It's not easy to be the patient these days. This week, it has taken every IQ point, every yogic mantra, and every ounce of emotional intelligence I have to get through the preop procedures and actually make it to the surgery without strangling someone.
Gone are the days, of course, when you checked into the hospital the night before surgery and had all the tests necessary to determine whether you were "good to go." Now those are all done in different places by different people whose systems don't communicate, and as a patient you feel like a rat on a grid by the time you get finished preparing.
Months ago, I chose the surgeon and the date, and began an exercise program geared especially toward hastening my recovery: Pilates, water aerobics, glute-strenthening exercises, and meditation on the positive outcome.
I chose the surgeon because she was willing to show me my X-rays, explain the procedure, and answer my questions. Before her, I went to see one who pooh-poohed my fears that what was done to my hip might influence my spine and make my back problems worse. He told me he had done 30,000 hip replacements, and I shouldn't worry. He said he didn't know much about backs. He said minimally invasive surgery was the way to go. Then he left the room and his staff began telling me the realities behind his hard sell. That was Dr. Maltrey. I'm sure he's a fine surgeon, but he scared the hell out of me. I like to think of my body parts as connected.
I left unconvinced. When I found Dr. Janet Whirlow, I cried in her office because she actually began to answer my questions. Later I came to find out she also answers her own phone and calls her patients personally to explain things.
So I scheduled the surgery, and planned a trip to China for the week before. I figured jet lag would be a good accompaniment for surgery. When I told Dr. Whirlow this, she laughed. It turns out I would have to give blood, in case I needed it, and have all the pre-op testing in the week I had planned to be in Guangzhou.
So I revised my plans. In the past two weeks, I have driven the 40 miles to and from Scottsdale Healthcare North a dozen times, mostly to act as my own courier, bringing my X-rays, tests, etc. from one place to another. Three times to receive "blood doping" shots I should have been able to get much closer to home.
My family doctor was on vacation, so I saw his nurse practitioner for my pre-op exam. She didn't have a rcent stress test in my chart, and told me I had to take one. I told her I had had one less than six months ago, and where to get it. She then told me there was no record of it at the hospital I told her to call. I had to go to Banner Samaritan, to the bowels of the basement, and pick up my own records, hand carrying them back to her office. Like a breathless retriever, I arrived in her office with the envelope in my teeth. She smiled: "you're good to go."
Then she never faxed my medical clearance to the surgeon. Last Friday, five minutes before I was to go on the air as a guest on a radio talk show, I got a panic call from the surgeon's office saying she was still missing the clearance. I made an emergency call to the doctor's office and made them promise to fax it within the hour.
When I got off the air, the surgeon's office called again. Yes, they had the clearance, but the lab had lost my UA. Would I mind going out to the hospital lab and peeing in a cup? Can I do it at the lab around the corner? No, because the surgeon can't get into their records.
I hop into the car (if you have ever needed a hip replacement, you know that hopping into the car is a metaphor) and drive out to Scottsdale. I present myself at the same outpatient lab that drew my blood the day before. I ask for the cup. They say I have to be admitted before they can take my sample. I proudly flash the hospital bracelet they had given me the day before at PreAdmission and Testing, and say I was already admitted. Hand over the cup, please.
The lady behind the desk said that was a hospital admission bracelet, not an outpatient bracelet, and I had to be admitted to the outpatient department. But the admitting lady was not working there on Friday afternoon, so I would have to walk around the entire hospital to the main admitting area.
I am walking with a cane, the hospital is under construction, the hallways are long, and I am pissed. I know I am already in their system, and that I have filled out the same forms about ten times in the past two weeks. I walk around to admitting.
The admitting lady laughs, and prints out another piece of paper for me to carry back to the lab. Can't you just email this to the lab? Or can't they see it on a screen, I ask? Nope. You have to bring the piece of paper. I ask why.
HIPAA, she answers. For the past two weeks, as I fetched and carried all the films and pieces of paper from place to place, I amused myself by asking "why is this process still done with paper?" The answer is always "HIPAA." I've begun to believe that everyone relies on HIPAA as the universal excuse -- it's code for "we're too lazy to figure out how to change our work flow."
No one working on the business side of the health care system cares a fig for the patient. They care only for the process. They do not care that patients may work, and be trying to get some things accomplished before checking out for surgery. They do not care that orthopedic patients may be uncomfortable walking and driving. And they certainly do not care that the inept processes they follow must cost billions of dollars a year.