Tuesday, June 4, 2013

Visit-based medicine

Monday after Eastern Sierra, a reminder from Valley Medical on the voicemail. 9:30 Tuesday morning. Too late to cancel.

They make the appointments automatically. Blue Shield - well, the house is full of pieces of paper from Blue Shield saying they don't have to pay for an MRI of my neck. Those people are shameless. Meanwhile if my travel pillow and I spend a night apart, the pain returns. Yeah everyone has that.

The doctor that sees me first is another doctor-in-training from Stanford. The fourth one so far. I'm training an entire graduating class for free. This guy is Mr. Fixit. He acts like we should do pain medication or warm water therapy or physical therapy. I've already been there. I'm doing stuff on my own that's better than that. TRX and yoga and cycling. Costco sells the big bottle of Advil, no Rx needed.

He keeps pushing. Maybe I need a medication patch. Maybe I need the pain-reducing effects of certain anti-depressants (that apparently work on the pain centers of the brain). Can't make this shit up. I tell him I'm only interested in root cause and maybe he should work on Blue Shield instead. He gets mad and I get mad.

He brings in Dr. L., the supervisor. They sit there together, looking at me, two against one. We talk about how dysfunctional insurance companies are and how it's been that way for 10 years. Then he shrugs and washes his hands of it, as if doctors are not complicit. Good to be him.

What are the possible causes of the pain in my neck? I want to know if medical science has any real help or if this is just jumping through hoops. He says he needs the imaging to take a guess. I don't believe that but let it go. Both of them have asked what I would like them to do today.

Well, Valley Medical made the appointment. My role is to say how I'm doing. As far as what you can do, that's the part you fill in. Otherwise I wouldn't need to come here.

This seems like basic logic to me but Dr. L. doesn't seem to like the response. Because, of course, this is how they make money. Next he asks if I have a GP, maybe I need an OB/GYN. He's suggesting the reason I'm pissing him off is menopause. In your 40's that's what doctors say to get you out of the office. And to make sure you don't come back.

I laugh pretty hard at them both and point out it's the wrong part of the body. I should ask what evidence he's working from. But I don't really care. He's shown his cards, there's nothing there.

I drive home and think, you are SO FIRED.

Later it dawns on me that people with brain injuries are directed to Valley Medical not because Valley Medical really knows how to help them. For the moderate and severe cases, people have no insurance. They lose their jobs, they have no money, their families fall apart. They have no choice but the county hospital. And the staff expects patients who can't push back, even though they have almost nothing to offer. That's part of the deal. It's a Dickens orphanage.

I wish this were a joke. Honestly, it's great to be free of those cretins.

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