Monday, October 13, 2014

When They Say It'll Be Simple...

Don't be too quick to believe them. Especially when they're just sending along second-hand information.

Take a piece of medical advice I received as an example. I need my coagulation levels checked, now that I'm finally conceding I need to be on a blood thinner. We're still juggling the dosages, trying to find the level that prevents a clotting stroke during some future A-fib episode, without allowing me to bleed out in case of an accident.

Moving in the middle of the start-up process is a complicating factor. I needed to find a new lab in a new state without any actual medical referrals from my former clinic personnel. They don't know who practices in Arizona, who's good or not. They have no connections.

What they do have is other patients who've turned snowbird, needing the same kind of follow-up medically. Those other patients have successfully located labs to do the testing, sending the info back to the Minnesota staff for feedback on medication levels to maintain the proper coagulation levels.

Therefore, it must be simple.  Right?

First, there's finding the right kind of lab. I wanted something associated with the local hospital, keeping travel simple, along with maybe establishing a medical relationship with someone with local admitting privileges. I started with the hospital's administration office.

 Is it too much to ask that somebody might actually know what I was talking about? Much less know how I might go about learning what the area choices may be? They did finally refer me to a clinic several miles away who couldn't figure out what I needed but would be happy to accept me as a new paying patient. Ummm... no.

 Start again.

There are medical referral systems down here. You can look them up in the phone book, after, of course, trying in vain to find the exact specialty needed in the lists of doctors and clinics names. I go way back to when Yellow Pages listed doctors both by specialty in one list and by locality in another. All my local phone book offered was an alphabetical list, leaving me to try to figure out who was local as opposed to 40 miles away, and who would know what I needed.

Having given up on getting anybody who understood the term "coumadin clinic", I figured I could at least ask for a local cardiologist, thinking their staff should know how to locate a lab. They did. It was there, right in their office. And did I want to establish a medical relationship with one of their cardiologists, so I'd have one locally who knew me and my history should something happen?

Well, yes, in the near future. But right now I just needed a finger prick test done (more of a stab, actually), resulting in a number ideally between 2.0 and 3.0 that could be faxed back to Minnesota as per the "snowbird letter" my clinic sends south with its patients, allowing them to contact me with their recommendation for any dosage changes and how soon the next test needed to be done. Besides, my bills from previous work, accumulating after Medicare paid their bit, were become discouraging. If my heart would behave, my budget could get a break. Then let's talk.

Apparently they heard only the "yes" part. A letter was sent out requesting four pages of medical history, to be filled out and brought to my appointment this morning. Fine, I could do that, but the more blanks I filled in, the more I wondered just what all they figured on charging me with once I arrived.

Deciding to clarify that with the receptionist when I checked in, I caused a minor back-up at the window while she checked with other staff to see if they could do that little wee thing for me. Oh, and the copier was just fixed leaving a backup of copying to be done so she needed my Medicare card for a while so they could copy it. (Note to self: don't forget to get it back!) I finally requested to sit down while that was straightened out, incidentally allowing the next 7 people to check in.

When I was called back, we went through weighing, BP check, and the nurse was going to have me undress and put on the paper gown before I got it through to her just what I was actually there for. Now she too had to leave to see if my miniscule request could be granted. After all, silly me, coumadin clinics were only held on Tuesdays and Wednesdays. My inconvenient appointment was set for a Monday. While she checked, I should sit and the Doctor would be in to talk with me shortly.

His first question to me was whether anybody had ever talked to me about a surgical solution to my A-fib.

Really. I'm in for a simple blood test. You start talking surgery. Already I'm starting to have issues with this guy. Not getting enough money from the procedure. fella? He continues, pushing my need to establish a medical relationship with a local cardiologist in case... etc. etc. I'm liking my 50 mile commute to Fairview Southdale back in Minnesota more and more as this guy talks. Eventually, however, he decides to respect my declining another EKG, opting for a simple stethescope listen to prove to himself whether or not I can actually feel for myself when I get a flutter.

I almost think he was disappointed to detect normal sinus rhythm.

For the record, once I was finally down here, stresses removed, sleep schedule not ruled by alarm clocks, tasks accomplished by convenience and momentary need versus arbitrary schedules, there has not been a single flutter nor A-fib episode. Not a one. And leading up to the move, they had become a fairly regular part of my daily life. I hadn't realized they were gone until I started thinking about this appointment.

He also took my BP while I was in his exam room. The nurse who took it several minutes earlier got 110 / 70, my normal on medication. He got 160 / 110. I'm thinking he pissed me off. Or maybe she's just better at taking it accurately.

Finally he got me set up for the test, with a last offer to experience more care from him before turning me back over to my nurse.

The major inconvenience I caused by showing up on a Monday involved turning on a room light, getting out the test meter, inserting a test strip, getting out an alcohol wipe, setting up the "stab", squeezing a drop of blood on the strip, and reading the resulting number about 30 seconds later (2.5), then offering me a cotton ball to hold against my finger until the bleeding stopped,  and throwing away the stabber and test strip. A number was entered on a piece of paper, and they prepared to fax it to the Minnesota clinic.

That last paragraph is the usual routine for this test. In Minnesota they also offer a bandaid. It is simple. It should have been simple down here. I understand the expectations that getting tested down here would be simple.

Except that it wasn't.

No comments: