BLOOD PRESSURE RISING

WARNING: RANT AHEAD

A few weeks ago I tried to get a refill on a prescription for my low dose blood pressure medicine, but my request to my mail order pharmacy had been ignored when I was on vacation.  I returned home early this month and tried again, and finally heard from my (newish) doctor that he would refill it but I had to come in for a recheck on BP and labs.  OK, fine.  Made the appointment and went in.

First the nurse confessed there was a screw up along the line and my meds should have had a whole year of renewals instead of none.  Uh-huh.  Agree.  Then as she reviewed my med list she rattled off a bunch of supplements I had been taking but at my last visit the doc told me to stop some of them.  Guess they had not made that note in the electronic records (which were supposed to make things oh so much easier!)  When I told her he took me off them, she sort of rolled her eyes and said she still takes the supplements she wants to; she tries never to go to the doctor; her supplements are her business, etc etc.  Hmmm...team approach to health care?  When I laughed and said I would follow her advice, she did try to backtrack, but the damage was done.  Nurse undermining doc -- noted.

Then the doc came in and immediately after saying hi, without taking a breath, started telling me about his recent trip to NYC.  He went on and on about this and that person, event, meal, site, death in family, family birthday, Uber experience, income inequality in NYC, tips for being safe on the street, price of restaurants, gentrification of Brooklyn and his dislike of Queens ....  Interspersed was some minimal attention paid to why I was there, but really I learned MUCH more about his life than he about mine.

He reviewed the lab results and I think he was ready to leave me on the lower BP med dosage, in spite of my numbers being intermittently a little high and also seemed to want to ignore my rising cholesterol numbers since going off the previously prescribed statin from which I had some minor side effects.  He also said those labs shouldn't really have been done yet, since he'd need to repeat them in a few months, but he was out of town and, well, someone approved them.

I was actually glad we had the labs because with the new results I insisted he take the numbers seriously.   I have a family history of cardiac disease and vascular dementia/stroke and I want to be well-controlled, not borderline.  He said OK, but not to worry about dementia because most people don't get it and all you have to do is challenge your brain with new learning which is why he is learning French and then he showed me he has the French version of Harry Potter on his Kindle.  Sigh.

What I think should have been a 15 minute visit strung out to 40, but there was the value added travelogue and brain exercise tip, so no complaints.  And I got a good laugh out of the whole experience.  (Also, after two visits with this guy I'm looking yet again for a new doctor.)

Since that appointment last Friday I've waited for an email from the pharmacy to let me know my meds were on the way....thinking he'd called them into my mail order place.  No word yet, so today I went online to check.  No orders pending.  Then I thought maybe he called them into the local pharmacy so I called them.  Sure enough they had his order.  I asked why I hadn't received a call from them.

The tech on the phone said, "We didn't fill the orders because we didn't know if you wanted us to."  What?!?  Of course I wanted them to fill my prescription.  She said they often just wait to hear from the patient.  I was so confused, I let it go, telling her to fill them asap!

But the more I thought about it, the madder I got.  What the hell?  I called back for an explanation of the delay and the protocol for filling prescriptions.  A new tech told me they often get orders from docs that people do not intend to fill at that pharmacy if the patient isn't already in their system.  They don't have the staff or stock of medicines to fill orders that will never be picked up.  So they just hold the order until the patient calls in...eventually...as I did.

I let her know I've been using that pharmacy for 30 years on and off and I definitely should be in the system.  Turns out they were recently sold to another outfit and my information was there, but "old".

I fell into the category of "don't do anything until the desperate and/or irate patient figures out we aren't filling their prescription."  "We will go ahead only when the patient calls from their deathbed  due to untreated this or that because BY GOD WE, THE PHARMACY,  WILL NOT TAKE 2 MINUTES TO CALL AND GET THE PATIENT'S OK TO FILL A PRESCRIPTION CALLED IN BY THEIR PHYSICIAN!"

I do not have dementia (no foreign language study notwithstanding) and I speak English; I have a college education and fair degree of confidence in dealing with authority figures.  And I know how to navigate an infuriating health care system (with persistence).  What of those who have any number of difficulties that preclude figuring all this out?!?  I sort of ranted to the pharmacy tech that I hear loudly and clearly that it is obviously the patient's responsibility to coordinate their health care needs among all the various entities involved.  She basically agreed, but assured me I'm now current in their system.

I simply cannot fathom trying to negotiate all of this as a person who is critically ill, disabled, alone, hearing or vision impaired, mentally ill, maybe with a touch of dementia, whatever....  You have to be the picture of health to get appropriate health care!   And I'm not dealing with some back country mom and pop GP office.  This is the largest multi-specialty clinic in the region, with the ridiculous marketing slogan, "We're Here for Your Health".  Are you?  Are you really?

