Our Medical Health Care System

This is not my take on Medicare for All, or Medicare for All Who Want It, although kudos to Mayor Pete for a good turn of the phrase (and good luck in the Iowa caucus this evening), but rather my anecdotal experience with the system we depend on to keep us healthy, just this morning.

First, last week I scheduled an appointment, on line, with the Baylor, Scott & White Downtown Clinic for this Wednesday, February 5th, 11:40 am. It’s basically a check up, a couple of shots I need to get and a couple of questions, since it’s been more than a year since I last saw my primary care doctor. (Who is now gone, so this is a new doctor, but that’s another story).

The two options to choose from were ‘new patient visit’ or ‘office visit/established patient’. I had some question, since it is a new doctor, would that count as a new patient of his? Didn’t actually make sense, but since I was not talking with anyone, thought I would check it and see what happened. What happened was a note that I couldn’t do that, not enough time for my chosen time of 11:40 a.m. (Why, since I had checked ‘new patient visit’ it had given me an option for a time that would not work seems like a design flaw, but that’s another story.)

So, I opted for office visit/established patient, and it worked, at the time I wanted to schedule it. Success! Afterwards, on January 28, I first got a text that I had a message in the BS&W portal, and then when I opened the portal, the message confirmed my appointment for February 5th at 11:40 am. Friday, January 31st, I got a voice mail, confirming my appointment, with an arrival time of 11:25. (What’s up with having an appointment time AND an arrival time? Seems a bit weird, but that’s probably another story.) So far, so good. Reminders are a helpful thing.

Then this morning at 7:18 a.m, yet another message in the portal, preceded by a text telling me that there is a message in the portal, confirming my appointment for February 5th at 11:40 a.m., with that 11:25 a.m. arrival time. Ok, I am officially reminded.

But just getting started. Next voice mail this morning at 8:43 a.m. A call from O__ from BS&W, has a question about my appointment on the 5th, could I please call back and leaving what (turns out) is the main number for BS&W downtown clinic.

After getting back from the gym, I call BS&W and go through the inevitable phone tree. My option is #4, which is designed to get me to a person, although it doesn’t immediately, but after about 10 minutes (ok it was probably 1 or 2 minutes, but it always feels like 10 minutes, something that proponents of automated phone systems should keep in mind, but then that’s another story) and I finally got a person.

I explained that I had just had a voice mail from O_ who asked me to call about my appointment on Wednesday. I gave my date of birth. Slight pause. Then I gave my address, although I forgot to say that I was in Austin, two blocks away from the clinic I am hoping to visit on Wednesday, but did state it, when I was asked, “what city.” Then I was asked why I was calling. I explained again, I had a phone call from O_, and I wasn’t sure what she wanted, but since I had received numerous prior communications reminding me about the appointment, I thought it was probably something else.

I was then asked if I knew who O_ worked for? I didn’t think she meant BS&W, I thought that would be obvious, so I said I didn’t know and she said well, she didn’t have the names of the people who worked on the staff. Now it’s not a huge clinic, but it could be her first day or maybe O_’s first day, but that seemed a bit strange. Then she said, does she work for Dr. G_ (the person I am trying to schedule an appointment with or Dr. C_ (my former doctor who is no longer there, remember, the first other story). I replied I didn’t know, but I didn’t think it was Dr. C_ as I didn’t think she still worked there.

She said well there’s nothing in the system. So, I once again offered, that I didn’t know, but O_ had called, just this morning, and left a voice mail, and I thought it was not just another reminder. That prompted the idea that maybe she should see if she should get “them” on the line, and even without knowing exactly who “them” was, I was in total agreement.

