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Unicorns, my anus*, and healthcare for all: Three things adults don’t discuss in polite conversation

“I’d like socialized medicine. Of course I’d also like Unicorns to fall out of my anus*; but today, all I really need is a referral to some place where my daughter can walk-in and we can leave with a $8 prescription for a basic antibiotic.” –DocForeman, 1/25/12 speaking to a receptionist.

My daughter, Jane has strep throat this morning: A simple childhood ailment, with a simple, inexpensive solution. And it only took four hours of traveling, five stops, and $188.50 dollars to take care of it. Of course, that is a few hundred to a few thousand dollars LESS than I might have paid, had I not been an insistent and informed consumer. Let’s review this morning’s events:

My daughter is unlucky to have contracted strep throat on the one week she is uninsured while her parents transition into new jobs in a new city. However, she has several things going for her. Her parents have an above average income, education, transportation, and a mother known for being…let’s just call it assertive. *wink*

7:30am: I take my son to school, and let the receptionist know my daughter will be out sick. Several teachers in our new neighborhood offer recommendations for a half-dozen pediatricians she can see once she is insured and enrolled in their clinics. I also get confusing advice about which urgent care clinics are open at which hours, vague directions, and an involved story about which clinic takes which insurance, on a given day, when the wind is blowing the right direction. I had also already used Google for several options. With a list in hand, I set off to find healthcare for my feverish, limp daughter.

LESSON 1: It is hard to actually find the right healthcare you need. There are now so many factors to consider, and an overwhelming configuration of options. This is not optimal when someone is sick and in pain.

8:15am: I arrive at an ER, which is at the address where my phone and Garmin have told me I will find Urgent care. The kind man at the check-in desk tells me that if I want, my daughter can be seen here. I know from experience, that this is a very expensive, and time-intensive choice. I ask for a referral to an Urgent Care facility, or a walk-in clinic. I get directions, and address, and phone number.

LESSON 2: You can always get outrageously overpriced, inappropriate care. No one will ever discuss that with you unless you bring it up yourself. You’ll just get an astronomical bill many weeks later, after it is too late to make other arrangements.

8:45am: I am stuck in traffic, unable to find the clinic where I was referred. I only get a voicemail message letting me know the clinic will not open for hours. The message offers no alternative care options besides dialing 911.

LESSON 3: No one is going to direct you to good appropriate care. You’ll either find it on your own, end up at the wrong place, or just give up and take your sick daughter home so she can at least lay down.

8:50am: While stuck in traffic I use my smart phone to Google major hospital clinics, and I call the information number. After waiting through several menus, and some really terrible 70s elevator music, I finally speak with a nice, and thoroughly unhelpful staff member. I specifically ask for a referral to any clinic where my daughter can walk-in and be seen, and say I’ll pay cash. I get directions and address to another clinic, and head that way. I’ll later find that I’ve been sent to an office that is locked, closed, and to another voicemail that only recites office hours.

LESSON 4: “Nice” is not the same as competent. Accurate, helpful information about where to get care is crucial. Putting someone on the other end of the phone line who can’t help a confused, frustrated, worried mother get her child to a doctor is bad healthcare. If I can’t get to a doctor and medication, nothing else matters.

9:20am: I walk into the primary care clinic next to the locked, closed “After Hours” clinic I’ve been mistakenly directed to. The receptionist rudely and repeatedly asks me why I don’t understand the meaning of “After Hours,” and tells me to go somewhere else. I state that I appreciate this, and would like to call ahead to make sure that is the place to take my very sick, pale, limp, but patient daughter, before I drag her around any more. The receptionist, after very strong urging from me, produces an incorrect phone number.

LESSON 5: Rude staff members may know what you need to do, but if they lack people skills, and are not very insightful, they still aren’t helpful. A front-line staff person’s people skills could be a deciding factor in someone’s healthcare outcome.

9:30am: I see a pediatric clinic next door. I check on-line, and they have good reviews from patients. I walk in, explain my situation, and ask for a referral. A patient, polite, competent receptionist gets my information, takes a minute to make some calls, verifies the location of the clinic I should go to, and invites me back to this practice when we’re insured, and have the advance notice to schedule a new patient visit. She is so great that I’ll probably take my children there. But that doesn’t help in the immediate moment.

LESSON 6: The current healthcare system requires insurance, and lots of advance notice and bureaucracy for regular primary healthcare to be delivered. My family is lucky. This experience is a fluke, and we’ll have access to this care shortly. But anyone with fewer resources is stuck with the care that I have to seek for my daughter today.

10:15am: I arrive at the one Urgent Care clinic that will let someone walk-in during business hours. I am happy to just give them the $180 dollars it will cost for my daughter to spend 10 minutes with a Physician’s Assistant. I am lucky to be able to afford this. I use my smart phone to check on reviews of this clinic, and find out that they don’t tell patients about the costs of lab work upfront, and that I’m likely to get a $200+ bill in the mail if I don’t ask about it during the visit. Sure enough, they start to initiate lab work, so I mention this, and that I am paying cash. They are happy to just write a prescription for an anti-biotic, because it is really clear that my daughter has strep throat. My husband meets me there, and goes to fill the prescription for $8.50.

LESSON 6: Buying Healthcare, even when you have the means to pay cash, is still difficult with a mysterious and highly variable price tag. My daughter’s care could have cost me anywhere from $0 to thousands of dollars depending on any of a number of factors. And it would have been nearly exactly the same care, in the same city. As patients we have a huge burden to manage these costs, under stressful circumstances, and without necessarily having good information.

LESSON 7: Social Media and a smart phone saved me about $200 dollars in medical costs. Most people won’t do what I did, however. They’ll just get stuck with an unnecessary bill.

11:45am: My Kindergarten-aged daughter and I get home, and she immediately crawls into bed, exhausted. She has traveled for four hours, in pain and feverish.

LESSON 8: Our Healthcare system is fragmented, and is not designed to direct sick, distressed people to the correct level of care in an effective, timely way. It is very easy to just refer people on to the next clinic. It is exceptional and noteworthy if you can find or are sent to the best place for you to go. And, for your hassle, the pricing and billing practices of this system are difficult to predict, and likely to get easily out of hand if you are not vigilant, with above-average resources.

I occupy healthcare, as a provider, a patient, and above all as a mother because my daughter deserves better. It is not necessary or appropriate to ask a sick, hurting 6 yr. old to patiently wait through four hours of hassle and travel, just to get a commonly available antibiotic from the store at the end of our block. It is not acceptable to put even one more barrier between my daughter and good medical care.

I’d like universal health care, and unicorns to fall out of my anus*, but mostly I just want my daughter to be able to get the care she needs, when she needs it. I want that for your daughters, your sons, and for you, too. But this morning, mostly, I just wanted it for Jane

*Anus is an anatomically correct and appropriate term. It has been suggested that some people might react strongly to that word. If that is the case, I offer the following response: If the only thing about this story you can find to react to is the word “anus” and not the plight of a sick child in pain…Well that’s exactly why our healthcare system is not better than it is. We’ve come to find illness and bureaucracy acceptable. We have lost perspective on exactly why healthcare needs to be changed. The word “anus” should not be the most troubling part of this story. And, if it is, it should cause us to re-examine ourselves as a society.