Remember that TV show from a decade or more ago? When a contestant failed to answer a quiz question correctly, the host would sternly declare, “YOU ARE the WEAKEST LINK. GOOD-BYE!”? Remaining, of course, were the more knowledgeable contestants, presumably a stronger chain of smarter people who could get the job done.
Oh man, how I wish I had been able to invoke that host’s dismissal powers this past week! As both my husband and I had to deal with different parts of the healthcare system, we encountered roadblocks – the weakest links – and in each case, we had to go over their heads to get what we needed. THEY were the weakest links. The problem is, they are still working there, stymie-ing patients every day.
And over and over again, the words of so many of you echoed in my head, “How do people who don’t understand the healthcare system manage to get what they need?”
The problem I ran into was a mere frustration. My primary care doctor’s practice, purchased by one of our local hospitals about a year ago, finally moved to electronic medical records earlier this year (using Epic). Prior to regular visits, I get blood work done – standard stuff – and in the past, my doctor has always just handed me a written prescription for the blood work, which I would take to the lab for a blood draw a week or so prior to my next visit – in, out, done.
But at my last doctor visit, no more written script. Instead, I was handed a print-out from my new electronic record which indicated what blood work was needed and I was told to just take that to the lab when the time came.
Having lived in this dysfunctional healthcare world of “nothing happens the way it should” for so long – I decided last week, the day before the blood draw day, to call the lab to confirm that indeed, they would accept that print-out. But no – they could not, because they didn’t have access to the Epic system, and therefore had no way to verify the order.
BUT! she told me… “If you can fax me a copy of your paperwork, one of our other offices has access to the Epic system, and I’ll just ask them to send over a copy of your orders. We’ll see you tomorrow morning.”
Aha! As good a solution as I was going to get, right? It seemed to satisfy what they needed, what my doctor needed, and what I needed. I thanked her for offering a solution and immediately faxed my paperwork. I called her again 10 minutes later, confirming receipt. She stated that she had everything she needed and would make sure the orders were available the next morning.
Now – you can probably guess what happened next. When I arrived at the lab the next morning, there were no orders. They didn’t have what they needed. They refused to draw my blood. There was the weakest link! A promise made with no delivery on that promise… “We’re sorry – but you’ll have to come back when you have the orders we need!”
But you know me. I don’t accept irresponsibility easily! I pitched a fit – a professionally polite, but pointed, relentless FIT – which resulted in the office manager giving them permission to go ahead and draw my blood, with their apologies for screwing up (for being the weakest link). (It worked – I already have copies of the results.)
How do people who don’t understand the healthcare system manage to get what they need?
My husband’s hurdles were much more of a problem. He woke up Monday morning, dizzy and off-balance…. enough so that he had to call his boss and cancel his trip to Boston. He then called his doctor and I drove him to an early afternoon appointment during which he was diagnosed with vertigo (“benign positional vertigo”, to be exact). To be on the safe side, his primary ordered a CT scan, and also ordered PT – a treatment that can correct the vertigo almost immediately. He also wrote a prescription for an antihistamine. As my husband’s advocate, I asked all the questions I knew to ask, in particular about the PT and the drug. We left the office expecting to hear by the end of Monday, or early Tuesday at the latest, that our insurance had approved the PT and the CT scan. Everything had worked the way it should, so far.
From there it went to h*ll in a hand basket.
My husband’s primary’s practice was also purchased by that same hospital that now owns my primary’s practice. One of the big benefits promised to the doctors whose practices were purchased was that all those pain-in-the-neck tasks they hated would be absorbed by the hospital – including acquiring insurance approvals. It turns out that those insurance approval people in the hospital’s system were last week’s weakest link. Beginning early Tuesday afternoon when we had heard nothing at all about approvals, we began making phone calls to both the approvals office AND our insurer, every few hours. Of course, they simply blamed each other. Once again – we went over their heads, and it turned out the weakest link approval department person had lied over and over again about submitting the approval (supposedly marked URGENT) – until finally, my husband told her on THURSDAY that he would wait on the phone while Madame Weakest Link Approval Person faxed the requests to the insurer…. which she did…. and when he called the insurer immediately afterward – surprise! The requests had arrived. They were approved quickly. By noon Friday he had both the CT and the PT (which did work its magic – the vertigo is history.)
In total, he spent a week dealing with a problem that might have been solved in 36 hours. He missed a week of work. He was dangerously dizzy and unbalanced for days longer than should have been – and all because of one irresponsible approval person.
None of our doctors – yours, your clients, or ours – can be any better than their weakest link.
Further – when patients don’t get what they need, then their doctors look at their records and consider them to be non-adherent! And we all know how providers feel about non-adherent patients.
How do people who don’t understand the healthcare system manage to get what they need?
It’s no longer a question of whether someone can advocate for him or herself. It seems the only time they can is if they understand how to do it – professionally.
- If someone is thrown in jail, they can’t get out of jail themselves – they call a lawyer.
- If someone is audited by the IRS or the CRA, they can’t defend their tax returns themselves – they call a CPA.
They might TRY to handle those circumstances themselves, but doing so means they risk losing out on their best case scenario, a best case they might never even be aware of unless they work with a professional. And what they might end up with is a worse or worst case.
And so it is with the healthcare system.
As private professional advocates, that’s our job – to protect clients from losing out because they don’t understand this system of weakest links.
How do people who don’t understand the healthcare system manage to get what they need?
The answer is easier than most realize. They hire a professional advocate.
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