At least, that's the view from here...©

RATS IN THE MAZE OF MODERN MEDICINE

AAAARRRRRGGGGGHHHHH!  That's me screaming in frustration.

Backstory:  The local multi-specialty medical clinic here was, until a couple of years ago, physician-owned and operated, founded by a handful of doctors in 1924.  When my husband joined the clinic in 1982, there were 33 doctors (one female!)  He went through a round of interviews, two of which included me.  These were social events, but I was aware that we were being evaluated as to whether we'd be a good "fit".  For my part, I was asked if I was sure I wanted to move so far from my midwest home and family -- they didn't want the little wifey to get homesick and demand to move back home to Illinois.  I told them we were looking forward to our new life in Washington.  Assured that he wouldn't flake out and quit, Hub was hired.  The docs in those days committed their entire careers to the clinic.

The clinic has grown tremendously since those early days and now has 500 care providers and 2,000 staff members and dozens of satellite clinics in outlying communities.  My daughter-in-law manages one of them and got the position all on her own!  No nepotism!

In 2016 the Board made the controversial decision to "merge" (which was a sneaky way of saying "sell") to a larger corporate outfit.  Big payouts went to some shareholders, to the consternation of others (us), and many took their wad of cash and quit or retired; everyone was in a state of flux.  No  one knew what to expect of the new bosses.

Well, the new bosses got in over their heads, grew disillusioned with their purchase and now have sold the clinic again!  The new new corporate bosses will come on board within the next year.  So the place is still in a state of flux.  Doctors are bailing left and right because they are overworked and understaffed and the bean counters want them to work harder for longer hours.  Support staff, as well, never know what the new decree from on high will be.

And patients, like me, are being jerked around!  Let's just establish that I admit to being bitter about this whole debacle because of my constant loyalty to and belief in the excellence of this clinic and it's doctors for the 25+ years Hub worked there.  To see it struggle now and to find myself a victim of the transition and the business (not the quality of care) of medicine is aggravating.

I had an excellent primary care physician for a number of years.  I loved her.  We got along great. But she decided to close her practice in 2014 and work in a different medical model (which is really cool and how all medicine should be practiced!)  I went to another doctor the following year and that did not go well.  She treated me like a warm body passing through the exam room, focused primarily on that stupid Medicare questionnaire about whether I've fallen lately and do I eat enough vegetables, etc.  She ignored what was important to me, brushed off my questions, and didn't order any routine labs.  Nope!  Not going back.

So I looked for another doc and found a woman who was sort of great. She helped me through a number of issues and I had a good rapport with her.  Whew!  I was relieved to find a new doctor I could rely upon.  Nope.  She quit.

I was "assigned" a doctor at that point, a man.  I hadn't had a male doctor in decades, but I was a bit worn down and decided just to check him out.  I liked him.  He was friendly and funny and listened to me and we were on the same page about being partners in my care.  I was happy.  I saw him a couple of times....before he quit.

Before leaving he referred me to a woman in the department, an Advanced Registered Nurse Practitioner (ARNP), who are being utilized more and more to "extend physician access".  Basically you don't have a doc, you have a Nurse Practitioner, who are also skilled primary care providers.  Anyway, he said she would be a great fit for me.  She was interested in a holistic approach to health care and would be open to me pursuing my interest a healthy lifestyle rather than taking medications.  I made an appointment in May to see her in August for my first visit with her.

I got a call last week confirming my August 13 appointment.  Then I got a call on Monday telling me she had to reschedule my appointment.  I was annoyed, because my last three doctor visits have been rescheduled due to the doctor needing to change the appointment.  This was becoming a trend.  But oh well.  OK.  I called back to reschedule and the gal in the Resource Center (nowhere near the doctor's office, in a separate building 3 miles away!) told me my new provider was leaving the clinic in September which was why she was cancelling and rescheduling some appointments.

My initial response was to laugh maniacally, I'm sure startling the gal on the phone.  "You've got to be kidding me!" I said.  "I've had 4 primary care providers in 4 years and I haven't even seen this one yet!"  I felt myself becoming angry, then sad, then discounted....I started crying as I talked, then sobbing.  Geez,  I could just imagine this poor young woman putting Behavioral Health on speed dial as she tried to help me with this dilemma.

I quickly calmed down and told her I knew a doc I wanted to see at an outlying clinic 20 minutes from my home, which frustrated me because I live 3 minutes from the main campus but it appears there are NO doctors there!  Whatever.  She checked and then told me the doc I wanted was no longer accepting patients.  I burst into tears again, ranting that I could have gotten in to his practice had I not wasted my time waiting to see the ARNP who had the gall to freaking quit on me!  I assured her several times this was not aimed at her and I was sorry for my reaction and I thanked her for her help.  Still, I hung up without an appointment with anyone.  But just before our goodbye, the gal in the Resource Center whispered, "Bless you."  So I guess I scared her into thinking I was a helpless lunatic.

