You probably can relate to this: I’ve just been through a frustrating and bordering upon lunatic fiasco with three medical offices.
I have had two colonoscopies in the last twenty or so years. It was time for another one, and I had some worrisome symptoms this past December, so thought I’d get on it and schedule.
Now, my husband says his recent reading (and he does a lot of it; his profession is in the microbiology area) indicates that colonoscopies don’t necessarily prevent deaths from colon cancer—unless the doctor who does them is particularly thorough. Then he tells me, “And our doctor is one of the most thorough.” So I didn’t really need to hear the stuff about the procedure possibly not being worth doing, just the “ours is great” part.
So, here comes a tedious story; just warning you. I will attempt to be my usual razor-y self so perhaps it will be partially entertaining. But my main purpose here is to reveal and vent, and I’d also like people to tell me their experiences and if you may have found a way to prevent what I am going through.
Way back in January (it is now the last week of April) I called the, well, “exit hole doc” (is he a proctologist? I don’t think so; have to look it up) to schedule. No one picked up at that office; I got their VM message saying I should fill out a bunch of paperwork in order to schedule the procedure. But since I’d seen him before, I left a message to that effect—“you should have all the info on me; please call me so I can make an appointment.”
Didn’t hear back; waited a couple of weeks. So, I called again, got the VM again, and this time paid more attention, OR, he had augmented the message. It said, “This really is the fastest way to get a colonoscopy scheduled: fill out our application which you can get on my website, even if you are a prior patient.” I obediently downloaded the ream of paperwork, printed it out, and filled it out. This took over an hour, and I consider myself a forms afficionado, given I was a tax accountant for forty years; but, I am 75 and a polio and cancer survivor, so I have a lot to say about my body and prior health. I put it in a big manila envelope and mailed it.
I called them two or three weeks later, again leaving a message, saying, “Uh, did you get my big fat envelope with my application in it?” A week later I hadn’t heard back, so I called again. Keep in mind that this is probably the best gastroenterologist (there it is) in Marin County, not some newbie or unestablished fellow. A few days later… which was well over a month since I’d sent the paperwork in, they called and said the paperwork was with the endoscopy center, where the procedures actually happen. Me: “So, how long have they had it?” She: “I sent it over there a week ago.”
Okay, wait some more. Called again about a week later. Left another message, and the scheduler got back to me after a few days this time. Maybe we were making progress. “The endoscopy center has some questions.” “What are they?” “I don’t know, something with regard to your having had polio and your response to anesthesia.” “But I’ve had two before, and everything went fine, and they were at that center. They just have to be aware that I take a long time to come out of it, so they need to be careful how much they give me. As they were in the past.”
“Well, I don’t know…”
Waited again, until it had been maybe two months since I sent in the original paperwork. Called again. Left a message. This time, I also called the endoscopy center. They sent me on a wild goose chase to a doctor’s office that had nothing to do with my doctor, and the receptionist there was impossible to understand; when I said, “I’m sorry, could you repeat that?” she hung up on me. Called the endoscopy center again.
This time I got a different person who actually looked for my paperwork to see what was going on. She said, “Yes, I see it’s been over two months.”
“And this has been sitting in your office and he didn’t send anything back to the doctor?”
“Yes. That’s right. And it looks like there’s a problem because you said you were short of breath.”
“What? Oh, oh, I remember… the questionnaire says something like ‘Have you ever in your life been short of breath?’ I have; I’m a polio survivor with a paralyzed leg, and if I walk two or three blocks, that will make me quite short of breath, just like when a normal person goes for a run. So what do I do to move this forward?”
“It says you need a workup from your primary care.” I called the colonoscopy doc again and left another message saying I now knew what they needed.
Called my primary care and made an appointment for a “workup” with a nurse practitioner, a week away; my actual primary care doc would be a month out. Receptionist says, “What kind of workup?” Me: “I don’t know, whatever kind of workup you need for a colonoscopy.” “Well, there are several different kinds [she listed them]. You need to find out what kind they want.”
