Urgency Care

[Martin Hash]

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My wife, Gwynne, and I travel a lot, and subsequently, are seated in a stationary position for long periods of time. In the last couple months, I've been sitting for almost 100 hours. For some people, me for example, this is stressful on their body, and in my case, I can get a Urinary Track Infection if I'm not careful to drink liters of water. Normally, I take some antibiotics, Azithromycin, is my favorite, but I ran out after a few tablets and the pain had not completely gone away. I also had a low grade fever. Gwynne said that if it wasn't cleared up by tomorrow, we were going to the Urgency Care clinic at the hospital.
“Can't you just pick it up?” I asked her.
“You're a doctor, you know you have to be there.”
“For a drug you can get at the grocery store anywhere else in the world; it's crazy,” I complained.
But pain is what it is, so I reluctantly went with Gwynne to the hospital the next day. First, turns out, they don't open until 1 pm. I guess people don't have any urgency before then? But they did have a receptionist to triage things like UTIs and she put us through. A nurse asked me my history; I told her, mentioned I was a doctor. She kept getting the history wrong, but whatever. She took my temperature, saw that I had a fever, and told me to go down to the lab for a urine analysis.
“That's a lot of effort for an antibiotic prescription for a known UTI,” I complained.
“The doctor on call requires it,” she insisted.
So off I went across the hospital to the lab. There the intake receptionist gave me a cup and a sticker, and another sticker for a blood draw.
“What's this?” I asked.
“The doctor would like a lipid panel,” the receptionist explained.
“For a UTI?”
“It's standing orders.”
“I'm here for an antibiotic prescription. I don't want a blood draw.”
“Would you like to schedule it later?”
“I don't want to schedule it at all.”
We were at an impasse. I stood in front of the window for a minute or two then thought, what the hell.
“Okay, I'll get a blood draw.”
Seated at the station with a tourniquet around my arm, the phlebotomist asked cheerfully, “are you okay with a little pinch?”
“I'm a doctor; I used to do this; I hate a little pinch.”

After waiting another hour for the UA results to come back, the nurse finally called me back into the examination room.
“The results of your UA were not diagnostic; the doctor would like a more thorough exam,” the nurse said. “Are you okay with a NP or PA examining you?”
“Sure,” I replied, resigned, just wanting to get this over with.
“Are you okay with a female practitioner?”
I got a little suspicious with that question. We don't usually ask that of our patients unless...
“Wait, are we talking a prostate exam and a swab?” I asked.
“The doctor thinks a thorough exam would be appropriate,” the nurse replied.
“Hey, I came in here for some antibiotics. I'm a doctor. My wife, who is out in the Waiting Room, is a nurse. I've had a Urine Analysis, Blood Draw, we've been here for three hours, and now some woman is going to stick her finger up my ass?”
The nurse was rather surprised at my abruptness but she continued, “I can make you an appointment for tomorrow.”
“For tomorrow?” My incredulity increased. “I wouldn't be in here today if I didn't need something now. No, don't be making any appointments; I wouldn't show up if you did.”
The nurse smiled at me. I waited.
“Are you going to let me walk out of here with nothing?” I asked.
“I could set you an appointment.”
I was somewhat flabbergasted but I kept my mouth shut, stood up from the exam chair, and walked out, but it gets better.

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Statin Recommendation s.JPG

The next day my blood work came in and I read my Lipid panel: all fine. Remember, I'm a doctor. About an hour later I received a message from the doctor. He said that with my blood pressure and cholesterol results I needed to go on a daily regiment of statins, and he provided a prescription. Let me put this in perspective: for an acute presentation of UTI, I couldn't get some antibiotics, which most nations sell like aspirin, without an examination, but I could get a daily dose drug I would have to take for the rest of my life that would only lower my heart disease risk by 4% over 10 years! That's not all: the indication for this prescription was my borderline blood pressure, which was still okay for a man my age, but if I lost 10 pounds, my BP goes down and I would no longer flag for statins. But the doctor never suggested I diet; how could he, nobody weighed me at the hospital. They had me pee in a cup, poked a needle into my arm, wanted to stick a q-tip up my dick, but I never stepped on a scale... Why? Because Political Correctness has overwhelmed the medical field, and weight is now a taboo subject due to “weight shaming.” Heaven forbid some fatty wants to wear a bikini without feeling self-conscious; instead somebody's got to put something up my butt.

[Fife]

With your experience, you should write a modern Kafka story about what passes for medical care in the US today. I don't know how much it would sell, but it would be very entertaining.

It would be a great object lesson, also -- for everyone who thinks that just a bit more central planning and risk management via remote-control will make everything all better.

[Martin Hash]

While I was visiting my grandson in Lima, Peru, I stopped by a pharmacy and bought an ample supply of antibiotics for 60 cents a box, no DRE* required.

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*DRE (Digital Rectal Exam)

[doc_loliday]

Do you think we ought to be selling antibiotics like aspirin?

Funny story by the way.

[SuburbanFarmer]

With your experience, you should write a modern Kafka story about what passes for medical care in the US today. I don't know how much it would sell, but it would be very entertaining.

It would be a great object lesson, also -- for everyone who thinks that just a bit more central planning and risk management via remote-control will make everything all better.

This is an excellent road to fame. And a legacy.

[Montegriffo]

I'm old enough to remember when you could only get an analogue rectal exam.

[Martin Hash]

After I bought all those antibiotics in Peru, my wife, Gwynne, asked why I didn't just get them in the U.S.
"You were there," I exclaimed. "They wouldn't give me a prescription."
"Just call the Travel Clinic," she explained. "They do it over the phone and send the antibiotics in the mail the next day."
So I did.

Bringing the story up-to-date: The Urgency Care clinic turned me away after a 3 hours with nothing even though I had a fulminate fever and history of UTI, a dangerous condition, BUT I was able to buy antibiotics over the Internet from the same place with nothing but a credit card. They were $9.84; that's the subsidized price, still a lot more than Peru. The Urgency Care visit was $205.

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[SuburbanFarmer]

American health care uses the ‘fuck you pay me model’. It involves maximum extortion, Byzantine paperwork, and constant threats, to accomplish its sacred mission of creating pill addicts.