It’s not your insurance coverage. It’s not who you know. It’s not even the urgency of your medical condition. While these influencers can be important, they run a distant second to two much more important factors.
This advice is not intended to treat, diagnose, or cure any condition. Nor should it be taken as the last word on what you can expect if you have to navigate the icy waters of our current healthcare system. But after six doctor’s office visits, one trip to the ER, and dozens of phone calls to four different specialists—all for the exact same condition clearly shown on an MRI, and attested to in the written summary that accompanied the imaging—this is a pretty good litmus test of what you can expect.
I will publish my personal experience soon in part two of this blog, including my interactions with my primary care physician and four specialists (including a Pain Specialist, Physical Medicine Specialist, Physical Medicine & Rehabilitation Specialist, and Orthopedic Surgeon), as well as the care I received after five hours in the ER.
For now, here is the summary of my experience to, hopefully, give you some answers right away.
The First Important Factor to Getting the Medical Attention You Need
The level of care you receive is in direct proportion to the level of empathy of the person who answers the phone.
I’m not talking about the operator who directs your call to the right office. I’m referring to the gatekeeper between you and the doctor—often a nurse practitioner. The person who takes down the reason for your call, relays that information to the doctor, and communicates the doctor’s recommendation back to you is your lifeblood.
The Painful Truth
You have no control over who takes down the reason for your call and relays that information to the doctor, nor do you have any control over their level of compassion.
This was the first unexpected and painful truth I was forced to accept after repeated—and I do mean repeated—calls I made to four different doctor’s offices. If the person who answers the phone is having a bad day, is annoyed by you, is jaded by their job, or, worst of all, is just generally not an empathetic person, your medical condition will not be communicated to the doctor with the urgency it deserves. Therefore, the doctor will treat you as a low priority. It may be months before they’ll schedule you, even for an urgent (but not life-threatening) medical condition.
Most of the time, I was cutoff before I could even finish explaining the reason for my call. Their response was simply, “Go to the ER.”
My copay to see my doctor is $30. The average cost of an emergency room visit is $1,233, with some estimates as high as $2,168.ⁱ
While the ER will address your symptoms the same day, “Go to the ER” is not an acceptable response to an insured, established patient who needs to be seen for an urgent medical condition. Yet this was the exact response I received four times, both over the phone and in writing.
The Second Important Factor to Getting the Medical Attention You Need
The level of care you receive is in direct proportion to how big of a pain in the a** you are.
If you’re a cliché person, “The squeaky wheel gets the grease.”
If you’re the Bible type, read Luke 18:1-8—the Parable of the Unjust Judge (also known as the Parable of the Persistent Widow). Basically, a compassionless judge gives a poor, but persistent widow the rightful ruling she deserves. Not because the judge is just, but because he is so sick of her coming to him day after day with the same request. He gives her what she needs so she’ll go away.
A Hopeful Truth
You do have control over how big of a pain in the a** you are. But let’s call it persistence instead.
Operate from the mindset that nobody in the healthcare system will advocate for you. This is your battle alone to fight. Your doctor is not Mahatma Gandhi. He or she is not clergy. They have bad days. They get grumpy. They get diarrhea. They are just like you and me. Do not expect them to be any more just or empathetic than you are. In fact, they may be much less so.
Therefore, be the squeaky wheel. Be the widow. Be persistent.
Call. And then call again. And again if you have to until you get the answers you need. If one nurse practitioner isn’t giving you the response from your doctor you need, call on a different day at a different time in hopes of getting a more compassionate, empathetic practitioner.
Be calm, be firm, and be truthful. I was worried that the worsening symptoms caused by a compressed sciatic nerve—unrelenting pain, tingling, and numbness that radiated from my spine to my foot—would, if left untreated, become debilitating. But it took multiple calls. The first three times I called, I was repeatedly told that August 8th (a month and half out from my diagnosis) was the soonest I could be seen. It was only when I reached a fourth nurse practitioner who was compassionate and concerned about my condition, and who then relayed these concerns to the doctor in an urgent manner, that I got an appointment that day.
When persistence on your end meets empathy on the doctor’s end—results happen quickly.
If after repeated calls, you still don’t get the attention you need, the answer is simple. Find another doctor.
The Most Painful Truth
I am a white, middle-class male with pretty good insurance, and I couldn’t get a timely appointment with a specialist, even for an urgent (but not life-threatening), potentially permanently-debilitating condition. If you are of a different race than me or a low-income wage earner, expect even more roadblocks. If you are of a different race than me or a low-income wage earner with below-average insurance, you haven’t got a prayer. Go to the ER. It’s the only way you’ll get treatment.
ⁱ This a cross-sectional study of the 2006–2008 Medical Expenditure Panel Survey, analyzing 8,303 Emergency Department encounters, representing 76.6 million visits:
“How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department; http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055491