Medical Care Concerns 2005

Medical Care in the ‘Burbs in 2005

I don’t have physician phobia or physician aversion and don’t want to partake in an unjustified doctor bashing, but I have real criticism of the orthopedic doctor I’m seeing for my broken ankle, and I like to hear other opinions about my treatment. Maybe I’m over-reacting?

Understand that the Fairy Blogmother lives in a small city, although ‘the powers that be ‘ prefer to call it a town as it gives its occupants a feeling of quaintness and safety. There are about 45,000 citizens in our insular township, one or two good restaurants, a multitude of café type eateries and fast food and chain restaurants, one movie theater, a Curves and two or three other fitness centers, a Wal-Mart, a Home Depot, several grocery stores, a book store, two high and middle schools, nine elementary schools, and even a prestigious private prep school. The Town is said to hold the record for the most liquor stores for its size. (Guinness Book of Records.) We have about 50 doctors listed in the yellow pages. In times of emergency illness, our citizens use the community hospital in the adjacent town, or they travel to one of two bigger cities, each within one half hour’s drive. Consider the scene set. We are essentially the ‘burbs.

At 7:15 AM on a Saturday morning in August I slipped down a small hill near my home and injured my ankle. In thinking about my medical care, I choose the community hospital with a good reputation for care, and the one in which I would most likely receive a speedier response than I might expect in the big city ER. Maybe the injury was a simple sprain, I reasoned while trying to decide in which direction to drive for help that morning. “Less crowded in the E R, easier parking,” my husband said, and thus, the small town mentality took over and we drove 10 minutes north. And no, the hospital was not the problem. I was seen quickly, treated respectfully, x-rayed, fitted with splint and crutches, and on my way out of the sliding ER door before 9 AM. I was given two Rx’s for pain and the name of the orthopedic doctor who was ‘on duty’ at the hospital that morning. with instructions to call him by Monday for an appointment. The doctor was not at the hospital. I saw the PA in the ER. I guess my ankle break was rather ordinary. I considered that a positive thing.

I was given an appointment for the following Wednesday and ordered off the injured foot until I met with the doctor. I obeyed the instructions, and checked the internet to learn how to better navigate stairs while on crutches. At the appointed date and time, I arrived at the orthopedic office on my crutches and waited by the receptionist’s desk while she spoke on the phone for 5 minutes. It seemed like 20. (Not even a nod!) I was surprised and a bit annoyed at the insensitivity, and wondered if this was the normal orthopedic greeting. (Encourage the crippled to fend for themselves; the build character sort of idea?) A little sensitivity training including a day on crutches might work wonders with the staff here. But eventually I was told to go around the corner to a waiting room, and after a brief wait, the PA introduced herself and brought me a wheel chair to make my trip to the treatment room. ( A good sign.) Once seated on the examining table, she looked at my hospital x-rays, and the ones taken there in the office. She began to fit me with a plaster cast. “Will I be seeing the doctor?” I asked. “Not unless you go to the funeral,” she replied curtly. (‘How to talk to patient’ training might be fit into the sensitivity training class as well.) The PA then went into a defensive lecture listing her training and history in the practice. Had I transgressed a boundary? I understood the Orthopedist absence, my admonishment, and made a second appointment for three weeks time. Surely I would see the doctor then, and most likely he would call to discuss my treatment beforehand. After all, this was the orthopedic specialist with the best reputation in our town. Alas, I expected too much - No call. Why even my dentist and the dog’s vet call after a procedure. Perhaps they have more business savvy, are more caring, and are less arrogant.

I arrived ten minutes early for my second appointment three weeks later. (It is difficult to estimate the amount of time one needs to crutch or wheel in and out of buildings My husband, not a patient waiter, accompanied me, and we both knew we were in for quite a wait as the patient room was over-flowing with people. “Double booking” is what they call it in airline vernacular. (I fantasized inciting a mutiny with my fellow patients.) I had my own wheeled seat, but my husband was left with the last seat in the place- the child’s stool. He squatted there by the table with the blocks and next to a double bounded woman whose two shoulders had been dislocated in a seizure. (I do make conversation with everyone.) I didn’t have it so bad after all, At least I could hop and feet myself, so I waited my turn patiently as was expected, no doubt.