Called the endoscopy center back. Got the helpful woman again.
“I’ll talk to the anesthesiologist. He’s the one who made this note.”
Waited somewhat patiently. After about an hour, this very competent admin woman actually did call me back! She caught the anesthesiologist after one of the procedures. She told me “He says you need a pulmonary workup.”
“Can he refer me to the pulmonologist?”
“No, we don’t refer people. Your PCP has to do that.”
So called the primary care and told them this; I said, “Can’t my doctor just order one, given she’s going to want me to get the colonoscopy?”
“No, you have to have an appointment.”
At this point I am swearing, over or under my breath every time I talk to another person and get off the phone. I decided since I only needed a referral I’d change the appointment to video.
The gastroenterologist’s office called me back, at last. I told them I needed a pulmonary workup; could they make the referral? No, they can’t, it has to be my primary. “But, the endoscopy center is who wants this, and it’s for your doctor to perform the procedure.” No, we can’t do the referral.
Rackofratz! And that is not what I really was saying. That’s a comic swear word from a 1960’s commercial. My blood was boiling. (There’s a literary exaggeration; that’s impossible, but, it’s perfect metaphor.) I had a week to cool off before I saw the nurse practitioner.
In the video appointment, the NP said the reason I had to have the appointment was because I’m on Medicare and they require an appointment to evaluate whether I actually need a referral to anyone else. When I was not on Medicare, and had other insurance, I could just call up my primary and ask for a referral to any specialist, if I even needed a referral.
But once you’re on Medicare, it’s way more complicated. This is a Catch-22 because if my doctor could just refer me, I wouldn’t be charged for that, no appointment necessary, and there would be no charge to Medicare; much cheaper. Medicare is a very inefficient system, although I find that with Medicare plus AARP United supplementary, I rarely have to pay out of pocket for anything. I’m happy with these two insurances in terms of costs and payments, although there are some things they won’t pay for at all, such as one of my prescriptions which I need because I am allergic to the one they will pay for. Which they don’t care about. (I’ve talked to them.)
Additionally, it’s much harder to get appointments with my PCP and some other doctors now, because they only set aside a certain number of appointment availabilities for Medicare patients. Since they get paid less from Medicare and supplementary insurances, they have to fill their schedule with patients whose insurance or wallets pay higher fees.
And, for anyone who still thinks Medicare is free, let me disavow you of that. I pay about $360 a month for Medicare, because my husband still works, and I pay $300 a month for United. Both of those costs go up annually. The government is paying for part of the costs, out of the money we and our employers have paid in. This is a good price; I’d probably be paying at least $1,200-$1,500 a month if I were on private insurance. But it’s not free.
The NP said she didn’t understand why I needed a pulmonary workup. I explained the whole thing to her. She went and checked with a doctor in the PCP’s practice—mine wasn’t available—and was told that given I am not currently short of breath they could not refer me to a pulmonologist, it wasn’t necessary.
At this point I was losing it. I was visibly and audibly angry. I told her I couldn’t get the damn colonoscopy without it. Catch-22 again. Her attitude was basically, “Well, I’m sorry.” I was ready to scream when we hung up. I think my exact words were some in succession which start with S, F, C, and P. This is my go-to swear sequence when I’m really, really pissed off. The first time my husband heard this out of my mouth, before we were married, he said, “WHAT? What was that string again?”
I called the endoscopy center and the gastro doc back, still furious, not such a good thing. Told the good woman who runs defensive for the anesthesiologist that my PCP won’t give me a referral. Left a msg for the gastro people. Told them I thought they really needed to communicate more with the endoscopy center, that this situation was absolutely ridiculous.
I got a call back from the gastro office within a day or two. They said they had talked to the endoscopy ctr and I could just get a pulmonary workup from my PCP, I didn’t have to go to a pulmonologist. So I called the PCP two or three times and was on hold fifteen minutes each time. Left a msg for the NP. Called again and left a call back request with the appointment line; they did call, and now I have an appt for the PCP to do a pulmonary workup… in another ten days.
