Tag Archives: receptionist

Feb 25 2014
16 Comments
Whine is Gluten-Free

Don’t waste my time! (On “patient autonomy” and health insurance)

If there’s one thing that makes my blood boil, it’s having my time wasted. I only have so much, and I waste enough of it myself that I really can’t afford to lose any to others’ incompetence.

Unfortunately, one of many frustrations that come with a chronic illness is wasted time. Managing celiac disease takes a fairly large toll on your time in the form of food research and preparation—though that’s, arguably, time valuably spent rather than wasted. Far more annoying, really, is dealing with doctors.

I, for example, have an HMO (health maintenance organization) insurance plan. The main difference between that and a PPO (preferred provider organization) plan is having to be referred by a primary care physician (PCP) in order to see a specialist. Even a specialist specializing in the chronic condition I will have for the rest of my life.

Researchers have actually felt the need—and gotten funding—to study the benefits of long-term follow-up care for celiac disease patients. Turns out (surprise!) it’s good for us. (See, e.g., this article in the Canada Journal of Gastroenterology.)

Judging from that, for the rest of my life, or at least the next few years, I should see a celiac disease specialist now and again. So can’t I just have a standing referral?

No.

Instead, before I can see my gastroenterologist to try to find out why I still feel crappy after over a year of being as carefully gluten-free as can be, I have to:

  1. call my PCP’s office
  2. wait on hold
  3. talk with a receptionist who seems determined not to understand what I’m asking for or help me to get it
  4. wait nearly a week for a return phone call
  5. follow up myself
  6. learn they need me to supply the doctor’s ID number (whether they were planning to ever, oh, call me for that information, or why they couldn’t ask me for it the first time I called, I do not know)
  7. tell them the ID number
  8. be advised to see my primary care doctor about whether I need to see the specialist
  9. snap that I have a chronic condition that my doctor already knows about
  10. feel bad for losing my temper
  11. agree to wait several days more for them to put through the referral
  12. and then and only then, finally, make the appointment with the specialist I already saw a year ago, who we all know I need to see.

I understand Oxford wants me to get referrals rather than run around willy-nilly to specialists and expect insurance to pay for it. They don’t trust me to know who to see, and why should they? Most people are idiots, and I haven’t proven to them that I’m not.

But wouldn’t it be nice if I could?

Look, I’ve been SAT tutoring for a while now, and if there’s one thing SAT tutoring will do, it’s turn everyone involved off of standardized tests. But some tests are necessary proving grounds or barriers to entry. No one wants people behind the wheel who haven’t passed a driving test, right?

So what if there were a test for basic medical common sense? Since “the prevailing ethical mantra in medicine” is supposedly patient autonomy (scoff), we could call it the PAT (Patient Autonomy Test). Those who passed could be trusted to refer themselves to specialists.

Insurance companies should be on board with this—after all, if I wind up needing to see a specialist, they lose money by making me see another doctor first to get the go-ahead. With the PAT, we all save money (and time).

Questions might include:

What kind of doctor should you see if you have a lifelong disease primarily affecting your gastrointestinal tract?

a) a gastroenterologist
b) a podiatrist
c) a cardiologist
d) none of the above

In your opinion, specialists and specialized medical tests and procedures are:

a) fun toys to enjoy at a whim
b) resources to turn to under specific, necessary circumstances
c) both

Are you:

a) a child
b) an adult capable of rational thought
c) a complete idiot
d) really struggling with these test questions

A quick reading comprehension portion on a passage describing recommended follow-up care for a specific condition could come next. And then a section on triangles, because—as my SAT students could tell you—that’s stuff we all really need to know.

bubbling an answer on standardized test with pencil

Don’t make any stray marks, now.
Photo © biologycorner | Flickr

What time wasters get your blood pressure up? And do you daydream about patient autonomy, too?

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May 03 2013
7 Comments
Biopseeing Is Believing

Stress Test

By now, I think just about everyone I know has shared this New Yorker comic with me:

david-sipress-it-s-a-simple-stress-test-i-do-your-blood-work-send-it-to-the-lab-and-nOkay, fine, it was only about five people, but I still find that significant. Of all the New Yorker comics that exist and of all the neurotic people that could jump to mind upon seeing them, this comic puts my friends and family in mind of me.

Fair.

Recently, I watched the movie Romantics Anonymous (Les émotifs anonymes) with a friend. (The movie is very sweet, and French, and available on Netflix, so if you’re into romances about socially anxious people and chocolate, check it out.) In it, a character claimed that the three most stressful situations in life are moving, weddings, and exams.

My friend wondered, “Are exams really that stressful?”

I said, “Maybe he means medical exams.”

She replied, “You would say that.”

Also fair.

Recently I underwent a new medical exam of my own, and alongside it my usual trio of Stressing, Obsessing, and Second-guessing (yes, that’s SOS for short).

