Really… ours the best health care system in the world?

By Weekly Archive On Mar 24, 2011

Al’s Loupe

By Alvaro F. Fernandez
alvaro@progreso-weekly.com

“I will remember that there is art to medicine … and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. … I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being…”

— Excerpted from the modern version of the Hippocratic Oath

Our system of health care does NOT operate humanely. That is if we are to still believe in the Hippocratic Oath.

For me, events of the last month have crystallized this. Let me tell you as briefly as possible the story of my life since February 25 of this year. On that Friday, I had a colonoscopy performed. It was a simple case of preventive medicine. Results were good, I was told. Strangely, the following day, Saturday, at about 2:30 in the afternoon, alone in my home, I had to lay down in bed. I had a pain in my side. Back pain, I told myself. For a few minutes it became excruciating, but in 45 minutes it was gone. I went on with my life.

At approximately 2 a.m. on March 8, about nine days later, the same terrible pain woke me. It became worse as minutes slowly dragged on. I did not know whether to sit or lay down, walk or stand on my head. I wanted to cry, but didn’t. I screamed, but nobody heard me. The scream did not offer comfort. At about 4:30, I desperately looked through my medicine cabinet and found pain-killers that had been prescribed for an ear ache. I took a pill. It relaxed me, allowed me to sleep for about 90 minutes.

At 9 a.m. I called the doctor who had performed the colonoscopy. He ordered me to the Aventura Hospital emergency room. After almost a full day spent there, and after numerous tests and procedures, I was told I had kidney stones. Oh great, I thought! I had never had kidney stones, but had always feared them. I’d heard the stories of the pain they can produce.

The doctor prescribed medicine and sent me home. I was told to see a urologist. And the next phase of this terrible adventure began.

I called the HMO I belong to and was told to call my primary doctor, who was the one who needed to call them. OK… I called my doctor. His nurse informed me she couldn’t refer me until they’d seen me. I told them of my day spent at Aventura. Still, she said, we need to see you or the insurance company won’t OK the referral.

The following day I was at the doctor’s office. Yes, he said, I had kidney stones and needed to see a urologist. He then ordered the nurse to proceed with the referral. Just as a reminder, to my reader, we’re now on Wednesday. Time proceeding does not mean my pain has subsided. It comes and goes, but it hurts – like hell! In the meantime, the nurse, busy with a million other things and forgetting that a patient may be in pain, does not fax the referral until Friday, late in the afternoon. In other words, the insurance company will not be getting to it until Monday.

That weekend I am more or less making due with pain-killers. That is until Sunday. In the middle of the afternoon the pain is becoming worse and no pill can do anything for me. I call friends and at about 5 in the afternoon I am taken to the emergency room at Mt. Sinai in Miami Beach. While I wait to see a doctor I start sweating and freezing at the same time. The pain is that great. For the first time in my life I think of running unto the middle of the street and letting a car, a truck an ambulance pass over me, rid me of my pain. It is that bad. Thank god for friends who sit by you, suffer with you.

I tell the emergency room doctor my story and the first question out of her mouth is, “Why haven’t you seen a urologist?” I shrug my shoulder and remind her that it’s the insurance company who decides my medical fate, not the doctors. She shoots me up with morphine, writes a new prescription of pain-killers and sends me home. “You’ve got to see a urologist,” she says. No kidding, I tell myself.

The morphine is good until about 1:30 in the morning; it’s now Monday. I take another pill. An hour, 90 minutes later, I start to relax, again. Then I sleep. Maybe till 6 or 6:30. After 9, I’m on the phone to my insurance company. I am pleading, almost in tears, and definitely in pain. Please, I say, I need a referral to see a urologist. I tell her of my episodes dealing with the pain. My two visits to emergency rooms. She passes me on to a higher authority (I think). Then the bureaucracy kicks in to a higher gear. She says, “We received your referral on Friday afternoon. We just got to it today. We have the right to spend 24 to 72 hours investigating your case. We must first be assured that this is not a pre-existing condition…”

A pre-existing condition? Lady, I have never had stones, I tell her. Still, if I had, don’t you care that I am suffering, greatly, now for a full week? Her retort shocks me. “You should have read your contract more carefully…” she tells me. I start to argue and she hangs up on me. For the first time during this whole ordeal, I am at a loss for words.

A good friend, a doctor, comes to my rescue. She works the phones and on Tuesday I get a call from my primary physician’s office. The nurse who calls almost sounds mad at me, and tells me I have been referred to a urologist, a Dr. Tirado. I am so happy I write down the telephone number and call his office.

Then the world seems to cave in — again. The earliest he can see me is March 31. I explain my situation. I beg. I plead. They move it up to the 24^th. Remember, it is then March 15.

I call my insurance company and tell them what’s happened. I insist that there has to be more than one urologist in Miami who accepts my insurance. Flustered and bothered, the lady gives me a list of four or five names of urologists. She then tells me to call them and see what I can arrange. On the third call, a doctor’s receptionist feels compassion and tells me to show up the following day at 8 a.m. She’ll get me in to see the doctor.

But I am back to square one. I call my insurance company and tell them of the doctor who’ll see me tomorrow. The lady tells me to call my primary and have them call the insurance company. I do so. But the nurse at the doctor’s office tells me my insurance company has told her that Dr. Tirado is the only urologist authorized to see me. I tell her that Tirado won’t see me for more than a week. My primary doctor’s office has suddenly become as difficult as the insurance company. I thank her and tell her I’ll deal with the insurance company myself.

The insurance company insists that it’s the doctor that needs to call them. I explain that the primary’s office has been told that it’s Tirado or nobody. Finally a lady comes on the phone, I suppose tired of my persistence, and reads out the authorization number to see the new urologist.

That Friday I am operated on, but not before I had to jump through more hoops than a litter of circus dogs. Oh, and assure the insurer a co-payment of 2,100-plus dollars — over the phone. Yeah, when it’s money time, they don’t want you wasting time.

The operation – by way of sound waves and lasers – aims to pulverize the stones. Allowing you to later expulse them. It’s not as simple and as easy as some will have you believe. In my case, I had more than one very pesky stone stuck in my canals.

But the bureaucracy never ends. Now I am dealing with another round of referrals. The insurance company has to OK my return visit to the urologist who operated on me.

I can’t help but feel that we’ve created a system that has forgotten such words as warmth, sympathy and understanding. And there are too many who have forgotten the part of the Oath that says you’re treating a sick human being.

Still, I keep hearing many who boast that ours is the greatest health care system in the world. Well, if this is true, I’d hate to see what the rest of the world has to offer.