Monday, July 16, 2007

I Was Refused Care

Today I called a gynecological practice to make an appointment with a new gynecologist. I haven't had a gynecologist in quite some time (well, I haven't had a gynecologist EVER, but I got gynecological care through student health in grad school). I was referred to this practice by my family doctor as being best able to care for certain special medical needs I have, and it was specifically recommended by female friends when I asked around.

When I called, they told me I needed records from my last gynecologists. Well, I'd never had one, I told them. Pap smear? Not in quite a while, and Duke (for whatever stupid (and incidentally illegal) reason) keeps refusing to release my medical records to me.

Well in that case, I was told, we can't see you.


We can't see you.

They absolutely and categorically refused to provide gynecological care because I don't have a gynecologist! I asked if they were seriously refusing to provide care because of a lack of paperwork. Yes. I asked if they refused to see all new patients without prior gynecological care. Yes. So despite the fact that I am in need of medical care you refuse to see me because I haven't already HAD the medical care which I am in need of? YES.

I was almost literally speechless. I'm currently teaching medical ethics, as you know, and I was flabbergasted that a doctor would refuse to provide necessary care to a patient WITH insurance who CAN pay who was REFERRED by a primary care physician in the same hospital network ... !

What if I was actively pregnant and in need of prenatal care? What if I was ill and in need of urgent care rather than routine care? Apparently it makes no difference. Unless I have a CURRENT gynecologist, I can't see THIS gynecologist.

I made Mr. McGee call over, I was too upset, and the nurse HE spoke with said lack of prior records are NOT a bar to being seen and apologized for the way I was treated. So perhaps I just got one really mean and uncaring and hidebound nurse. This nurse suggested I have my primary care physician call over so we can bypass the problem person and get me a faster appointment, so I'm doing that now and hopefully can get this problem solved.

At least I have something for my medical ethics class to talk about tonight. I am seriously appalled.


Knight in Dragonland said...

I'm always thrilled when I have old medical records when I see a new patient for the first time, because it's always better than having to reinvent the wheel. However, I can't come up with any justification for a primary care physician like an OB/Gyn actually refusing a patient over a lack of medical records. If you have to start from scratch, you start from scratch.

I have refused to give immunizations without prior records - because I don't know what the child has or hasn't had before, and I don't want to double dose a vaccination they've already had. I'll go ahead and do the physical, though. I don't see how a lack of prior pap results correlates with that situation.

Ethically, this physician should be rushing to get a patient without adequate prior evaluation in to the office so that proper evaluation & screening can be initiated. Economically, they're just stupid for refusing a patient with insurance!

Eyebrows McGee said...

I have the letters from the labs on my prior pap results that are in my personal files (they might take a bit to dig up), but apparently that's not good enough. And I'm sure that with six months to bicker, I could eventually get something released from Duke, but should I really have to wait six months to get routine gynecological care? If I haven't had a pap smear in FIVE(ish) YEARS, shouldn't we GET ON THAT RIGHT AWAY?

One of the things the mean nurse said was that they couldn't risk THAT I MIGHT BE ILL (presumably, abnormal pap smear indicating possible cervical cancer) and wouldn't take me on as a patient if I was! I am forced to presume this was one nurse on a power trip because I can't IMAGINE this as an actual policy. I realize that's what insurance companies do (refuse to insure patients who are ill) but if there's a doctor out there who's actually doing that, that makes me sick. And furious.

Eyebrows McGee said...

Oh, also, I'd really like to be able to talk to the DOCTORS in charge of the practice and express my disappointment with the way I was treated, as well as my concern that they apparently AREN'T rushing to get a patient without adequate prior evaluation in to get things started. But what are the odds I'm allowed to actually talk to a doctor unless I'm there for an appointment?

I feel like I'm between a rock and a hard place because this IS the best practice for my care, but with a nurse like this on staff, that makes me very uncomfortable. And whatever is going on in the office, the fact that a staff member feels comfortable making those assertions to members of the public ("we don't treat patients who don't already have care, we can't risk treating patients who might be sick, we wouldn't provide you prenatal care if you were actively pregnant because you don't have prior test results") makes me have serious questions about potential ethics problems in the office. Is this what being a patient there is going to be like?

I don't feel like I can have those questions adequately answered without speaking with the doctor(s) in charge, and I don't think anybody's going to be in any great hurry to let me do that.

Billy Denis said...

Five bucks says this doctor was associated with OSF. You know, the hospital thyat USED TO BE named after Saint Francis.

b said...

Oh I can top that.
So here's the short version:
After my incident I am lying in the ER of a hospital. This is as a result of an at home radiologist improperly reading an X-Ray and discharging me. They had to call me back but wouldn't tell me why. This hospital has no neuro trauma ward so they need to transfer me to one of the larger University Hospitals with nuero. Only problem is I was considered not critical and as such neither facility would take me. Note that a compression fracture to the C5/C6 with a spinous process that is floating about is considered not "critical" yet I was not allowed to get up to move about at all.
I had two options:
1. Wait
2. Be discharged by the facility I was in and then walk into the ER of another.

