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.”
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…”
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.”
“Ah Bartleby! Ah humanity!”