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Category: Healthcare

The View From the Shoulder

The View From the Shoulder

To point out the obvious, I survived the surgery that was the subject of my last posting, and have been in a process of slow recovery over the past three and a half weeks. The surgery – a quintuple cardiac bypass, which I didn’t even know was a thing – went well, and I’m told my recovery has been as good as could be expected. I’m grateful to my surgeon and all the others who were involved in getting me through this, as insane as it all seems to me.

Where I’m at now is a world of difference from where I was in the first few days after the surgery. There are still lots of inconveniences and things that are not yet back to normal, but at least I’m past the excruciating pain and weakness that characterized those initial days. At that time I had to wonder why I ever put myself through such mutilation and torture, and still I can’t imagine ever going through anything like that again. I had a pretty clear sense throughout the whole ordeal that I could return to normal functioning and an active life, but I realized that if all I had to look forward to was permanent disability and struggle, as others I saw around me, I’d have a pretty hard time justifying it. Even today, as far as I’ve come, I had to wonder how the mechanisms that are my heart and body could sustain all this and keep on functioning. This is a mystery I may never unravel.

In case you’re wondering about the title for this posting, as much as I’m now ambulatory and functioning at a relative level of normalcy, I still feel I’m sitting on the shoulder of the road. Other than emails and shopping lists and questions for my doctors and a couple of business-related items, this is the first piece of any sort of coherency and even marginal creativity I’ve been able to write in 26 days. And it’s admittedly pretty thin. I’m hoping in the next several days I’ll be able to write more, and then more, and I can resume more regular posting to these blogs, but I’ve found that gathering mental energy is virtually as hard as gathering physical energy. And having anything worth saying is yet a step beyond that.

Four days past the surgery I attempted to get online, and was met with the shocking reality that I had forgotten all my passwords. I still couldn’t muster the strength to have someone fetch my laptop from its bag or to hold it on me, and trying to do things on my phone reinforced the feeling of insanity of doing anything serious on a phone, even when in normal health. I had that sense before the surgery, and that disconcerting experience only confirmed it. Two days later, when I finally did get onto my laptop, I was astounded at the number of typing mistakes I made. It was like my fingers were not in direct contact with my brain and they took on twitches and strokes that defied my best attempts to control them. Not quite as disjointed as the time I tried to work on a Turkish keyboard, but close. I’m told that anesthesia can really scramble both brain and body cells, and so I’m chalking these aberrations up to that. I’m doing a lot better now with typing and other fine motor skills, and the files on my laptop helped me recover my passwords, but the process has been a continuum.

Other bodily functions – notably an astoundingly annoying throat irritation and coughing, and problems with peeing – have slowly been recovering, and while not back to what I’d characterize as normal, are hugely better than they were in the early days.

I had five and part of a sixth day in the hospital following the surgery, and then four and part of a fifth day in a rehab center, located on the same complex as the hospital, after that. At that point I got the boot, and two wonderful friends and fellow boat people came to fetch me, assist with getting food and medications, and establish me back aboard my boat, which is my home. I don’t know what I would have done without them, and I’ll be forever grateful to them. It’s two weeks today that I’ve been back aboard, and I think returning here was the best alternative. This past Tuesday my surgeon, with some persuasion, gave me back my driving privileges, and that made a huge difference in my life. And two days ago my primary physician told me I’m very impatient. I told her I know I’m a pain in the ass, but I wasn’t challenging her expertise. That’s just me. And she laughed.

I’m going to have lots more to say about the medical and healthcare situation in this country in coming weeks and months here on FJY.US and I may have some fictional things to say about it on Stoned Cherry. I’m fortunate in that I have access to Medicare and private insurance, and that made a huge difference. It shocks some people, but I really have nothing negative to say about my insurance company. And I have lots of praise for the doctors, nurses, aides (known, it appears, as Patient Care Technicians in some circles these days), therapists, and all the others who assisted and supported me through all this. That said, when there were rare failures they were pretty notable, and one thing I came to discover is that it usually is the little things, the small details, that can have the biggest impact on a patient and the patient’s experience. I’ll have more to say on this, too.

