Valley Commentary : Let’s Put the Caring Back in ‘Managed Care’ Medicineh : A recent encounter with a respected HMO after an auto accident points out the flaws in the health system our country is moving so rapidly to adopt. Doctors did no harm--but not a whole lot more.
When I totaled my car recently, I worried more about auto insurance than medical insurance. For years I’d been covered by what is considered the country’s best health maintenance organization, the group that promises comprehensive womb-to-tomb care. I’d had some checkups but hadn’t used the system much.
Unfortunately, my first real encounter with the so-called “managed care” system toward which the country is moving so fast--and which is the cornerstone of President Clinton’s health care plan--proved to be traumatic in several ways.
When the paramedics gingerly got me on a gurney, after I’d been knocked unconscious and was bleeding from the nose, I was told they had to head for the nearest hospital, not my health maintenance organization. Here I was given an EKG and X-rays which revealed no broken bones. A seemingly indifferent doctor chewed gum as he performed a one-minute exam and pronounced me “alive.”
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Left alone for several hours until my husband could be reached, I shivered and floated in and out of consciousness. No one checked me or offered a blanket. Finally I summoned my strength and crept down the corridor to the bathroom like a wounded animal. In the mirror, I was horrified at my bloody face and cleaned myself with paper towels.
When I returned to my cubicle, new patients filled the place. It was the hour of triage. I’d become a GOMER. “Get out of my emergency room” was written in every gesture of the attendant who stripped my sheet and threw my things on a chair.
I was discharged without pain medication because, the duty nurse explained, my HMO was now responsible. It would have been a blessing to be transferred to its hospital for a night of observation. But, cost-containment being the first consideration, I walked to our car dressed in blood-spattered shorts and blouse to spend a hellish night of incredible pain.
To my surprise, when I arrived at my HMO’s urgent care department the next day, no one knew of my accident, though both hospitals had been in touch the night before. Someone asked why I hadn’t brought my X-rays. We started from square one. Tests revealed a broken nose. “You might need surgery later,” an anonymous doctor on duty commented, writing a prescription for pain killers.
Since I’d assigned this health plan both parts A and B of my Medicare coverage, I was a captive of the system and could not select my own doctor. My “primary physician,” whom I’d been assigned about a year before and seen only once, didn’t know me from Eve when he finally returned my call. When I asked to see an orthopedic specialist for my badly hurt right knee, he said to use ice packs and heat; later on he’d recommend physical therapy.
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Now, almost two months after my accident, neither orthopedist nor internist has checked me. It’s been telephonic advice amounting to “take two aspirin and don’t call me in the morning.”
Despite my highly touted coverage, a flurry of bills has arrived in the mail with warnings to pay in 30 days. They total $1,700, including $150 for the gum-chewing emergency doc. At this point all parties engaged in managing my care seem bent chiefly on passing on the costs to my auto insurance company.
Yes, I’m fortunate to have survived and feel strong enough to write this. I can’t prove my care was inadequate at any point along the way. But I wonder at the cold indifference of modern medicine. I wonder if I should have spent at least one night in a hospital after being knocked out in the crash--or at least have had the benefit of an unhurried explanation from a doctor.
I remember my late uncle, Dr. Hymen Frank, who practiced on New York’s Lower East Side for 50 years.
Multiethnic patients filled his waiting room. A general practitioner, he made those long-lost house calls. Double-parking his Buick on narrow, snowy streets, he mounted flights of stairs to treat children with fevers, pregnant women, the elderly infirm. There was more medicine in his black bag than in all of today’s technology.
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We’ve come a long way with antibiotics, surgery and life-saving techniques. But for routine care, medicine is sadly deficient. As I experienced it, emergency room treatment proved an outrageous rip-off, whereas “health maintenance” is performed on the cheap.
We certainly need universal coverage for all Americans, but it ought to be patient-oriented and compassionate. The healing profession is in serious trouble when doctors follow only the first tenet of their profession, to do no harm.
