Modern Medicine Woes

Modern medicine, including robotic surgery, antibiotics, immunotherapy, vaccines, CT scans, is great. But the practice of modern medicine leaves something to be desired.

How today’s doctors diagnose

About six months ago, pain began in my upper left leg and left hip. I’ve been procrastinating seeking medical help. Why? One, it’s hard to get an appointment. And two, when you finally do, most likely the doctor can’t give you an immediate diagnosis. First, an X-ray is ordered. If the X-ray shows arthritis, these four options are offered:

• Pain medication for 10-14 days (opiods)
• Cortisone shot (may or may not work)
• Physical therapy
• Surgery (if all else fails)

If, after the X-ray, the doctor still can’t pin down what you have, an MRI might be ordered. That means being stuck in a noisy, uncomfortable tube for 30-40 minutes. After all that, maybe, or maybe not, the radiologist will make a diagnosis.

The modern way to seek medical help

I gave up procrastinating at the beginning of August. Who was I kidding? Being in pain is no way to live. There were two options. One, get an appointment with the “hip doctor” at the large orthopedic practice two miles from home, or two, see my primary care doctor, whose office is 10 miles away. I’ve had three appointments with the orthopedic doctors in the past nine months (neck, knee and thumb). Maybe it was time for the primary care doctor to weigh in.

Most large physician groups are owned by hospitals or for-profit companies. Modern medicine is about seeing many patients in as short a time as possible and then billing the insurance company. Somebody has to pay for the fancy, high-rent office space and/or the latest high-tech diagnostic devices. It’s not going to be the doctor; it’s going to be you, the patient.

Speaking to a human being in a large practice is a thing of the past. Have a question for the doctor? Need to refill a prescription? Want to make an appointment? Use the portal!

Different doctors’ groups have different portals, unless your primary care doctor and specialists are affiliated with the same hospital (such as Hopkins, Mercy or the University of Maryland). Some portals are use-friendly, others not so much. And all of them have a disclaimer that goes somewhat like this: “Your message and/or request might take up to three working days to answer. If this a medical emergency, call 911.”

I bit the bullet and went on my primary care doctor’s portal to make an appointment. Not surprisingly, the first available appointment was more than six weeks away. I grabbed it anyway, but then wrote a message on the portal telling the staff why I needed to be seen. Surprisingly, 10 minutes later, the phone rang. A lady from the office (receptionist? scheduler? medical assistant?) amazingly offered me a next-day appointment with the nurse practitioner. “I’ll take it!” I said.

The modern check-in process

Approximately 30 minutes after making the appointment, I received an email from the office asking me to go into the portal. There, I could complete the “pre-check.” This wasn’t difficult; it involved confirming name, date of birth, address and insurance.

At the end, a message popped up that I was checked in. I received a QR code to scan at the office kiosk the next day. That’s how they would know I was waiting to be seen.

As requested, I arrived 15 minutes early for my 3:00 p.m. appointment. It was time then to face the dreaded kiosk. Just like portals, all kiosks are not the same.

This one stumped me. There were no directions on how and where to scan the QR code. With no receptionists in sight (they are hidden away, far down the hall), I tapped the kiosk screen to begin the check-in process all over again. That meant inputting the same information done at home yesterday. This part wasn’t so bad. However, the killer was getting the machine to copy my insurance cards. I had no idea how to do that. All this time being attacked with darting eyes and nasty looks by those behind me.

I fumbled around for a while and then noticed a square opening, down below in the front of the machine. This is where the cards were supposed to go. What wasn’t clear was that they had to be placed all the way inside the opening, on a glass surface, face down so a camera could take a picture. The only instruction on the kiosk screen was to repeat the above for the back of the card. With a Medicare card and a supplemental insurance card, the machine had to take four pictures. There were no signs telling anyone what to do.

Hooray! Finally, the message on the kiosk read, “You are checked in!” It was now time to take a seat and wait for my name to be called. They knew I was here!

Waiting

I waited and waited and waited, watching patients who came after me being called back. Twice I asked two medical assistants, who popped their heads out, why the wait was so long. Both said they’d check for me, but they never did. By 3:30 p.m., having been at the office for 45 minutes, it was time to get an answer. Somebody knew I was here.

As mentioned above, personnel who might be receptionists sit behind a plexiglass counter, far away from the waiting room. They don’t appear to be busy. Who knows what they do? They certainly don’t interact with the waiting patients. I walked up to the first one and asked nicely – you catch more flies with honey than vinegar – why the wait was so long.

“Oh, the nurse practitioner is running late.”

I replied, “Do you know how much longer I have to wait?”

She picked up a phone and maybe pressed a button (you can’t see much behind the counter) but immediately hung up. “I don’t know. Do you want to reschedule?”

“No,” I said, sighing. “I’ll wait 15 more minutes.” She smiled and shrugged apologetically.

Fifteen minutes came and went. I approached her again and told her I had to leave. She was polite and said not to worry, she’d make a note that I left. Stupid me did not ask her for her name.

What happened to the customer is always right?

The next day I received an email from the practice. A message was waiting for me on the portal. It was a form letter from the nurse practitioner, admonishing (i.e., scolding) me for not showing up for my appointment. “Patients need to give the office 24 hours’ notice if they intend to cancel!”

Drat! Why didn’t I ask that lady for her name? I did, however, write a detailed message back explaining exactly what had happened: The kiosk gave me a “you are checked in” message, I asked two staff members for help, and lastly, told the lady behind the counter I had to leave. She said it was okay. While I didn’t know her name, I was able to describe her (nose piercing, curly hair, African American, tall and thin).

A reply came back saying my message would be passed on to the office manager. I heard nothing after that.

The end of the story?

Maybe I should have gone to the orthopedist. The appointments are usually no more than two weeks out. Making an appointment on the computer is easy for non-techie people. Yes, there will be an online appointment check-in the day before, and the inevitable kiosk in the office. But the receptionists (who have nothing to do since the patient does it all) sit right there.

Addendum

One day after this incident, I made an appointment with the orthopedist. Of course, I waited at least 20 minutes to be called back. After speaking with the medical assistant in the exam room, X-rays were taken. Twenty-five minutes later, the doctor finally came in. And wouldn’t you know, he prescribed pain meds and told me to come back in six weeks.

The end?

Please leave your comments below.

Read more by Eileen Creeger.