Health...Care?

It is hard to evaluate the health care one receives when there is no diagnosis. This scenario tempts me to be overly critical and negative about the care I received. But another scenario demands that I view my experience in a positive light. This scenario, the one that I am living now, is that I have come out of whatever it was that handicapped my life for five months. Barring an unforeseen problem, I am healthy on all fronts.

Now to the care…Once Kate and I decided to seek professional help, which didn’t take long given the whole loss of taste and facial paralysis thing, we were able to get a neurosurgeon to order a CT without a prior visit. This was the first of many perks of being married to someone in the health care industry. Kate knew someone who knew a neurosurgeon that did a big favor for us which eliminated the usually necessary visit to the doctor before a CT is ordered. That saved us $350. If you are wondering, that is after insurance. We did have to pay for one visit with this neurosurgeon so he could tell me that there was no visible tumor or huge problem with my brain.

This same doctor wrote a prescription for dexamethasone a few days later when it was determined I had Bell’s palsy. This prescription was written without a consultation—another perk. Although there were those perks and a few others, namely having a nurse practitioner as a mother-in-law and an anesthesiologist as an uncle and a wife who is a pharmacist (who also could double as a MD sometimes), I can’t say the perks drastically improved the quality of the health care. In the long run the perks saved us some money and some appointments by bypassing some health care bureaucracy.

The range of doctors I saw was a direct consequence of not having a diagnosis. Being sent from a neurosurgeon to a neurologist, to an ophthalmologist, to an ENT doctor, to a rheumatologist and to a family practice doctor is the unfortunate path of a patient with an undiagnosable illness. That journey wasn’t a byproduct of poor care, rather it was a byproduct of a health care industry that needs reforming. And with that thought, maybe it is a sign of poor care. Let me elaborate. With all the doctors I visited I came to realize how hard it is to find a choice doctor. There are many doctors out there, but few see patients as anything besides a chart or can remember why the heck you are seeing them for the second time that week. I went to more than one appointment where the doctor was hesitant to order tests or prescribe drugs that they sent me to another doctor even though they knew that ordering that blood work or giving me that drug is going to be the end result. When there seemed to be risk involved, half the doctors covered their asses by referring me to a doctor with the fortitude to order the test.

This slowed down the process of actually getting the care I needed or the answers I sought. It is a practice that prioritizes one thing—the doctor. Not surprisingly, the doctors that were referred to me by the doctors too afraid to make the call were always significantly better. They asked a lot of questions. They sat quietly while listening to my answers and I could see the wheels turning. There was much more patient-doctor dialogue. Probably most importantly, I felt like they were concerned about my health like it was their own life on the line. The care I received from these doctors was also more efficient. In one appointment the doctor quizzed me about my whole ordeal, came up with a list of likely problems/issues, and acted on one of these issues right away by ordering an x-ray. I got the x-ray, waited fifteen minutes and was able to meet with the doctor to discuss the results five minutes later. Let me remind you that this was all in one visit and, if you haven’t figured it out yet, not ordinary.

In stark contrast to the doctors that truly cared about me, there were two who were certifiable assholes. The first, an ER doctor that was convinced I had cluster headaches. She put me on oxygen, prescribed fiorocet, and discharged me from the ER. It was an agonizing few hours. We realized she wasn’t going to do any more for me so we obeyed her orders because that was the quickest way out of the ER that afternoon. The second, an ophthalmologist, was the worst doctor either of us has ever encountered. This guy met and exceeded all of my expectations of the crappiest, most arrogant doctor. He always seemed to know more about my health than I did. He would ask me questions and interrupt me while I was answering. Kate was often along on the visits to this doctor and on the last visit her patience with the doctor expired. She was beginning to ask a question of him and after she got out the first two words, not nearly enough for the doctor to know what she was asking, he held up his hand and stopped her and said, “No.” Kate started again, putting some frustration in her voice. This time he let her finish but immediately said, “No.” Again, he gave no explanation.

These two doctors represented some of the lows throughout my sickness. It was hard to imagine how they might have loyal patients. They consistently did the minimum in order to expedite the process. For the eye doctor, it was all about the money. You could tell he didn’t put much thought into his work. Sad to say, but he was a bitter, crabby, old man.

In addition to the poor doctors, the lack of diagnosis was the most frustrating factor to deal with, but that wasn’t necessarily a sign of the quality of the health care. Although at times I forgot that. With that said, I still think the care I got was only mediocre. Kate and I have great health insurance. We are in a highly rated health care system. However, this health care system appears to be very bogged down by bureaucracy and a few silly rules that are probably in place to ensure that patients can’t work the system. That’s a shame. It is also a shame that I ran into a few doctors that seemed reluctant to use the powers they had at their disposal. Why do they do this? Well, I assume some don’t want to be accused of a misdiagnosis or ordering unnecessary procedures. I don’t have the answers, but maybe some of them are just too afraid. It might be as simple as that. Or they could be deliberately passing me on to a doctor that they believe is better than them. Fine, but that process is slow and expensive. It might mean weeks between appointments and even longer before the next test is ordered or the next drug prescribed, thus making for an agonizing wait for a diagnosis or a result from a test. In this system there is no quick route to a diagnosis even if from the beginning the patient’s symptoms match those of a specific disease.