In advance: I stressed over whether I was following the preparation diet properly. I went online the day before—never wise—and found prep instructions from other doctors that included instructions mine hadn’t, all of which it was too late to implement. I stressed over how my change in routine for the day of the test would affect me for the rest of the week. I stressed over getting another diagnosis. I stressed over not getting another diagnosis.

On the day of: I stressed about whether my doctor’s office was properly handling the referral and billing process for my insurance (with good reason, turns out). I stressed about whether I was blowing the right way into the breath tester thingamabob. I stressed about the fact that midway into the test the receptionist realized she’d overlooked a detail about my insurance.

Properly dealing with this detail, I learned, would involve time travel. I stressed about not knowing how to time travel.

For the rest of the week: I continued to stress about the insurance, making phone calls to two different doctor’s offices and to the insurance company and not knowing what to say once I got on the phone with any of them.

To one, I said, helplessly, “I feel like the middleman here; I don’t know what I’m talking about,” to which she replied, “You are the middleman. You’re the patient!” I also said, to the same receptionist, “I’m only twenty-three!” Poor thing, she had no idea she was in for an impromptu counseling session, but she handled it well. Maybe twenty-three isn’t that young, considering in some places and times I’d have several children by now and be managing a household. Be that as it may, it’s true: I had no idea what I was doing. And it was stressful.

When I got the results: I compared my chart to others online and stressed over whether my doctor had gotten the diagnosis right. Those graphs don’t look the same! I thought. The peaks aren’t right! I stressed about taking a potentially unnecessary antibiotic. I stressed about my insurance’s prescription coverage. I read studies, second-guessed my doctor’s choice of antibiotic, then worried that I wouldn’t hear back from the pharmaceutical company before the weekend to learn whether my new tablets were gluten-free.

Now: The test is over! All I have left to stress about is whether I’m taking my antibiotics with enough time before and after meals and between doses and with enough water and without lying down within the next 10 minutes—why is that?—and without forgetting a dose. I’ve woken up several mornings convinced I’d forgotten to take it the day before (no wonder I’m having nightmares).

Oh, and if all that’s not enough and I feel myself entering stress withdrawal, I can always stress about whether or not any of this will do me any good.

Or about how stressed I am.

Tell me how you deal with stress, and your thoughts on the top three most stressful situations in life. Do you too Stress, Obsess, and Second-guess?

If you’re looking for more on medical stress tests, the fine ladies behind Breaking Up With Captain Crunch and Sassy Celiac have both written hilariously about their colonoscopies—fun!

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Mar 12 2013
12 Comments
Breadcrumbs in the wilderness

Remember you are not the doctor.

Photo © Josh Clark | Flickr Creative Commons

Photo © Josh Clark | Flickr Creative Commons

Doctors’ receptionists have a tough job. They deal with stressed, unhappy, contagious people all day, and when they aren’t doing that, they file and photocopy paperwork, deal with ancient fax machines, and, I bet, put up with crap from the doctors. I’ve read that some offices don’t even provide their front-desk staff with internet access—which, to me, is practically a human rights violation. They probably get ill constantly from all the germs, and when they aren’t physically sick, they’re sick of their job.

Knowing this, I try not to be one of “those” patients. I’d say I’m pretty friendly, and I know I’m polite. In return, I hope for civility and, ideally, a bit of compassion. In my most recent medical experiences, I’ve encountered neither. My doctor never called me with my positive bloodwork results, and when I scheduled a follow-up, he and his staff forgot to check my results until I asked about them specifically. They were brusque and unapologetic and they sent me a duplicate copay bill.

When the time came to get my biopsy results, I didn’t want to go in and do it all over again (not to mention pay another copay or two). Instead, I tried to find everything out over the phone, and it got messy. In the end, the receptionist got fed up with me and said, “Remember, ma’am, you are not the doctor.”

This stuck with me, and not only because I found it funny that she called little ole 23-year-old me ma’am. It was also simply good advice. As I gear up for my first appointment with a brand-new doctor, I thought I’d share it. If you are a doctor, this may not apply to you. But otherwise:

Remember you are not the doctor.

Remember you do not have the doctor’s medical training, or credentials. Remember that to many, your understanding of your own health will never count. Remember you are presumed ignorant. Remember if you speculate or self-diagnose, you will be accused of hypochondria. Remember that not everything you’ve read or heard is true. Remember you may be biased, and remember fear can cloud your judgment.

But also: Remember it’s okay to be scared.

Remember to stay calm. Remember you care more about your health than anyone could who is paid to do so. Remember you have spent many recent hours researching your symptoms, and that if your doctor hasn’t kept up with latest research, you may in fact be better informed. Remember you are open to new ideas. Remember you do not have hundreds of other patients to keep track of. Remember you are focused. Remember you are the world’s leading expert on your own medical history and feelings.

Remember you are you.

Remember it is you, and not your doctor, who must live with whatever treatment—or lack of treatment—you’re prescribed. Remember you can seek a second opinion, or a third, or a tenth. Remember instinct counts for something, too. Remember it is easier for you to walk out on your doctor than for your doctor to walk out on you. Remember you’re worth more than a copay. Remember there are people rooting for you or relying on you to get well. Remember you are your own best advocate, but you are not your only advocate.

