Bigger Is Not Necessarily Better

I had a really shitty day yesterday.  It wasn’t supposed to be.  I took the day off work to take care of some EMT related business and then I was going to have the rest of the day to do with as I pleased.  I went to my doctor to get a physical of sorts.  The state of California requires a Medical Examiners Certificate (which sounds like I ought to be able to perform autopsies after but is actually a Medical professional Examining me and Certifying that I am physically fit to drive a commercial vehicle.  And then once I have this certification of fitness I can get my ambulance driver license.  My appointment was at 10:00 and was supposed to be a fairly quick experience.  Because my health care provider believes in an assembly line method of delivering healthcare I knew I would have to make another stop on the campus to provide a specimen for the Urinalysis that I saw was called for on the form.  I knew the results would not be instantaneous and so I knew this would not be completely resolved in one day, but at least that part would be quick.

I have a like/hate relationship with my doctor.  I really do like him.  He’s a nice man who takes good care of me, and seems genuine in his interest and concern for his patients.  I also dread going to see him because I know there will be a discussion of weight.  The fact is, my healthcare provider, which for those of you who are keeping track at home, is also my employer, requires all of the physicians to have a discussion with every one of their patients about weight, smoking, diet and exercise… in addition to finding out and treating whatever the patient is there for (all of which is supposed to be done in under 15 minutes), so I know my doctor is just doing his job.  But my doctor is about 6’3 and weighs about 160 pounds.  As a rule of thumb, this is a condition people like him come by naturally, so I’m really not sure he can understand what a struggle this is for me.  I knew I had to see him.  I knew I had to get this certification from him, but I kept putting it off, because I knew I had gained back some of the weight I had lost.  I knew I weighed more than the last time I saw him and I was dreading having to discuss it with him.

I went to my appointment.  Went through the usual torture of having the assistant take my temperature and my blood pressure (which is always high at first and lower when he checks it again later) and have me step on the filthy, lying whore of a scale that always adds five pounds to what ever my scale at home says; as if the insult on my own scale weren’t bad enough.  Then she took me into the exam room and asked me what I was there for.  I handed her the paperwork that I needed the doctor to fill out and sign and she told me that she didn’t think he would be able to do it.  “I think you have to take this to the medical secretaries to get this filled out and then he can sign it.”  My healthcare provider uses a computerized medical records system so the medical secretaries will just pull whatever information my doctor put in the system to fill out the form…  The fact that my doctor will be writing it all on paper before it gets into the system and therefore could just as easily write it on the paperwork is, apparently, irrelevant and won’t become a real problem until later.

“That’s fine,” I told her, “I just need to get the exam.”

The doctor came in and discussed the form with me and did the exam which was pretty simple stuff. He asked me about my sleep habits.  “How quickly do you fall asleep?”  Fat people always have sleep apnea, you know.

“Usually really quickly,’ I told him.

“And when you wake up do you usually feel well rested?”

“Almost never,” I replied.

“Do you snore?” he asked.

“I don’t know,” I answered, “I’m asleep.”  We established that I live – and sleep – alone.  And if I’m snoring, or stopping breathing, Mischa’s not telling.

My blood pressure was excellent, as usual, and so he ruled out sleep apnea because people with sleep apnea generally have high blood pressure.  I only get about six hours of sleep most nights and so I’m chronically sleep deprived.  I’m sure glad I have insurance and only had to pay $10.00 for him to tell me this thing that I already know.

I need to get more sleep.  I also need there be another six hours in the day.

For the first time in ten years, he asked me my sexual orientation, which I thought was kind of odd and it tripped me up for a second, but I didn’t mind answering honestly, (if “gay” is on my medical record, does that make it official?)  Based on my answer there were some additional things he wanted to discuss with me.  Having established that I sleep alone, I couldn’t help laughing when he asked me how often I used condoms and if I had been vaccinated against Hepatitis A.  Um.  I SLEEP ALONE!!!

In a theoretical world, yes, condoms 100% of the time.  I was vaccinated against one of the Hepatitises (Hepatiti?) last year before starting my EMT training.  It was Hep B.  They strongly encourage the Hep A vaccination for “men who sleep with men.”  Um.  I’m a man who sleeps with NOBODY, but OK, sure.  I only pay $10.00 to come here.  Whatever you want.

That’s another stop on the assembly line.

“When did you get your last tetanus shot?”

“No idea.”  Tetanus booster, with the Pertussis (whooping cough) element is recommended for healthcare workers.  Sure why not.  Make me a pin cushion.  I’m already going to the injection room anyway.