I really feel bad for writing all this self-centered drivel, but I felt some explanation of where I’ve been for the past weeks was in order, a kind of transition from the breakdown on the shoulder I went through to getting back into the traffic pattern. I’ve seen the moon and the sun since my last posting, and so day-by-day it’s time to get on with life. I promise, barring any unforeseen circumstances, this will be the last posting focusing on this whole thing, and I now can say, enough of these adventures.

I’ll be pulling off the shoulder pretty soon, so watch this space for what’s to come.

Physician, Heal Thyself!

Physician, Heal Thyself!

No, this isn’t about drugs or addiction or ODing, or any of those things. It is about frustration, though. Frustration with the medical profession. Frustration in trying to create sense where sense seems not to exist. Frustration that can lead to scenes such as in the image. Fall down on the floor, tear out your hair, rend your garments sort of frustration.

To be perfectly clear, this posting is based on a personal incident – drama is more like it – playing out now with certain elements of the medical profession. To protect both the innocent and the guilty, I’m not going to name any names. Now. But if I continue to be stymied, that decision might change. Watch this space.

If you’ve read my piece on The Biggest Shell Game in the World, which you should before reading on here, you know how I feel about the so-called “healthcare system” we have in this country. You’ll also see I elaborated on some specific actions that might help ease the growth in the cost of healthcare. That posting focuses on the macro dynamic of the system. This posting focuses on the micro dynamic, the one on the doctor level.

It’s no longer a laughing matter – it never was a joke – to say that much of the medical profession is still anchored, not just in the last century, but maybe even the one before it.

When I lived in Montana some dozen years ago, my physician – an author of the reputed Helena Heart Study, so no slouch – presented himself as advanced because he took his notes on a laptop. Why that should have been considered advanced when small computers had been in fairly wide business use for a quarter century already is a good question to ask, if you’re inclined to ask questions. Now, all the doctors I go to use laptops for their notetaking and recordkeeping. Of course, it is, at last count, 2017.

The one thing my Montana doctor did that really stood out was to communicate by email. Quick, easy, asynchronous. Email. One would think this also would be pretty standard now. That’s what I thought. I mean, I run a global business and communicate with clients all over the world at close to 100% by email. So picture my surprise to be out of Montana and in a southeastern state that also shall remain nameless (besides, I often reverse the “d” and the “i” in the name, which is embarrassing) and to find that email does not play a role in typical doctor-patient communication.

Does one even have to wonder why calling a doctor’s office often leads to more frustration, lengthy stays on hold listening to dreadful “hold” music and self-serving promotions, being asked, finally when you get past the official hold, “Can you hold, please?” (Okay, at that I’m tempted to fire back, what are my options here?)

Again, how can almost any organization in 2017 function without email? It’s not only a fast and easy means of communication, but it also can be used as a system of sending health information to patients and even, if one is allowed a bit of crassness, as a marketing device. But, no, this seems to be beyond the understanding of most doctors.

Then there are those doctors’ portals. Potentially great idea, completely mutilated, misused, and just plain not used, in execution and practice. First, they’re all clunky in that clunky way that special-purpose software (like used in lawyer and, yes, doctor offices) always is. I don’t know, maybe it’s me, but I’ve had a litany of problems with the portals of several doctors and healthcare groups. Sometimes I’d have to enter a new password each time I signed in. Sometimes things I’d want to see, like reports, are there. Sometimes not. One portal doesn’t even tell me my next appointment, which would seem pretty basic. I’ve yet to be able to get a prescription refill put through based on a request posted on a portal site. And, perhaps the biggest issue I’ve encountered, often doctors’ front offices don’t mind the sites, so sending a message to the office through the portal is like throwing a quarter down a deep well. “Pathetic” is too kind a word.

Okay, despite all that, that’s not my biggest problem nor the most immediate. Oh, no. I have a far bigger gripe, which we’ll get to now. The one that concerns the Health Insurance Portabliity and Accountabillity Act – HIPAA – and how doctors not only seem not to know much about its requirements but, worse, seem to think it exists to protect them and not the patient. Which is wrong.