Remember you are loved.

Remember you are smart, and strong, and beautiful, and kind, and worthy, and interesting, and special, and whatever else you need to remind yourself of before you walk into the waiting room for your next appointment; but for God’s sake, remember you are not the doctor.

And remember you’re important anyway.

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Feb 22 2013
17 Comments
But seriously guys

The Week of the Nutter Butter

It was heartening to learn yesterday that not every doctor’s office gives out crackers after a celiac endoscopy. (There were also some less heartening doctor stories, but that’s pretty much par for the course—this is going to be another one, fair warning.) But the conversation raised another question for me: If you (or your kids) have been tested for celiac disease, did you eat gluten while you were waiting to hear the biopsy results?

Snide remarks about Keebler’s aside, I must admit—I did. While I waited for my results, I chowed on garlic naan; I slurped cookie dough pudding from Sunshine Happy Something-or-Other Bakery in Chinatown; I went to a dear friend’s apartment for dinner, where he served up mushroom-barley soup. (“It’s gluten-free!” he said. “Besides the barley?” I said. “…Oh,” he said.)

But, mostly, it was the week of the Nutter Butter.

I ate Nutter Butters almost every night of the week after my endoscopy before my diagnosis was confirmed (nine days, actually, not that I was counting). I’d get to the end of the day thinking, “Maybe I won’t do that again today,” and then I’d buy a pack anyway. The guy at the corner store came to recognize me and probably wonders where I’ve been lately. If I’d been more honest with myself at the start of that week, I could’ve bought one family-size package and done the whole thing much more cost-effectively. This may be pushing the limits of strange eating behaviors to which it’s okay to admit on the Internet, but on several of those nights I opened up the cookie sandwiches and spread them with jam. (Great with strawberry, and surprisingly good with fig.)

41283530-260x260-0-0_Nabisco+Nabisco+Nutter+Butter+Peanut+Pattie+10+5+O

I ate those things like I’d never be able to again—which, of course, I was correctly assuming would be the case. (Oh, sure, Pamela’s has a peanut butter cookie, and there are knockoff recipes all over the web, but if it’s not in the shape of a peanut and mass-produced it doesn’t count.) Do I even like Nutter Butters that much? I don’t know. It was a compulsion.

By Monday, going in to week two, I was ready to quit. I just needed to know I had celiac, wanted my doctor to get it over with and tell me to lay off the Nutter Butters. But Monday his receptionists put me off all day, so on Monday night I enjoyed my daily fix. This is the last time, I thought.

Tuesday morning, I called again, and hung up dejected at the response that my results still weren’t in. I spent the day playing phone tag with the two receptionists who took turns feeding me conflicting stories: “We’re waiting for a fax from the lab”; “We’re waiting for the doctor to get in and review the results”; “Oh, actually the lab still hasn’t sent them”; and, finally, “I have your results, and everything’s fine! You don’t have any bacteria in your stomach!” (Yeah.)

By that point, being told “Actually, everything’s fine” was not an option. What about my 97 (or 95, or 98, or 90, depending on what source you check) percent chance of having celiac disease based on my serology results? What about all the psyching up I’d been doing for the past few weeks? What about all those stupid Nutter Butters? I’d been eating them as a final hurrah! A farewell! And what the heck did bacteria have to do with anything?

I let myself get more and more frantic on the phone, thinking that would eventually get me my (real) results—which it did, when I strong-armed the receptionist into faxing me the results, found that they did indicate villous atrophy, and called back to demand another number at which to reach the doctor, who had by then left for the day (because I had “called too late”).

Even though I’d been sick for two and a half years and for much of that time accepted I’d just always be sick, suddenly the thought of spending even one more evening eating peanut butter sandwich cookies opened up a vast black maw above me. (An exaggeration? Fine, it was cloudy with a chance of Nutter Butters.) And whether I got my results that day or not, couldn’t I have just gone home and not eaten Nutter Butters? Couldn’t I have gone gluten-free at any time I wanted? Did I really need that harried 30-second phone call with my doctor to know, “You’re positive. Try to avoid wheat, rye, barley”?

Yeah, for whatever reason, I did. I needed certainty; I needed a real turning point; I needed closure. I’m pretty sure that without that lame conversation with my doctor, I would’ve gone home, bought my mediocre sandwich cookies, and steamrolled a few last villi. Then spent all of Wednesday trying not to let the same thing happen again. Funny how habits work, isn’t it?

Since receiving my diagnosis, I’m proud to say I haven’t (knowingly) eaten a single speck of gluten. And after a bit of a slump, the past few days I’ve even felt my cooking mojo stirring again. I’m looking forward to putting the finishing touches on my kitchen setup, feeling better, and eating well for life. Though it’s probably going to be a while before I try out a Nutter Butter imitation.

Tell me some of your food memories (fond or otherwise, -free or otherwise) in the comments! Do you miss Nutter Butters and or Oreos?

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