(this one’s long, you’ll need a good chunk of free time to get through all of this)
Sting had a great tune out years ago called “If I ever lose my faith in you” (lyrics at http://www.azlyrics.com/lyrics/sting/ifieverlosemyfaithinyou.html). In the song, he basically says he’s not going to lose sleep at night for losing faith in science, progress, the holy church, politicians, etc.
I think he needs to ammend the song to include the American HMO health care system.
Whoa, what’s that you say? Ian’s getting political? Is Ian in support of Gov. Arnold’s “universal health care” proposal for California? Well, I don’t support free health care at the expense of my taxes for people in California who also do not pay California taxes, but this isn’t about politics. Read on …
I’ve had an annoying symptom since I was a teenager, a postnasal drip that refuses to go away. I remember trying various OTC cold remedies trying to clear it up, and relief was always temporary. In college, I started getting bad headaches that never really went away either, they’d be pretty random occurences in terms of environment, whether or not I ate or what I ate, time of day, no pattern that I could discern whatsoever.
Skip ahead a little. A year ago when Elizabeth and I got married we discussed health care and whether it made sense to move our medical records from her Kaiser provider to my Blue Cross provider, or just stick with Kaiser and add me to her health care plan. In the end, it turned out to be a good move to move me to Kaiser since I left PriceGrabber this past spring.
So in November 2005, I called Kaiser and asked if they could please assign me a primary care physician (CPC), which they did. Good timing too ’cause I decided enough with the headaches, it’s time to see somebody about it. At this point, the frequency was up to about 3 headaches per week and one hit me so hard I had to stay home from work.
Except the first doctor I met at Kaiser wasn’t my assigned PCP, it was someone else. Okay, he’s busy, whatever, just help me. That doctor thought my headaches were due to a sinus infection, and gave me a nice strong antibiotic to kill it off. A week later my body decided it was allergic to that medication. I go back, meet *another* new doctor for the allergic reaction. Finish the allergy steroids, book a follow-up appointment, meet *another* new RNP who prescribed a preventative medication that has actually worked very well. It’s not foolproof, but Nortriptyline has been quite handy since I started taking it.
So I book another follow-up to address the sinus issue, meet *another* new doctor (for those keeping score, this is #4 since joining Kaiser, in 4 visits) and this doctor isn’t my PCP either. This one puts me on a nasal spray which choked me up in the middle of the night causing my poor wife to panic and race me to emergency ’cause I couldn’t stop coughing long enough to catch a breath. Emergency puts me on a steroid that claims to lower my immune system for up to a year and now if someone across the room coughs, I catch a cold or sniffles.
Obviously I stop taking the nasal spray, meet doctor #5 (also not my PCP) who puts me on a prescription-strength decongestant which after it ran out wasn’t refillable.
So after 5 doctors, I’ve had a chest x-ray, sinus x-ray, blood work, two urgent care visits, one emergency visit, and told I have sinusitis. No, a sinus infection. No, rhinitis. No, you’re just congested.
I decide enough is enough, I want an appointment with my PCP and log into Kaiser’s web site. The earliest date is 5 *weeks* away. I sit and be patient, I finally get to meet the guy, and he’s a very pleasant guy, but seems more intent on my willingness to drop a few pounds than the fact I’m there to discuss my migraines and sinus issues. He does a quick once-over, ponders whether the postnasal drip is allergy related, refers me to an allergist, walks out the door, and is almost never heard from (by me) again.
Just before leaving, I tell him I haven’t had a physical for over two years, so he tells me (and I quote almost directly), “Call and make an appointment for a full physical with me in early September.” I ask when I should call, since I just waited 5 weeks via the web site. He said he didn’t know when the system opened his September schedule (this was a Wednesday in late August, btw), and that I should call ‘tomorrow’ or ‘Friday’ or maybe the next Monday in case it opened up after the weekend.
So I go see the allergist right away who tells me the migrain preventative will mess up a skin allergy test, so they draw some blood, come back in a *month*, and in the meantime, here’s another sronger nasal spray and some Allegra to take in the meantime.
