Wednesday, October 02, 2013

Slipping through the Cracks

I've been in withdrawal for the past couple of days. This should never happen, but it does, with increasing frequency. I was diagnosed with hypogonadism about three years ago. My body, or to be more accurate, my testes, aren't producing enough testosterone themselves. Because of that, I have to make up the deficit by injecting it into myself. Most likely the psychiatric medications I take to treat an entirely different ailment are to blame. I hope for better drugs, knowing I must live with the side effects until then.

Endocrinologists are in short supply in Washington, DC, mostly because insulin-dependent baby boomers are using them to regulate their diabetes. This means that quality of care suffers for everyone. I'm not upset at my provider, instead I'm frustrated at the inefficiency of the system. That being said, I am an enthusiastic supporter of Obamacare and hope it will find a better strategy to manage bottlenecks like this.

Reforms of any kind require flexibility on the part of the planners. No one could have foreseen the obesity epidemic and the consequences of a sedentary lifestyle. Not every case of diabetes has the same causes, of course, but a particular strain due to lack of exercise along with a poor diet has grown more and more prevalent. Reform must take into account trends and patterns that no one could have foreseen. Twenty years ago, AIDS was a death sentence. Now it is a treatable chronic illness, provided you can afford the medications. Hands up for anyone who saw that coming. I didn't think so.

Forgive me if I have no new profundities to share with the world. It's exhausting leaving five different voicemails to five different departments, and never receive a reply. Over time, I've learned that even the most clogged bureaucracy can be circumvented, but like with the rest of life, it depends on who you know. For example, I have figured out that if I call for new prescriptions from the urology nurse, the matter will be seen to in a timely fashion. If I leave a voicemail for the urologist's secretary, it may be hours before I receive a reply.

If the health care law functions as designed, then shortages and lapses in care like these should not happen, or at least should be rare. And in all fairness, most of the time, they don't. The two most exasperating problems I have dealt with personally are doctors with too high a patient load and prior authorizations for prescription drugs. I haven't read anything about Obamacare that directly addresses these two problems. 

Prior authorizations are a way for health insurance companies to save money. They require extra work from doctors and nurses, who must justify in writing why their patients must be on a particular drug. The intent, in part, is to badger doctors into prescribing lower cost alternatives. Usually, prior authorizations are granted, but they're a pain for doctors and nurses, sometimes taking up to a week to process. I wonder if health insurance companies will use these more liberally from now on to make up costs.

The system, as designed, works well when doctors are not rushed, and when the same is true for their staff. By contrast, when doctors and specialists have to rush, then everything grinds to a halt. I was a patient at the National Institute of Mental Health (NIH) for a research study a few years ago. Research hospitals have time to devote to patient care and can develop a one-on-one relationship that would never happen elsewhere. It was impressed with how smoothly everything went. Insurance companies did not make demands or threaten ultimatums, which seems to complicate almost everything elsewhere.

Meanwhile, I continue to wait, knowing that the doctor will get back to me eventually. I have no say in the matter. My doctor is too busy to correct a problem that would take, at most, 10-15 minutes to resolve. Being angry about it doesn't do much good, but I silently catalog another wrinkle and peculiarity. Next time, I'll know better. Next time, I'll know just what to do. 

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