By the time the colonoscopy is actually scheduled, assuming the NP can actually do the workup and it gets sent to the endoscopy center and the gastro office right away, it will have been about five months since I first tried to get the appointment. It usually takes at least a month to get on the schedule once every box has been checked in this process.
I have told all of these offices that if I had run my tax and bookkeeping service in this manner I would have gone out of business. I would have lost clients left and right. They all acknowledged that it’s not working well.
I don’t know what the solution is, but I suspect it’s not something so simple as Medicare for All. I mean, that’s a nice idea, but someone has to pay for it. I’m not unwilling, I’ll vote for my taxes to be higher… I’m just saying… it’s not the full solution. The system is screwed up, aside from medical costs.
It seems likely that paying for medical professionals’ education as they do in some countries, so that they don’t have to go a quarter million dollars into debt and then find a way to pay that off and also live well would probably help. I mean, if I’d gone to medical school, I would definitely want to have a good life. Nice house, vacations, put my kids through college. It’s hard, studying all that stuff, going through residency and then having to pay off huge debt, in addition to what you pay for on the way in, whatever you can; seven years of room and board and so on. And if doctors’ educations were subsidized, they’d have to get used to the idea that they were not going to live extravagant lifestyles. That they’d be paid like plumbers and mechanics. Comfortable, though.
Snd since the pandemic, many medical professionals have quit. They just don’t want the risk and the very long hours and the fear and the anxious lifestyle, the worry about people’s health and so on. So now we have a doctor and nurse shortage, which leads to being unable to get appointments.
But having a poor voice mail system and not hiring enough admin people who follow up on paperwork, or are available to answer the phone and make appointments, to me sounds like a totally different issue. It sounds to me like incompetence on the administrative end of medical professionals. It sounds like being cheap at the expense of patients, whose time is also valuable, even if we’re old.
That’s unfortunate. I mainly use my chart to communicate. Since it is documented and I have always received a response. My sister-in-law has Kaiser and always communicates with my chart. If no response she will do it again and state this is my second request. At UCSF they respond within 24 hours. Here at our local medical care a bit longer but always within a week. I also have AARP, and have made my own appointments (with various specialists) no referral. As a cancer patient I have to have a colonoscopy every 5 years per MM specialist even though report said ever 10 years, because of secondary cancers being an issue. Also at UCSF I can make appointments with specialist without a referral could be because I am in the system.
Same with Bary, he got a second opinion with a hematologist, no problem with Medicare or AARP. I trust a research center.
Hi, Mary! Thanks for all that. My PCP is in the UCSF system, a subsidiary, and three of my other providers are as well. However, I find that communicating with them via email is slower than calling them. My orthopedic docs are under two other systems, the shoulder and back doc are on one, and the foot is on another. All of those have separate digital systems. Some are easy to navigate (UCSF affiliate) and some are not; some don’t even let me send emails. My polio specialist is with UC Davis, yet another system. Fastest to call or send her a direct email; I don’t think they have a digital system, or if they do, they haven’t directed me to it (yet). But I only need to consult with her every couple of years.
And our gastroenterlogist is an independent; years ago he was in the same system as our PCP but went on his own when they changed the corporation and went with UCSF as an umbrella. He doesn’t have any digital system at all. The endoscopy center is also independent as far as I’ve been able to determine, and all the gastro docs in the county (there aren’t that many of that specialty, actually) use that same facility.
Given I need specialists, as you’d understand, I have to keep all these providers.
My main issue is that they don’t communicate with each other. I realize this would take, gasp, phone calls or emails and not just logging in to the digital system they already have, but shoot. That was not a problem at all about 5-10 years ago.
I see why people go with an HMO, but I would lose the providers who are serving me really well, at least serving my body, if not my emotional state.
Thanks again, appreciate your comments.
PS I can make appts with most of my specialists without a referral. But this request from the endoscopy ctr had to go through my PCP and they said no! So now I’m getting the pulmonary workup from the PCP, thankfully. I was ready to go to my PCP’s office and pitch a fit.