An hour later I got a voicemail from the clinic from a nurse in the ARNP's office telling me I should have my labs done prior to my appointment on 8/13.  WHAT????  I thought they just told me I had NO appointment!  I called back and after 13 minutes on hold finally talked to the Medical Assistant in the office who confirmed the ARNP is leaving the clinic but she would still see me once and that my appointment shouldn't have been cancelled after all.  NO!  Why would I establish care with a provider who has one foot and half her brain out the door, only to have to establish with another doctor in short order?  The MA agreed this made no sense.  She recommended a few other providers, but I hung up with no appointment.  I have research to do and a letter to write to the CEO and Board President of the clinic.

I'm grateful to be healthy, able to navigate this craziness to some degree, articulate enough and savvy enough to know what I want and have some idea how to get it, but still I feel ultimately at the mercy of a system that no longer treats patients with the respect and care we deserve.  I'm sick of being a "customer" and paid the lip service of being their "#1 Priority"when the reality is anything but.  I'm sad for the many, many people who don't have the confidence, the courage, or the inside info I have to advocate for themselves.  I'm sad for those truly ill, confused, and those with hearing issues who likely can't navigate the six automated options offered every time you call the freaking doctor with a simple question!

We come to health care providers in a vulnerable state.  Our very lives are at stake.  We share with them the most intimate details of our physical and emotional selves.  Being shoved around like rats in a maze, expected to adjust to a new system (devoid of friendly faces now that check-in is completely automated and no receptionist is in sight!), and then expected to accept any care provider who happens to have an opening at any given time  (and who barely look up from their computers and are loathe to see us unclothed or have to touch us) is disrespectful and dismissive.

I guess I'm old enough now to compare this experience to the "good old days" and I hate that stereotype of being stuck in the past.  I'm all for change and modernization and generally welcome it, but in some cases we got it right back then.

At least, that's the view from here...©

Photo Credit:  www.pixabay.com

https://www.nbcnews.com/business/business-news/doctor-out-why-physicians-are-leaving-their-practices-pursue-other-n900921?cid=sm_npd_nn_fb_ma

ADDENDUM TO THAT SUCKY POST

OK.  Yes, my post yesterday was a bummer.  I am tempted to take it down.  But not gonna cuz I still think connections get made when we tell the truth.  And that was/is my truth.

But today, things are looking up!  I went to my doctor appointment this afternoon, an Internist I've never met who is relatively new to the clinic I go to.  Mentioning this upcoming appointment to some friends over breakfast last Friday we traded stories about how we of a certain age have begun to feel ignored and dismissed, with providers spending the minimum time with us, on things only marginaly related to our actual ailments (that social welfare checklist and to resuscitate or not) and often rudely at that.  I decided, "Nope!  Not gonna happen again!"

I sat down early this morning and wrote a three page letter to this new doctor introducing myself, my expectations of our health care partnership, listing the things I wanted to address at our appointment and my preferences around health care philosophy.  I was clear, concise, assertive, friendly, funny.  I hand-delivered it 3 hours prior to my appointment with only about a 10% expectation that she'd get it and read it before I was sitting in the exam room.

Turns out she got it AND read it AND genuinely appreciated it!  We were able to zero in quickly on both my physical and mental health issues and create TOGETHER a plan that has me jazzed and hopeful!

My physical issues are real, not emergent, and most importantly not my fault.  I have hereditary factors that are causing some cardiovascular risk factors to creep up with age and I have agreed to a medication that will help mitigate these.  My mental health issues are real and not my fault -- again heredity plays a role when we sat and reviewed family history, going back a couple of generations.  I am not going on meds, but will seek a therapist who specializes in Mindfulness Cognitive Therapies for anxiety and depression.  There is a plan!  Yay!   Feeling hopeful.

Other observations:  Apparently is it no longer necessary for a doctor to actually touch one's body.  At my last two doctor visits I did not disrobe.  My doctors did not touch me or look at my naked body or even pay much attention to listening to my heart.  Blood pressure and pulse, that's it.  Alive and upright?  She's fine!

This is surprising to me, but good news in one way.  I sort of dress up to go to the doctor -- a throwback to a different age, apparently, as I looked around the waiting room at the sweat pants, dirty jeans, team jerseys, and scuffed, dirty, weird footwear.  I take a shower, do my hair, smear on some make-up and put on nice clothes.  This has often felt like a wasted effort since in the olden days the first thing we were asked to do was to don a gown.  But today, my doc and I got to discuss fashion and my cute jacket.  It was sort of a "Hey, girlfriend!  Lookin' good!  How ya feelin'?" exam.

Whatever....I feel better.   And this whole therapy thing is likely to be great blog fodder!

At least, that's the view from here... ©