Another period of time on hold, until I was finally connected to D_, who after a much quicker period of birth date and other info confirmation, informed me the the problem was I had scheduled a ‘physical’ and there was not enough time for that in my scheduled and much confirmed 11:40 a.m. appointment on Wednesday. . Rather than inquire how I could have scheduled a ‘physical’ when there were only ‘new patient visit’ and ‘office visit/established patient’ options, I chose to defer to her suggestion that she look at times when we could do it. (One of the luxuries of being retired, a much more flexible calendar.) Happily, time for physical, meant only a wait of 90 minutes, so I am now scheduled to see Dr. G_ for a ‘physical’ at 1:20 p.m. this Wednesday, February 5th.

While I have not yet been officially reminded, nor do I know my “arrival time” the 1:20 pm appointment does show up in my portal under appointments. Fingers crossed till Wednesday.

Second, last week, out of the blue, I got a text from Optum Rx, the online pharmacy that my medicare Rx insurance company recommends. After resisting prior encouragement to use them, I finally agreed and it is much easier to get a 90 day supply of the pills I take on a recurring basis than having to trek over monthly to the downtown pharmacy I had been using. I do lose the walk, which is one of the benefits of living downtown, more walking, healthier lifestyle, but that’s another story. Actually, the NYT Ellen Gabler already wrote the story, which makes it clear notwithstanding losing the walk I may be better off not using one of the large retail drug chains.

Optum Rx, in their text had helpfully listed four prescriptions that could be refilled, and all I needed to do was text Yes, which I did.

Then this morning, when checking the BS&W voice mails from this morning and last Friday, I realized there was also a voice mail from Optum Rx last Thursday. My order had been placed on hold and I needed to call (24/7) to avoid any further delay.

So, after recovering from my BS&W call, I took on Optum Rx. After going through birth date/address confirmation, I explained why I was calling. The first report was good. It did not appear that there was any problem with anything. I pushed a bit, to see if I could find out what prompted the initial voice mail. That took a little more looking, but the report was it appeared that there had been an issue with a co-pay, but it had been resolved, and there was no balance on the account, so everything was good.

But then a bit more pushing, just to confirm that what I thought had happened, that I had ordered refills of four prescriptions was actually in place and on track. A bit more research. Well, no. Nothing was in process. Apparently, there had been a problem, it had been resolved, but also the order had been canceled.

So, could we get back to where we thought I was, which was having ordered four refills by texting back “Yes”? Of course, what prescriptions do you want to refill? I know, I should know the medications (all but one generic of course) by heart, but somehow Amlodipine Besylate and Lisinopril-HCTZ, not even to mention the correct milligrams, are just not in the memory banks.

But good no problem, we go through a list of prescriptions that are ready for refill, and knowing that all on the list are ones I take on a recurring basis and will need, I just say yes to any that are available for refill.

There will be co-pays of course, and we discuss that. Do I want to pay using my credit card which is on file? Yes, thank you, and then the words I had been waiting to hear, my order was processed successfully and should be delivered. It did cross my mind to raise the question, if in fact there is a valid credit card on file, why there would have been a question about the co-pay that started us down this particular track, but that would probably have resulted in another story.

I have spent way more time writing up the two incidents than I actually spent on them (according to my phone, 11 minutes each). Still, I think the calls are symbolic of our healthcare system where way too much time is spent on the red tape of health care rather than the care itself. And in each administrative interaction lurks the possibility of action or inaction which could actually be harmful to one’s health.

I know health care delivery is a big and complex matter, with no easy solutions. But today, I am reminded of a comment made by a visiting professor when I was at UT Law School. Walter Steele, now a Professor Emeritus at SMU School of Law, was teaching me and 110 others criminal law, in the mid-afternoon of a spring semester. To say that our class participation was less than stellar would be an understatement. (As I recall Edith Jones, now the Honorable Edith Jones of the 5th Circuit, was an exception.) Which caused Professor Steele, to pause one day and say something along the lines of, “You know up at SMU, all we ever hear is how you UT law students are so damn smart. Well, I’ve got to tell you, so far, I’m not a damn bit impressed.”

After this morning, me neither,