In addition to sleep apnea, fat people always have diabetes.  “When did you eat last?” he asks me.

“Last night.”

“Good.”  Every year he sends me to the lab to have blood drawn to check my blood sugar.  (It’s always in the high normal range.)

“As long as I’m having my blood let, anyway,” I ask him, “can you order an HIV test?  I mean, I don’t really need it, but I’ve never had one and as long as I’m there…  I asked them to do it last time but they said they couldn’t do it unless you ordered it.” (Stupid)

“It’s always a good idea,” he agreed.  (Results were negative, in case I had you worried.)

As an afterthought, I asked him to take a look at a little 3-dimensional spot on my left cheek that didn’t use to be there.  “Welcome to getting older,” he told me.  “Its nothing to worry about.”

After 45 minutes in the doctor’s office, I went across the hall to the “adult injection clinic”.  I’m not kidding.  I check in there and literally take a number.  I’m number 84.  They’re on number 67.  They stay on number 67 for more than 10 minutes.  I waited almost 30 minutes to get into the injection room and then when I did get in I waited another 5 minutes.  Two jabs in the arm, one of which hurts a lot today (I assume it’s the tetanus booster) and I was on my way to the next stop.

Since the Medical Secretaries were moved to the new building across the main street on the other side of the hospital, I choose to go to the lab in that building and so I walk around the perimeter of the hospital to get there.  I haven’t eaten in twelve hours.  My head is starting to hurt (hunger, or something in one of the shots?) and now I need to pee.  I get to the lab take another number and then check in.  I ask the clerk, “If it’s possible for me to do the Urinalysis first, that would be awesome.”  She gives me the plastic cup and I take care of business.

Then I wait another 20 minutes to have my blood drawn.  I never really understood why some people have issues with finding veins.  You can spot mine at twenty paces.  I’m glad I have good veins and for the first time in my life I watch as the Phlebotomist inserts the needle and my blood flows into the ampules…  quickly.

Finally, I go to the Medical Secretaries office.  It is noon.  My head is splitting, my shoulder throbbing, my opposite arm is tender and has a self clinging bandage wrapped around my elbow and they close at 12:30 for lunch.  I arrive at the office to find a crowd of people and yet ANOTHER take a number machine at the door.  I’m number 88.  She (and I do me that as a singular pronoun) she is on number 72 and everyone is arguing with her.  I’m NOT leaving before I’m seen so I’m sorry you’re all alone and going to be late going to lunch.  I listen as one person after another argues with the Medical Secretary about how “so and so told me that I could sign this on behalf of my legal age, mentally competent family member, so why are you telling me that I can’t?” when it’s just her job to know and, duh! why would you think you could sign on behalf of the legal age, mentally competent family member?  I turn to the lady next to me and say, “Why is everyone arguing with her?  It’s her job to know these things.”

FINALLY, she calls number 88.  I hand her my forms.  “I was told to come here to have this filled out based on the physical I just had.”

“What is this?” she asks me.

I sort of assumed that she would know, because this is something they do.  “It’s a Medical Examiners Certification for the DMV.” I tell her as I point at the size 72 font DMV logo in the corner of the form.

“Oh.  They changed the form,” she says in a tone that suggests it’s a problem.  “I don’t have an old one to show you.”

I didn’t question you. “I printed it from their website, yesterday.  Obviously, it’s the right form.”

“Well, there’ll be $30.00 fee,” she tells me and I’m certain it was a joke.

After a long pause where I just stare at her, I finally say, loudly, “Excuse me?”  She repeats the absurdity.  “There’s a $30.00 fee for you to fill out a form that the doctor could have filled out WHILE HE WAS DOING THE ACTUAL EXAM?  There’s a $30.00 fee to FILL OUT A FORM???  Give me a pin.  I’ll do it!”

This, in case you’re wondering, was not the bombshell.

“Oh, wait,” she says suddenly.  “We can’t do this anyway.  You have to take this down the hall to Occupational Medicine.”

Seriously?  I’ve waited here for 30 minutes and now you’re telling me I have to go somewhere else, even though both my doctor and his assistant said to come here?

“Sorry,” she says unconvincingly.

I snatch my forms from her and say, “No you’re not,” and stomp off.  I’m not even out of the small office before I hear her call number 89, like everything is fine.

