beyond.” I won mine in 1969 for slugging it out with an NVA company for six hours while part of a four-man ranger team… and getting all my guys home safe. Try that sometime from a drone console! So, subordinating the BSM with V to the DWM… no way! Doesn’t make sense.

So, here’s what I think!

Definitely keep the DWM! Whacking bad guys with drones and not having terrorists using my credit cards to buy stuff is highly desired. If soldiers do that well, pin on the DWM’s!  Throw in a few Oak Leaf Clusters. That’s successful and meritorious Cyber-Combat!

But, subordinate the DWM to the both the Purple Heart and the BSM with V. Whether the DWM ranks above the BSM for service (no V device), is max nix to me.

I could live with that. So, could The major, I imagine… as long as they don’t start giving out awards for paper cuts, eye strain, and missing Happy Hour at the club.