A friend of mine recently had an angioplasty procedure, the second one in a handful of years and she balked. But because of a mysterious shadow or something on her heart, the cardiologist insisted. It took her a while to get around to submitting to the procedure, but finally allowed his staff to set the date. She went into the hospital at the appointed time and got it over with. Afterward, the cardiologist walked into the room and asked her why she had had it done. Was this a trick question? Completely taken aback she reminded him that it was at his insistence. “No, I didn’t,” he said. “I never ordered this.”
Okay. My friend may not be up on the latest AMA handbook, but she knew this was a hospital, not a service station. You can’t just walk in and ask for an angioplasty and while you’re there, check under the hood and clean my windshield. You must have a doctor’s authorization. Two possible reasons for that bizarre remark could have been: (1) He didn’t find anything (and he didn’t), and knew he would be called on the carpet for an unnecessary procedure and maybe not get paid for it, or (2) his office got her records mixed up with someone else’s. Either way, it was reason enough to tell this doc to take a hike. And she did.
When I told my aunt about it, she had a tale of her own to tell. Again a cardiologist. My aunt had open heart surgery a few years back (and that story in itself will curl your hair), and the doctor put her on Plavix. Since aunty keeps up with the news better than I do, she had heard a few rumbles about the drug. During an appointment she brings it up to her doctor. “Why am I taking Plavix?” she asked. “You’re not”, replied the doctor, “I’ve never prescribed that for you.” No shrinking violet, my aunt snapped, “Then how in the hell am I getting it?”
I don’t know if it’s the same cardiologist/doctor as the one a few years ago, but when my aunt was rushed to the hospital with severe chest pains, she lay in the emergency room until the . . . okay, you know how emergency rooms work. It’s a wonder they don’t have to shove aside stiffs covered in dust from the Egyptian tombs. Anyway, the doctor comes in all in a rush, just knowing, in his omniscience, that this is another ugly Medicaid waste of his golden boy time. After a cursory examination, he pronounces her fit and fiddle to go. Don’t let the doorknob hit you in the rear on the way out. Only problem is, when he sits her up on the edge of the table, she falls off. Heart attack. She barely lived — and no thanks to the doctor, but to my cousin, who is also aunty’s niece and who was also a nurse for many years. Without her expertise our aunt would not be here today.
Now we turn a page to two of my own recent experiences with front office staff. The first was when I appeared for an appointment for allergy testing. The stone-faced woman behind the desk asks for my insurance card. I present my shiny, brand new, never-been-used-before Medicare provider card. She looks at it. Then she looks at me like I’ve tried to pass her a bad check or counterfeit money. You know the look. “This gives another doctor’s name,” she accuses. Yes, I say confidently. My health care provider will okay it. Just call them. I hand her a business card with a convenient phone number. You know. Phones are not that complicated to access these days. She half turns to look at the black land line behind her. Then turns back to me. Stone face. Doesn’t speak. Doesn’t move again. Just call them, I repeat. I’d call them myself, but my phone’s in the car. I’ll have to go out to get it. Silence. Not a muscle moves. This is getting extremely weird. I’m highly tempted to jump up and scream, “She’s having a stroke!” at the top of my lungs. But I restrain myself. As it turns out, this is the one doctor in a whole slew in the area not on my healthcare provider list. But she couldn’t have known that. She never looked. She never called. She just sat and stared, stiff as a board. Weird. Totally. After that first encounter she never spoke again. I didn’t bother saying goodbye.
The second through-the-looking-glass experience was with trying to get a very necessary procedure done after a requisite referral from my family doctor. I get a call one night about 8 p.m. with someone rattling off about . . . actually, I never understood a word of it. I was half asleep. Nothing on TV that night and I was between good books. Finally she slows down and enunciates clearly enough to make me understand she is from this specialist’s office upon referral. Okay. I wait for her to tell me the date of my appointment. Silence. “When’s my appointment?” I ask. In a chirpy, sing-song she rattles off, “EIGHT to five Monday through Friday.” Okay. So when’s my appointment? “EIGHT to five Monday through Friday.” I understand your office hours, lady, I just want to know when my appointment is. “EIGHT to five Monday through Friday.” What? I’m just supposed to pick a time out of a hat? Apparently. I’m so confused I don’t know what to say. “You want me to send you a packet?” she asks. Sure. Yeah. Do that. Maybe after reading up on something and not being half asleep, I might make sense of this.