Carol wheeled me into the treatment room an hour and twenty minutes later. (Maybe triple booking is at work here?) This time another x-ray was taken to determine my progress or lack thereof. “Ah, bone is beginning to heal,” was the Nurse Practioner‘s assessment. I had questions: “When will I see the doctor? Will I be getting a walking cast before my good knee gives out completely due to stress of doing the one-legged stance? Both questions were given short shrift. . Not today was the answer to both of my queries. At that point I was unsure if I was more upset about the doctor’s absence and my demotion from PA to Nurse, or the fact that I would have to hop around on one foot still. “Does the doctor look at these x-rays you’ve taken? I questioned Carol.
“Oh, yes. He’s here, but in with another patient. I have been trained by him and I know exactly what to do,” Carol replied. (That seemed to be the company line.) I think I was speechless. Surely, he’ll pop in and ask if I had any concerns I thought... It’s not only a professional way to do business, but just common sense for him to reassure a new and as yet unseen patient on his billing list. Hey what about the Hippocratic Oath he took?

But I was disappointed once again. Dr. Axtmayer never came into the examining room, or hallway, or waiting room. I wouldn’t know this guy if I bumped into him on his favorite golf course.

Nurse Carol removed one cast, and gave me a removable one. I think she sensed my frustration, or perhaps she knew how seriously I needed to shower without plastic bags. Carol then told me to make an appointment for 4 weeks time. “No weight on the foot at all until we see you,” were her parting words. “What about the $80 blue boot from the last appointment? Can you give it to another patient- one who might not have insurance?” my husband asked. No verbal reply was forthcoming, but the eye rolling said it all: It’s all about the money, dear, I assumed from the non-verbal gesture.

Four more weeks???? I couldn’t believe it. “Here’s a band, wrap it around your other knee from bottom to top as a brace. See you in a month,” Nurse Carol said on her way out of the room.

The busy receptionist gave me an appointment for five weeks time. I tried to insist on a change, but was assured that the doctor would not be in during the time I requested if I changed the date. “So I will see the doctor next time? “ I asked. “Oh, you’ll see the doctor while you’re under his care, but you’re scheduled to see the PA, but she and the doctor often switch between patients. Don’t worry, you won’t be released from the office care for a while,” was her comment. Was this the bait and switch technique? I’m still in shock. I should have asked if I would be billed at a discount rate.

And this, I think, is what is wrong with the American medical system. Patients caught between greedy doctors and controlling insurance companies, and protected by our elected officials who receive hefty donations from both groups. Lawmakers won’t take sides yet they fret and warn patient/consumers of the dangers of socialized medicine. “You’ll have to wait too long for service. You’ll rarely see a doctor,” they warn us. How does that differ from my present experience, I wonder. Is this why people pay a fee over and above insurance payments to guarantee the availability of a certified physician when they need one? Will decent health care soon be limited to the wealthy only? Or will insurers, doctors, drug companies, and legislators all come to their senses as more operations and medical care is out-sourced to foreign countries?

Am I sorry that I didn’t brave the wait at a big city hospital? Yes

Would my care have been better or more professional? Maybe, maybe not.

Have I grown more cynical about medical care? Be assured of that.

Will I bad-mouth this local doctor? You bet I will- loud and long.

Is current medical care all about the money? It sure seems so. The more patients seen, the more money on the bottom line for doctor and insurers.

Do I have questions I’d ask before making an appointment with any doctor in the future? You bet. And the first two would be:

1. Is it your custom to actually examine and meet with your patients at scheduled appointments, or do you use PA’s and Nurse Practioners and excuses?

2. How many children do you have in college?

What do you think?