I waited and a day and half later I got transferred.

And then after surgery the insurance war began cause no one wants to pay for spine surgery or the resulting excess charges due to the inefficiency of the systems.

As a result I have a very low opinion of the bureaucratic infrastructure that handles the processes in the medical community because all the outsourcing nearly got me killed and bankrupted.

So ethically they can all suck it, after they finish with my attorneys.

C. J. Summers said...

We had moved from a non-preferred-provider (NPP) to a preferred provider (PP) pediatrician for our kids. We loved our NPP and hated to leave, but we just couldn't afford it. So we transferred our records and moved to the PP pediatrician. I think I mentioned how awful our PP was -- having my son put in the hospital for every test under the sun and diagnosing him as "failure to thrive" when all we needed to do was increase his caloric intake and he was fine.

So, recently we got coverage through Illinois' All Kids program and can now afford to go back to our NPP pediatrician. Naturally, we wanted to transfer the PP records to the NPP. And so begins the rigmarole:

They use a third-party agency to copy and forward the records, which means I have to fill out a form requesting the records, then the third-party agency has to come in and determine how much it's going to cost to provide this service and send me a bill. I pay the bill, then the agency comes in and copies and forwards the records. Oh, but they only come every other Wednesday, so this process ends up taking 2-3 months, and costing me about $10-20 for each child.

I disliked that pediatric practice before, but now I hate it. Hate, hate, hate.

BeanCounter said...

That is quite sketchy. However, depending on how the practice is set up the doctor might not really be the one to talk to about this. A lot of times the doctors don't have much input on the schedulers/phone answerers, they are too busy doctoring. You should ask to spreak to the practice manager. If it is one of the hospital affiliate places, they have quality control personnel that handle things like this.

Katie said...

Wow! I am so sorry to hear that happened. Nazi nurses are the worst and I swear almost every doc has at least one! I wish you all the luck in the world on getting into any of the handful of actually all-around good OB/GYN's in the area. From hearing my friends' stories, you're lucky to get in as a new patient any earlier than 6 months.
You and Mr. McGee could just get pregnant....They'll get you in within a month for that. :)

Eyebrows McGee said...

apparently I got in fast because my doctor's office called over.

Anonymous said...

Bill, you must have some pretty broad shoulders to hold all those chips you are carrying.

Knight in Dragonland said...

They couldn't risk that you might be ill??? WHAT?! Now that makes no sense whatsoever. I was under the impression that, as a physician, the prevention and treatment of disease was, you know, MY JOB. Is this nurse working for the doctor or the insurance company?

Sue said...

In my earlier days....I worked for an OB/GYN practice. There was about 4 or 5 doctors and all of them had their own patients. We were instructed as receptionist/appointment schedulers that under NO circumstances were you to schedule a doctors patient with another doctor unless they were pregnant. In that case, they HAD to see all the doctors because the one who was on call the moment they went into labor would be the one that would deliver.

One day, and it was late in the day as I recall, a woman called in dire need of medical attention. She said she saw Dr. whoever but I had to give her the horrid news that sorry, he wasn't in and wouldn't be until the next week or so, in other words, she had to wait. She proceeded to explain to me that she has something on the lines of a yeast infection and girls, you know what I mean about unpleasant discomfort! This was in the day when you couldn't buy the crap over the counter and HAD to be seen by a physician before you could get a prescription. She had told me that she had seen the other doctors before because she had a baby so I thought it would be all right to schedule her with someone other than her original doctor. I did it and guess what...I got fired right after that. I did the right thing, but lost my job.

I have little faith in doctors knowing the inside of them. (sorry KiD) I recently moved here to Peoria and have not had a female checkup in 5 years because of the same thing you are experiencing EB's. I can't get in for an appointment with any doctors until next year and sorry, I don't know what is on my schedule that far in advance. I have been told to call back IF I have a problem and then I can be seen sooner. I have told them, I have a problem, I need to be seen, but unless I have something oozing out of me or in excruciating pain it's considered "routine" and it can wait...

Jeep2000 said...

Well, Eyebrows, I'm with ya. I wouldn't be too keen on being treated there after that encounter with the nurse.
But, if that's the best place for you to go, that's another story.
What a mess.

Anonymous said...

HI, I experienced something similar and have since emailed my Congressmen in the hopes of creating a Patient Portability Act that basically states that New Patients or Patients choosing a new doctor should be entitled to at least a consultation/ initial appointment with a new doctor. Basically what happend was a popular GP was busted for improper writing of prescriptions. He had thousands of legitimate patients. Patients trying to find a new doctor soon found out that other doctors in the surrounding area refused to see them. I guess out of fear. But the underlying problem is that as a group these other doctors are literally refusing medical care to a large group of people because of the personal mistake of one GP. What I see happening is that this large group of people have little choice but to use emergency room visits for simple care. Its overburdening the system and is causing insurance companies to be charged an emergency room visit for what should be an office visit. I also notice the non profit clinics are overburdened as well and its not right. Its like one huge patient blacklist.