At the other end of the hall, I walk up to the sprawling desk with six stations for clerks in Occupational Medicine.  There is only one person at the desk and as I walk up, she says, “Oh, sir, I’m closed for lunch, and my sign should have been up.”  Mid-speech she reaches for her closed sign and slaps it down in front of me.  “She’ll help you,” she says gesturing to the woman who had been standing there talking to her and is now sauntering to the far end of the counter.  I give the first woman the stink eye as I stomp off.

I hand the form to the woman and tell her what the Medical Secretary told me.  “Well, we can’t do that!” she exclaims and she has the nerve to actually sound put out.

“Excuse me?” I ask, all pretense of cordiality has drained out of my voice.  This is getting ridiculous.

“The doctor’s not going to sign for another doctor,” she says as if this explains everything.

“Riiiight?”

“So they can’t do this.”  Now you get it, right?

“I don’t understand what you’re telling me,” I say.  I’m fairly certain there is steam coming from my ears now.

“If your doctor did the exam, our doctors aren’t going to sign the paperwork.”

Now I get it.  “No one is asking for that.  My doctor is prepared to sign it, but he sent me to the Medical Secretaries to have it filled out and they sent me to you.”

“Well, this is for the DMV, for a commercial driver license,” she says, as if I hadn’t already established that fact, “your doctor can’t do the physical.”

I stare blankly at her.

“Our doctors have to do it.”

More staring.

“It costs $70.00 and it’s not covered by your membership.”

You know that sound that they used to (or maybe still do) use at factories and mills to indicate the start and end of shifts.  The old steam whistle sound?  Yeah, that.  Coming from my ears.  “What. Do. You. Mean. It’s not covered?”  Surprisingly she understood me through my clenched teeth.

“You have to pay for this.”

“Let me get this straight,” I said loudly.  “Not only am I a member of this health care organization, but I’m also an employee.  I pay my premiums every month out of my paycheck.  I have full medical coverage.  I just paid my $10.00 co-pay to see MY DOCTOR who conducted my physical for this form, because the man on the phone WHEN I MADE MY APPOINTMENT said I DID NOT have to come to Occupational Medicine.  I’ve been here for three hours because of this form and because the man on the phone said I DID NOT have to come to Occupational Medicine.  The woman down the hall tells me I have to pay $30.00 TO WRITE ON A PIECE OF PAPER THAT I PROVIDED and now you’re telling me that I have to see A DIFFERENT DOCTOR and pay another $70.00 OUT OF MY POCKET?  You’re telling me that even though I have worked here for ten years and been a member the ENTIRE TIME, and even though I have complete coverage, I HAVE TO PAY $100.00 OUT OF MY POCKET for something I’ve already paid for?  EVEN THOUGH THE APPOINTMENT CENTER GUY SAID I DIDN’T HAVE TO COME HERE?  IS THAT WHAT YOU’RE TELLING ME?”

“I’m sorry.  He was wrong.  And you don’t have to pay to have the form filled out.”  There was nothing apologetic about her tone or demeanor.

When I called to make the appointment, the man said “I think you have to do this with Occupational Medicine.”  I explained that I was not doing it for my employer and was he sure?  He put me on hold and then came back and said I did not have to go to Occupational Medicine.  So not only was he wrong but the person he went and asked was wrong too?

“Would you like to make an appointment?” she asked me as if I hadn’t just had a tantrum.

I did my best to stare death into her soul.  Apparently I do no wield that much power, despite what the Mormons think.  Dammit.  “I don’t guess I have any choice now do I?”

She turns to her computer.  “Would you like to do it today?”

“I CAN’T DO IT TODAY,” I tell her.

I have $37.00 in the bank until midnight.  I didn’t have the money to pay the $30.00 TO WRITE ON PAPER and pay the quickly mounting parking fee I’m amassing, I sure as hell don’t have the $70.00 to pay for the physical, I’ve already paid for AND already had.

Now I’m going back on Tuesday.  I will be telling this strange doctor I do not know that he can use my blood pressure from Thursday’s physical, BECAUSE IT’S BOUND TO BE ELEVATED ON TUESDAY.  He also damn well better use the results of Thursday’s urinalysis and they better have me in and out of there lightning quick!

The good news is my appointment is at 8:30 in the morning and I am taking the entire day off work again so maybe this day off work will actually be a nice one.

In my office building we frequently have various propaganda banners hanging in the lobby, touting our organization as being “First in service” or “Best Healthcare whatever whatever” or “Ranked number one among, something or other.”  I suppose if I actually read this crap anymore I could be more specific.

Something my company needs to think about:  Being the biggest healthcare provider in the area does not make us “the best”.