Don't waste my time! (On "patient autonomy," health insurance, and doctors' offices)

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—like celiac disease, which I have—is wasted time. Managing celiac disease takes a fairly large toll on my 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.

"Regret for wasted time is more wasted time."—Mason Cooley Oh, shut up. (Image © JD | Flickr)

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 pencilDon't make any stray marks, now. (Image © biologycorner | Flickr)

What time wasters get your blood pressure up? 

--
Molly
Based on a Sprue Story
http://spruestory.com | @spruestory

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