Once upon a time, as most of you know, SEK had cancer. His cancer requires he take thyroid replacement hormones for the rest of his life, but this January his Primary Care Physician informed him that he could not, in good conscience, continue to prescribe said hormones unless SEK saw an endocrinologist at least once a year, so he referred SEK to one who works at the UCI Medical Center. Because the United States has the best health care system in the world, three months later he arrives at the UCI Medical Center for his appointment.
SEK: I am here for the appointment I have been waiting three months to have the pleasure of attending.
NURSE: Do you have a referral?
SEK: My doctor referred me, otherwise I would not have the appointment which I waited three months to have the pleasure of attending.
NURSE: Let me call your Primary Care Physician. (dials phone, provides my name and information, listens) They have no record of a referral.
SEK: Then why am I here?
NURSE: (shrugs)
SEK: Why did I receive an email reminding me to be here today at this time?
NURSE: (shrugs) We can always restart the process—
SEK: And I can wait another three months to be told there's no record of my referral?
NURSE: Or you can see the doctor (which was becoming a pressing necessity, as SEK was experiencing some of the same symptoms that led to the diagnosis of cancer in the first place—most notably, an uncontrollable urge to nap) and pay out of pocket, straighten things out with your insurance company and be reimbursed.
SEK: Fine, fine, this is why the Good Lord invented credit cards.
SEK sees the endocrinologist, who is really quite extraordinary, has a few tests runs and leaves the office to get three gallons of blood work drawn at the lab.
SEK: I have this long sheet of paper covered in X marks and this pad of stickers. Please steal my blood.
LAB ATTENDANT: Gladly!
The LAB ATTENDANT rolls up SEK's sleeves and withdraws three gallons of blood from SEK's arms. As the LAB ATTENDANT's affixing the stickers to all the tubes, he says
LAB ATTENDANT: Wait a minute—these stickers have your Primary Care Physician's name on them in addition to the endocrinologists'.
SEK: And this is a problem?
LAB ATTENDANT: You needed to get this blood drawn at your Primary Care Physician's lab, otherwise you'll have to pay for these tests out-of-pocket.
SEK: (sighs) How much out of pocket?
LAB ATTENDANT: $1,800.
SEK: Fine. I'll just take these tubes and stickers and drive them to the other lab.
LAB ATTENDANT: You can't do that. You need a special license to transport blood.
SEK: My blood? I believe it's called a "Driver's License," and I used it—
LAB ATTENDANT: It's the law.
SEK: (feeling the effects of losing all that blood) So what you're telling me is that I need a special license to transport my blood—
LAB ATTENDANT: As soon as it's outside of your bod—
SEK: THEN BY GOD MAN JUST PUT IT BACK IN.
LAB ATTENDANT: What?
SEK: PUT IT BACK IT IN. Did I need a special license to drive it here?
LAB ATTENDANT: No.
SEK: But it'll cost me $1,800 to transport it to the other lab in those little tubes?
LAB ATTENDANT: Yes.
SEK: THEN PUT IT BACK IN ALREADY.
The LAB ATTENDANT is surprisingly unpersuaded by the logic behind SEK's argument. SEK leaves the lab minus the $1,800 pound of flesh they stole from him and THE END FOR NOW.
Your local healthcare-industrial complex may vary, but in my current plan referrals expire after ninety days unless they're actively renewed by the PCP's office. I was blessed for some years with a referral coordinator who took it on herself to keep mine up to date, but lately there have been some annoying and potentially expensive lapses. If that's the case, for appointments outside the 90-day window someone may need to remind the PCP about renewing, and by "someone" I mean, in all likelihood, you.
(Melanoma, two and a half years out.)
Posted by: Hogan | Wednesday, 11 May 2011 at 01:04 PM
(And I suppose it seems like I contradicted myself here: my new PCP does want me to see an endocrinologist every year, which I'm not keen on doing, but it's not a bad idea for me to see one every five years, which is why I went along with my new PCP when he suggested it.)
Agree with you on all the above, particularly since you still have thyroid tissue (albeit rendered useless). I had an uptake & scan at 5-years to confirm no new thyroid tissue (check!), so for all intents and purposes I'm considered "cured".
(My tumor was in the 1cm size range and on one node, so while I may have been a candidate for a non-total thyroidectomy, my endocrinologist suggested going total and be done with it.)
Also, something I alluded to I want to stress again - you are the main person responsible for your health care (I came to this realization having 3 doctors in about 5 years). If at all possible sign an authorization to have lab results sent to you (I never like the "everything's normal" form letter from the doctor - as an engineer I want the actual *data* :) ). Reading and self-education are good too. Ask questions of your doctor. In general be an active participant. I've found that I can get much more info from my doctor by engaging her in conversation and showing I've done some research and am actively engaged in the process.
Cheers (returns fist-bump).
Posted by: JimB | Wednesday, 11 May 2011 at 01:32 PM
Your local healthcare-industrial complex may vary, but in my current plan referrals expire after ninety days unless they're actively renewed by the PCP's office.
The problem is, that's how long it took me to get into the endocrinologist. It's not like I wanted to wait 90 days, it's just that's the date they appointed me when I called in December. Granted, I can easily imagine, at this point, them granting me before-the-fact an appointment after my referral's expired, but I'm trying to be optimistic here.
Agree with you on all the above, particularly since you still have thyroid tissue (albeit rendered useless).
One of the reasons I needed to appointment, besides it being five years, was that I was starting to nap uncontrollably again. So either I've acquire a new laziness I've never suffered from before, or my thyroid's acting up again. And this was in December. For a rough estimate, check out my archives: how often have I posted since December compared to my regular production. It's not a scientific measure, but it says something about how much energy I have in the late afternoon these days.
Also, something I alluded to I want to stress again - you are the main person responsible for your health care (I came to this realization having 3 doctors in about 5 years). If at all possible sign an authorization to have lab results sent to you (I never like the "everything's normal" form letter from the doctor - as an engineer I want the actual *data* :) ). Reading and self-education are good too. Ask questions of your doctor. In general be an active participant. I've found that I can get much more info from my doctor by engaging her in conversation and showing I've done some research and am actively engaged in the process.
No fears on this account: I a true Jewish nudgenik, classic, even, and have been bothering everyone I can for the past week and a half. And I can't read any more about thyroids, as I've got two double-parked shelves devoted to books about them. I've hit that hypochondriac-point at which I've read too much, have too many fears, see ghosts of thyroid disorders floating about my bed at night, etc. which is why I wanted to have my nerves calmed by someone who's actually an expert. Which is only to say, your advice is sound, I've taken it, and we're fist-bumping like fist-bumping fools.
Posted by: SEK | Wednesday, 11 May 2011 at 02:34 PM