So when the packet arrives a couple of days later I call again. Okay. I understand all this, I tell her. Now, I want an appointment. “EIGHT to five Monday through Friday.” Okay. Let me think about it. Now since the specialist I want an appointment with is one of a group of doctors in that facility, I couldn’t remember which one I had been referred to. The name was foreign and unpronounceable, though another family member had used him and said he was good. Silly me. I ask this chirping bird what doctor I had been referred to. I even had a pen and their letterhead in my hands so I could circle the correct one. A chirp came over the phone. “PICK one.” What? “PICK one.” I don’t want to pick a doc out of a hat, I tell her. I want the one my doctor is recommending. No intelligent answer, just, “PICK one.” By this time I’m thinking I’m the butt of a bad joke and some staff member’s pet parrot is on the line. I have people who don’t believe all this, but I swear it’s true and my husband is a witness to my end of the conversation. When he suggested that it might be me not making myself clear . . . okay, you don’t want to know. I can get loud, especially when I’m already ticked off.
I was so disheartened talking to this woman that I waited another week to call again. I had had the presence of mind to call my Medicare provider and was told I needed an authorization from them to the specialist’s office for the procedure. So I call their office again. There is a name written on the bottom of the papers they sent me in the packet – a staff facilitator, I’m assuming. NOW we were getting somewhere. So I call and get a nice, normal sounding person on the phone, but I ask for the name written out on my paper. I wait. And wait. And wait. I finally hang up. I wait a decent time and call again. Again I ask for this person. After a period of waiting, she finally comes to the phone. My heart drops. It’s the parrot. Assuming that it’s human, however, I explain that she needs to call my Medicare provider for authorization. “I don’t understand,” she says. You know. Medicare. My healthcare provider. “I don’t understand.” They-will-pay-the-bill-for-this-procedure. “I don’t understand.” The complete inanity of this “conversation”, and those preceeding it, just blew me away. I couldn’t think of what to say or who to talk to. Almost every doctor there was foreign, but this woman was American and couldn’t understand a word of English. And was apparently in a position higher than floor cleaner or even receptionist, who, by the way, sounded competent.
Another three weeks go by. This is a procedure I was supposed to have ASAP, according to my doctor. So I call his office and ask the nurse the name of the specialist on the referral and tell her the problems I’m having. I try not to go into too much detail because I sound like a ranting idiot just repeating the parrot-woman’s words. The nurse tells me if I have any more problems to call her and they will make the appointment. Good enough.
But then it is discovered that I must have a small operation BEFORE the original procedure, and the nurse tells me I can have both done by that same specialist. At different times, of course. So I call again. Again, I get parrot-woman. I tell her that my referral has now been extended to an operation BEFORE the original procedure. “Oh, we don’t do those operations anymore,” she says cheerily. But . . . but . . . my doctor’s office says you do. “Oh,” she chirps, “we do it a different way now — with laser.” But I no longer cared if they operated with guided missiles with scalpels on the end. I had had enough. WhatEVER! I say. Never mind. Good-bye.
The end of this story is that I call my sister for the name of the specialist she went to, a woman with a nice pronounceable name and highly competent. I go through my family doctor’s office and ask for a different referral for the one my sister recommended. No problem. I missed the call the next day, but touched base later. I didn’t even have to ask for an appointment. No rabbits out of hats. No PICK a doctor. No — I don’t understands. I was given a normal appointment by a normal woman who knew by the referral on her desk just which doctor in the group I am supposed to see. I sag with relief. IT WASN’T ME! It wasn’t me! It wasn’t me. I might be almost sane again, but for a few bad moments there, it was touch and go. And it leaves me wondering — how do parrot-people get these jobs? It’s got to be obvious they are not just incompetent. They are total goof balls.
No. Many office staff members are good at their jobs, managing a lot of people and information. How anyone like the women described above can slip in among them is beyond me. And the doctor in that medical group was recommended. I just couldn’t get past the parrot in his office. The medical profession? It’s a jungle out there. And you never know when something’s going to pounce.
For more reading on the medical profession in crisis, here’s my review of: Unaccountable – by Marty Makary, MD