In the meantime, I call Kaiser 2-3 times every week to try to schedule a physical with my PCP. Every time I called I got the same response:
“Hi, Dr. So-and-So told me to call in and book a physical in early September.”
“His schedule isn’t open yet, you’ll have to call back.”
“When should I call back? Do you know when his schedule opens?”
“No, we don’t know when it opens, only he would know that.”
“But he told me himself he didn’t know when it opened, how am I supposed to book my appointment?”
“Sorry, we don’t know his schedule, all we can see is that you can’t book a physical because his schedule’s not open yet. Maybe try again in a few days.”
Rinse and repeat. Finally I kinda get angry…
“Look, my doctor told me explicitly to book a physical with him, and it’s now getting close to the *end* of September. Do you think his September schedule going to open up before September is actually over?”
“Sir, do you want to just book it with an RNP (Registered Nurse Practitioner)”
“YES, good Lord YES, I’ve been trying to book this appointment for almost a month.”
So I schedule to meet “doctor” #6, and rush in the next day to get blood work done because Kaiser says it takes a week to get the results in the system. I give two small vials of blood, and within 48 hours had all of my test results on their web site. The prognosis: overall, pretty normal, exactly mid-point for most things, my good cholestrol is a little low, my ‘bad’ cholestrol is a little high, but overall, my cholesterol is 208 and they like it under 200, so not so bad. What it *does* show, which they highlighted in purple on the letter they mailed, was that my liver results are kinda crappy, could be having some liver trouble. The footnote at the bottom of the letter is from my PCP says something like “Call in October to book an appointment with me in October to discuss your migraines and liver, and we’ll consider medications.”
Now, I know enough about biology to know my liver filters my blood. Nutrients come outta my food, and go through my liver. Medications I take get filtered through my liver. Etc. So I’ve been on at least 6 different prescription medications this year, plus an occasional Advil if a migraine sneaks past the nortriptyline. No wonder my liver is jacked up, and now my PCP wants to prescribe MORE medication to treat my liver trouble?!
Doctor #6 performs the “turn your head and cough”, and then has me go get more blood to figure out what’s going on with my liver and tells me they want to do an ultrasound (I hope it’s a boy) to see what’s going on.
So a full month has gone by, my the allergist tells me that I have no allergies, and doesn’t believe my migraines are triggered by allergies. Funny, my allergist in Ottawa said in late 1999 that I indeed had allergies to dust mites, mould spores, and feathers. But after this allergist tells me I don’t have allergies, gives me a catalog of products aimed at people with environmental allergies such as matress covers, pillow covers, vent covers, air purifiers, etc.
I’m sitting there, staring at her truly dumbfounded, and finally ask why on earth she’s recommending (pushing) that I spend money to get all this junk if I don’t have any allergies. I tell her about my allergist in Ottawa who said I *did* have allergies — I watched the skin test in Ottawa, my arm reacted to all kinds of stuff including pollen, cat and dog fur, smoke, etc, yet this allergist is telling me my blood scored 0’s on all of that. (and I most certainly DO react around dust and feathers, not to mention smoke)
The allergist’s response was a stammered “Well, um, uh … just because your blood doesn’t show antibodies doesn’t mean it can’t be an *irritant*, which is different than being an *allergen*…” Make up your mind lady.
As an aside, I ask if her test included checking for an allergy to feathers because my wife loves her feather pillow and I felt like a tool ’cause she felt guilty enough to throw it in the trash last weekend. She starts listing off a dozen kinds of feathers they could test me for if I really wanted to go get a skin test done right now. I declined. I couldn’t wait to get out of her office.
So we come full-circle back to doctor #1 – the allergist also thinks I have an infection of some kind causing the postnasal drip, prescribes a nice strong antibiotic, which includes such side effects as headaches, nausea, oh, and LIVER DAMAGE.
Dude, seriously, I’ve lost my faith in American health care. Kaiser keeps talking about how wonderful they are, and I’ve read reports about their networking and IT for client records, yadda yadda, yet in the course of 9 months, I’ve met 7 doctors and 1 quack allergist who can’t agree on what’s wrong with me.
In the end, I have migraines which may or may not be triggered by infections and/or chronic sinusitis/rhinitis and/or allergies.