Who Cares About Health?

At the national level, health care often functions, or really doesn’t, in theoretical policy. Many in the crowded Democratic presidential field are touting Medicare for all; the president keeps defying his advisers, who just want him to ignore the topic, by raising the specter of repeal with no plan for replace; congress seems happy to pretend nothing needs to be done. At the state level, Colorado has taken some steps to strengthen its insurance exchange (which does no favors to any of us on the Western Slope, where we have a “choice” of one company), and it has put a cap on how much anyone can charge for insulin.

But when it comes down to it, at the personal level, people just want health care to work, and sometimes that seems to be an incredibly unreasonable request.

At my last appointment with him, a few months before his retirement, Dr. Wolkov consulted my record to determine that he had opened his clinic in February 1974, and I first visited in September of that year. I still go to that same building, but Dr. Wolkov sold his practice to the hospital, and several years later I remain fairly unimpressed with “my” clinic.

My biggest complaint would be that every time I go in I am asked to fill out the same basic information, information that doesn’t change. And every time I ask why I am having to fill out my family medical history yet once again, I am told they have changed software, and nothing transferred from the old system. This happens on an annual basis, and it makes me think about the book I started reading on health care systems in other countries.

In France, people carry a medical card the size of a credit card, and on a chip in this card is the patient’s entire medical history, entrusted not to any clinic — where prices are posted on walls in the waiting room, and what you see is what you’re really charged — but to the patient. Who are just as capable of losing things as clinics, but at least it’s then the patient’s responsibility whether he or she has to fill out the same information over and over.

My second complaint supersedes the clinic and reviews cracks that appear systemically.

I have three regular prescription medications that I take. One of them apparently doesn’t come in the dose I need, so I have to cut pills in half. I have been doing this for years, but no one along the way seems aware of this. Not the medical clinic, not the pharmacy, and certainly not the insurance company, which — in my view of the world — ought not to have any say in what sort of medical care or medication is prescribed. In reality, it often seems like the insurers are the ones really telling everyone how their care is going to go.

Lately, without any explanation, the pharmacy at City Market has been filling that prescription in “three month” increments. Since I only take half a pill, it’s really a six-month supply, and I am not complaining about that.

The prescription I have the most trouble with requires a monthly refill. Lynn keeps urging me to sign up for our insurance’s on-line pharmacy service, where I could get a three-month supply, but that would require dealing with the medical clinic, and I never get around to it.

But now I’m going to have to do something, because the medical clinic threw a big ol’ wrench into the works yesterday.

If you call a prescription into the pharmacy too soon, the insurance company won’t let you refill it. So when I had about three days left, I called in my refill, only I didn’t have any refills left. So the pharmacy sent a refill request to the medical clinic. This should have happened Monday morning.

Not until Thursday did the medical clinic leave me a message saying I need to come in and see the nurse practitioner who won’t fill it until I do so. But even if I call right away, they will not get me in for a month.

I know this because this is what they did to me last year. And earlier this year they hounded — and I do mean hounded — Lynn about her annual “wellness check.” They left her three messages, then followed it up with a written threat: If you don’t make this appointment, you will be stricken from our records. Seriously? And of course they didn’t mean it, because they called a fourth time. And then when she did try to make an appointment, they couldn’t schedule it in the next month, and they don’t schedule more than a month out.

They have a lot of dumb damn systems at this clinic.

And I don’t want to go see this nurse practitioner. Two years ago I went for a wellness check with a doctor then fairly new to the practice. I wanted to talk to him about a potential new therapy for sleep apnea, but he was very focused on my need for a colonoscopy. I told him I’d had one, but I couldn’t remember how many years ago and of course it wasn’t in my record because they keep starting my record from scratch.

In the intervening year the apnea therapy company bankrupted, so it’s just as well he didn’t follow up like I wanted. It turned out he sort of did; he sent a prescription to a local company with no access to the therapy, and that company sat on the prescription for three months before contacting me to see what they should do with it. (Our health system is great, isn’t it?) He also said, as he was leaving the room, that I was “with him now,” and would be under his patient care.

So last year when they called to hound me about my annual wellness check, which they started in June but then told me I couldn’t schedule until August for insurance purposes, they said my appointment would be with the doctor. But when I got there, I saw the nurse practitioner.

Which I didn’t think I cared about, until I wanted to discuss my achy joints but she wanted to focus on sleep apnea. She ran through a list of options, every last one of which I have already tried, then wanted to know which one I wanted to try, then got very impatient while I was trying to decide if I wanted to go through any of those processes again. “I don’t have all day to spend with you,” she snapped. And maybe if I had asked for this assistance I would understand her impatience, and maybe if her clinic could keep its hand on a record longer than a year she could have seen what I had tried, but the appointment did not leave me inclined to want to use her services again.

So now I have to call the clinic and try to explain that I am out of medication; their appointment system sucks (I can be more politic than that, but that’s the implication); and I would rather see the physician’s assistant who may be the last holdover from Dr. Wolkov’s office. And if this is supposed to be my “wellness check,” I doubt the insurance company will allow it before August, possibly September. Plus, I went to the health fair in April (a record they should, in theory, have), so they can see I got the blood test the nurse practitioner is wanting, and my level is fine.

I’m not feeling the “care” in “health care” these days.