Jul. 25th, 2017

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I have a known history of PVCs.  PVCs are "premature ventricular contractions" which basically means that the ventricles of my heart get a little over-excited and jump the gun.  Hence the "premature."  It is usually a benign heart arrhythmia.  They were noted on my sleep study, which was done three to five years ago.  Known history.

For Reasons, I got rather drunk Saturday night at Fourth Street.  While I was trying to fall asleep, I felt just plain weird, and I thought to feel my pulse.  I was missing every eighth beat.  That's...a lot of PVCs.  Since then, I've been noticing occasional tightness in my chest, a very slight something that one might call shortness of breath, and a lot of missed beats.  Now, at least some of the weird feeling in my chest is almost certainly muscular.  I don't wear a bra, I am old, and the muscles attaching to my rib cage are a bit stressed.  And some of the shortness of breath may or may not be related to asthma.

One night at work, with entirely too much time on my hands, as my patient was coming in late, I hooked myself up to the amplifier, just running the EKG.  (This cost my work exactly two disposable snap electrodes, one alcohol wipe, and one sani-wipe.)  Yep, my heart was throwing PVCs.  One morning, I was throwing between six and twelve a minute. 

Possible triggers:  alcohol, caffeine, and Allegra.  So, I've stopped taking Allegra, stopped having a nightcap after work, and reduced the caffeine.  I tried eliminating the caffeine, but that caused me to become depressed, and there's literally no future in that.  I switched to Claritin, which doesn't work as well, but man I need to not claw my eyes out.

I repeat: PVCs are almost always a benign arrhythmia.  There are tests.  I should probably have them done.  Possibly a Holter monitor, probably a (shudder) stress test.  Ick.  Probably expensive.  Sigh.  After a month of monitoring my pulse for missed beats, messing about with my chemical profile, and whinging and moaning about not liking doctors, I sent an email to my doctor through the automated system, describing my symptoms, providing the above information, and asking for an appointment.

And now we get to how health care is really not a consumer good.

I get back an email stating that they cannot schedule me an appointment based on my reported symptoms, and I need to talk to a nurse, first.  I roll my eyes.  I call the clinic's Nurseline, and go through all the above information.  I assume she can also see my email to my doc, but who knows.  She asks me a series of questions, the answer to most of them is "no."  Am I in pain?  Does the pain radiate? Am I dizzy?  Do I feel nauseous?  No, no, no, no.  She then says, "You should go to the Emergency Room."  I explain that I will not do so.  I point out that PVCs are almost always benign.  (When they aren't benign, they still aren't a terminal rhythm.  They're a symptom of cardiomyopathy or some other serious damn thing, but not instantly fatal.)  I am still paying off my last visit to the ER, eight months ago.  The nurse tries to insist.  I tell her that I will, under no circumstances, do any such thing.  We get rather cross with each other.  She states that their guidelines do not permit them to schedule an appointment for these symptoms, the guidelines require that I be seen on an emergent basis.  I point out that this is health care, and I can refuse any damn thing I want. 

Eventually, she says that she will have to talk to my provider, and will call me back.  I point out that I evidently have a condition so dire that I must be seen on an emergent basis, but if I refuse, they will not permit me to see my own damn doctor, and how does that even make sense.  We became even crosser with one another. 

I wake up to a voice mail stating that I can call my clinic and schedule an appointment.  By this time, of course, the clinic is closed, and after hours people cannot schedule. 

So, this morning, I call the clinic.  And am offered an appointment at 9:40 a.m.  I explain that this simply doesn't work, as I have to go to work tonight, which means I need to be in bed by 11:00 a.m.  The nurse asks why that doesn't work.  I point out that even if I get in and out in an hour, I'm still not home before 11:00 a.m., and that means probably not in bed until 11:30 or noon, and that assumes that they don't decide to do a bunch of stuff, and what's the chance of that?   She allows as to the justice of my remarks, and offers me...Urgent Care.  Yeah, no.  While not as expensive as the ER, it a) doesn't solve my problem with needing to be in bed, and b) IT'S NOT AN EMERGENCY, FFS.  She says that the guidelines are that I be seen same day.

Quick note:  You know how I know that this isn't an emergency?  Because every time the nurse attempts to make me go to the emergency room, they say, "guidelines."  If it really were an emergency, they'd be talking about, you know, death.  (I did have a nurse say that to me once, in reference to a possible case of tetanus.)  The fact that the nurses sound vaguely unhappy about the guidelines is also a tell.

We go a couple more rounds.  My normal provider doesn't work on Thursdays, is full on Wednesday, and is also completely booked on Friday.  It is suggested that perhaps I call back on Wednesday morning and see if anything has opened up.  I point out that the system is completely broken.  The nurse agrees.  Eventually, she asks, "Do you have to see your usual provider?"  No, I don't.  I mean, I like my doctor, but I'm willing to go to someone else.  So she schedules me for 7:40 (oh god) a.m. on Thursday with some guy I've never seen.

I am a price sensitive and informed consumer of health care.  And at every turn, the system is trying, desperately, to shunt me into a high cost alternative, for no good reason.  Additionally, I already know that there is no point in asking what any of this will cost.  The provider has no idea what my insurance will cover.  The insurance company typically will not answer these questions.  Moreover, once I surrender myself to the professionals, they will run whatever tests they think wise, and I will have almost no say over them.  I will certainly not be given enough information about the test, the cost, the possible results, and the potential treatment to make an informed decision about whether or not the test is a cost-effective choice.  I have less control over my own health care, and less information, than I have about my cat's health, where they will cheerfully lay out exactly what the tests cost, what they might reveal, what the treatment path would be based on various scenarios, etc.  The other thing I have very little control over is my insurance.  I get insurance through work, and it is both expensive and not very good.  I have a $3500 deductible, and the things it covers at only 80% (after deductible) is long and irritating.  Nor can I, as an individual, shop around for a better deal. 

Health Care is not a consumer good.  A consumer good responds to market forces if the consumer is informed, if there is information available, if there are alternatives, and if the primary driving force behind the consumption is rational rather than emotional.  Most importantly, the consumer needs to have some control.  None of this is true about health care. 


 


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