Primarily not care

I promised you yesterday that I’d write about the second part of my Healthcare Hell Monday, so here it is.

It turns out that it’s right challenging to find a primary care provider (PCP) in the Metro DC area. Leaving aside the issue of finding a practice that accepts the flavor of CareFirst insurance that I have, I spent a solid two weeks a couple of months ago calling PCPs only to find that either they’re not accepting new patients or the first appointment I could get was months (as in more than eight weeks) out.

So I broadened my search and eventually found a nurse practitioner at a sizeable primary care practice affiliated with Virginia Hospital Center who could see me within a couple of weeks. The practice isn't on the same scale as my provider back in the Valley They Call Silicon, but I reckoned that as an interim measure (I needed new prescriptions for maintenance medications), I could tolerate this.

(And before you get up on your hind legs, I’m perfectly fine with nurse practitioners for primary care. They can be better diagnosticians and more attentive than actual MDs. As with any profession, it all depends on the individual.)

She wouldn’t prescribe without a full examination, which was okay with me. But when I discovered what passes as an exam in her eyes, I wondered what the point was.

Except, of course, for the revenue.

This is the first time in my life that an annual physical did not involve what you might call an actual physical examination. My clothes stayed on for the entire time I was with her. I had two issues I brought up—joint pain and skin anomalies (I have red hair and fair skin; any anomaly makes me nervous). She looked at neither. By which I mean, she stayed sat on the other side of the examination room and blinked at me while I described them.

She did order an X-ray to see if there might be a fracture, but she didn’t even take a look at the area when she did the absolute minimum: listening to my breathing and peering into my eyes and ears. Oh, and she tested my reflexes. And ordered blood panels.

This was also the first time since I was about 20 that an annual exam didn’t involve the physician doing a breast exam.

Well—I did get my prescriptions (and told you my sad tale about that yesterday). So I had accomplished my purpose. But as I was checking out, the admin staff handed me a document grandly called “Summary of Today’s Visit”. I’m glad that they didn’t take my blood pressure after I sat down at home and read that, because it was quite the work of fiction.

Here’s a clip from it:

Here’s my own summary: 

There was no discussion of ideal body weight, BMI or blah-blah-blah. I told her that I know I’m overweight and she nodded in what I assume is meant to be knowing sympathy. There was not a whisper of Weight Watchers or the ilk.

Sleep counseling? Dental health? Injury prevention? Safety?? (Bike helmet??? What the hell?) Guns? Seat belt? Alcohol? Not a peep. Seriously—not word one from her on any of those subjects. She didn’t even ask me about my drinking habits—first time in probably a decade that that question hasn’t been part of taking a patient history. (Yes, I filled out a questionnaire beforehand. But if she actually read it, she didn’t ask me anything about it and she certainly didn’t “counsel” me on anything.)

I told her I don’t smoke—on the health history questionnaire; there was no mention of it in person.

I brought up my concern about skin; I informed her that I never go out without sunscreen on; I told her that I stopped using the sunroof of my car six years ago. She never said a word, and she didn’t bother to look at my skin for damage even after I told her I had some areas of concern.

She said nothing about breast examination (and did nothing about it) beyond ordering a mammogram—preferably at the radiology department of VHC, which is a revenue source for the overall organization. When I asked if I could get it from another provider (one more convenient to my work), she got a sour look on her face, but said yes.

She did ask if I’ve had a screening for osteoporosis, ready to order that, as well. When I reported that I did within the past year and apparently have the bones of a 27-year-old (which appears to be the benchmark), she lost interest. That crap about dietary requirements for calcium and vitamin D—no. Never happened.

(I did report that I regularly take both vitamin D and Omega-3 supplements. She neither inquired about nor recommended dosage amounts.)

Obviously this “summary” was all boilerplate that she cut and pasted into the document. You can see that she didn’t even bother to do a good job of pasting; she just slapped it in willy-nilly.

I’m assuming that this crap was for the dual purpose of laying groundwork for showing comprehensive attention to care in the event of legal action, plus sending to the insurance company for payment. But for the first time in my life, I’m contemplating calling a health insurer and ratting out a provider. This kind of assembly-line whole-cloth fabrication doesn’t deserve to be compensated. If you’re too busy running patients through your practice to actually have in-depth conversations with them, okay. But don’t make up shit and attach it to your invoice as a statement of work performed.

And don’t assume that I can’t read. Especially since you expect me to engage with you exclusively through your website.

And I’ll write about that little joy tomorrow.