I had one doctor earnestly tell me that there is a $50,000 fine attached to a single HIPAA violation. Well, he was part right. Fines can range from $100 to $50,000, or $1.5 million maximum per year for ongoing violations. What puzzled me then, and which irks me now, is that the implication was that the doctor had to protect himself against violations and resultant hefty fines. The point that was completely missed, even inverted, is that denying a patient access to his or her records in whatever way the patient deems suitable seems like a more sure route to a violation than just providing what it is the patient requests, in the form or via the means requested by the patient.

Now that doctor’s office will fax me things like test results. Some will even (horror!) email them. And then there are others, like another one of my doctors, who refuses to provide records or results in any form other than by mail, or picking it up in person. Never mind the inconvenience of the latter choice, I would defy anyone to show me how snail mail is any less prone to pilferage or misdelivery than a fax or email. I even maintain an encrypted email account for highly sensitive information. But all that is irrelevant. The Department of Health and Human Services (HHS), which oversees application of HIPAA, is clear on the subject: A provider should email, fax, or accommodate alternative delivery means as requested by the patient. Look it up. It’s right there, explicitly spelled out by HHS, in the department’s HIPAA FAQs.

That’s really the key issue: Patients have a right to see and receive their own records and results, and HIPAA exists to protect them, not the doctor or other provider. So if a patient wants his or her bloody records emailed or faxed to them, HHS says the provider should accommodate that request. But you’d never know that from the patchwork of restrictions, most of which make little to no sense anyway, that one encounters when requesting one’s records.

Of course, all this assumes that a patient has signed a statement authorizing release of information to the patient and whatever third-party designees, if any, that the patient might include in the release. Now here is a suggestion – a strong one: Why not include a check-off box with a line where the patient authorizes positively (by checking the box) transmittal of records via email or fax? Easy-peasy, and takes care of any misunderstanding. And while you’re at it, how about another line with a check-off box authorizing the same thing for any third-party designees? Two lines, and you can sleep better at night knowing the patient has asked for this and HHS says you should give it to them. And it’s in writing, no less.

All this leads to the source of my current distemperous mood toward doctors and things medical. It’s been four weeks – not hours, not days, not business days, but weeks – that I have been requesting the results of an MRI from a certain specialist. I requested that the doctor or his nurse-practitioner call me before I left on an extended trip so I could at least have a sense of what the MRI revealed. I was told, well, he probably won’t call you. He likes to do things in person.

Well, I like to do things in person, too, when that works. But in this case, it wasn’t even possible to get an appointment in less than a month or more. And I was clear that I was leaving the state and needed the information before I went.

Ha. Fat chance. Four weeks have gone by, I’ve lost count of the number of times I’ve called this doctor’s office, had my primary care physician’s office call him, even the insurance company called the office when I filed a grievance with them over this. And still I can’t get either the doctor or the nurse-practitioner (which would be fine) to speak with me and discuss the test results, much less actually get those results. Now if ever there is a HIPAA violation, it would seem this is it. It will take a formal complaint to HHS, but that is imminent. I now even have my attorney on the case.

The doctor might have his procedures, but there are two parties to the transaction, the other being the patient, and in this case this patient has different procedures. And HIPAA is on his side.

It’s bad enough having to deal with doctors and tests and health issues without having to be put under further stress and duress by providers and offices that just throw more roadblocks and obstacles in the patient’s path.

All this seems very 19th Century to me. Doctors hold themselves up as miniature deities and patients are just supposed to accept whatever inconveniences, incompetence, or affronts that the doctor and doctor’s minions subject them to. And there are others besides those discussed here. Let’s just save my rant on the prescription system for some other time, ‘kay?

If you’ve encountered any of these issues in dealing with doctors, I invite you to tell everyone about it in the comments. And if you have a different and more positive story to tell, by all means post that, too, in the comments. And if you question the premises on which this piece is based, well, fire away with that, too.

Meanwhile, I’m going to fax this piece off to a few doctors I know (I have to fax them since I don’t have their email addresses) and maybe shake a few trees. Or else things will just go on as they always do. And watch this space if I decide it’s necessary to start naming names.

Physician, heal thyself!