Guess Who Went To The Doctor Today

Last week I went to the dentist. Today I went to my ob/gyn for my annual.

These days, any trip to the doctor is an infuriating, exasperating traipse through our screwed up healthcare system. And I’m a really healthy person, with really good insurance. Still, red tape and insurance bullshit manages to piss me off every damn time.

I had already decided I was going to ask my doctor about the mandatory pre-abortion ultrasound bills currently making their way through the legislature, in particular, the deafening silence from the medical community and ob/gyn’s in general on this and other issues affecting women’s healthcare. But dang, before I could even get to that we got in a debate about socialized medicine.

It started when she told me she wouldn’t perform the ol’ “blood in the stool” test, aka the FOBT, which I’ve had done routinely for 30 something years. This was because, she said, “BlueCross Blue Shield of Tennessee no longer covers it.” Lovely. I repeat: not because I didn’t need it, but because insurance wouldn’t cover it. And that, she said, was because over the past few years insurance has routinely been paying for fewer and fewer things.

This test is an easy, cheap way to detect colorectal cancer. But hey, I’m over 50 now, it’s not like colon cancer is a concern for us olds, right?

Don’t answer that.

It doesn’t matter because she said I need to think about getting a colonoscopy at some point, since I’m an olds, and of course it’s a better diagnostic test. Now, BlueCross BlueShield of Tennessee only pays for one every 10 years if the first one comes back clean. So let’s hope I don’t develop anything in the decade in between tests because apparently I’d have no fucking way of knowing about it.

Okie dokie, let’s hope what I don’t know won’t kill me! Thank you, BlueCross BlueShield of Tennessee! May you all get colorectal cancer and die an excruciating, miserable death.

Yes, Republicans. Do tell me more about bureaucrats coming between me and my doctor. I’m dying to hear.

So then we both commiserated about how awful insurance was. I asked her which insurance company was the best in terms of coverage, since she dealt with so many. She said none of them, they’re all bad. Okay, I said, fine, then why don’t we ditch them all and go to socialized medicine?

“Oh, no! That’s worse,” she said. In England, she said, whether you have a hangnail or cancer, you’re put into the system at the same place. In other words, serious health issues aren’t given any more priority than minor ones. She heard this from a patient who lived in London for two years. Her patient, however, was considered a “guest of the country” and was put to the top of the list, she explained. (I’m a little unclear how the patient would know, plus if that were true, wouldn’t there be astronomical cancer fatality rates there? Which doesn’t seem to be happening.)

“That’s certainly not what my Canadian friends have told me,” I said. “I don’t know about England, but they told me in Canada if something’s seriously wrong, you’re priority. It’s true you might have to wait longer for routine stuff, but heck, I made this appointment a year ago!” It’s true, I had.

“Oh no,” my doctor responded, wagging her finger at me. “I know someone who lives in Vancouver and when she needed something done she went to Seattle.”

Clearly we weren’t getting anywhere, trading our stories about “people we knew.” What I did say was, what do we do? This can’t be the best there is. What we’re doing now isn’t working, too many people are uninsured, and the poor are suffering the most.

“Oh, the poor have TennCare,” she said.

And so it went. Clearly my doctor didn’t know the first thing about people who weren’t her patients. She worked at a nice office in the heart of Nashville’s central healthcare campus, not the Vine Hill or Downtown clinics. Her clients weren’t the uninsured or marginalized. Nor did she know anything about what was happening in the state legislature. I asked her if she was aware that there were bills in the legislature requiring women to get an ultrasound before receiving an abortion.

“Really?!” She seemed genuinely surprised. Jesus, lady! I wanted to scream. You’re a gynecologist! This is your field! Don’t you pay attention to what legislators are doing affecting your own business?

I asked if there was any medical reason why this procedure would be necessary. “They need to do it,” she said, “to determine the age of the fetus.”

“But what if a woman is positive that it’s within the first trimester?”

“They still need to do it, to make sure.”

“To make sure?”

“To make sure she’s telling the truth.”

Wow. So we have this law to mandate a diagnostic procedure because women are liars. Got that, ladies? The government thinks you’re all liars, just like with all of that “legitimate rape” stuff, and so they need to check up on you with a diagnostic tool whose sole function is to make sure you’re telling the truth.

Yes, Republicans. Do tell me more about your belief in “small government.” I’m dying to hear.

Keep in mind, I was just told I wouldn’t get a routine colon cancer diagnostic because my insurance won’t pay for it.

Like an idiot, I asked my doctor if she performed abortions. She told me no.

“Does anyone here perform them?”

“No.”

“So where does someone go if they need one? Someone with insurance, who can afford it, where do you refer them?”

“Planned Parenthood, I guess,” my doctor answered. “Or Atlanta.”

Keep in mind, Nashville is a healthcare city. Healthcare is one of the largest industries here. We have several major hospitals here. The Nashville Chamber of Commerce proudly touts how healthcare contributes $30 billion to the local economy and creates over 210,000 jobs. But that’s all bullshit. None of that matters if you’re a woman who needs an abortion. For that, you go to Atlanta.

I asked why, although I already knew the answer. But I wanted to hear her say it. And she did. It’s just too controversial, she said. “It’s the religious people, they don’t want it,” she said. Insurance won’t pay for it. Hospitals don’t want to have anything to do with it. And finally she said, “doctors have been killed.”

I’m sure “the religious people” will be thrilled to learn they have successfully intimidated doctors in Nashville into not performing abortions. What’s sad is that Nashville is touted as being a progressive city, a patch of blue surrounded by a sea of red. But we’re still a city where women are second-class citizens because our healthcare needs aren’t treated equally.

It’s not just abortion. My doctor told me that as of January 2009, she can’t perform tubal ligations at Baptist Hospital. Baptist is one of the major hospitals here in Nashville and in 2002 Baptist merged with St. Thomas, another major player, so both are now under the Ascension Health umbrella, which is a Catholic non-profit. I had read that because religious hospitals all receive federal funds, they had to offer some kind of “secular floor,” where stuff the Catholics find religiously offensive can be done.

“It was a room, not a floor,” my doctor told me. “A separate room.” And the nurse technician that would assist her had to clock out, clock in again for the hour of surgery, and clock back out again, so she could be paid out of separate, non-religious funds. But as of January 2009, that room is no longer there. Someone who is not a Catholic will nonetheless have their medical choices made by the Catholic church.

Yes, Republicans. Do tell me more about your belief in “religious freedom.” I’m dying to hear.

This is all just so crazy to me. I didn’t intend to write a novel, but we just covered so much ground. What I wanted to know is why the medical profession hasn’t spoken up as the state house and senate legislate their profession. I mean, good lord, every time something happens in Washington we have a flurry of industry associations and phony astroturf groups telling us why it’s a bad idea. Where’s the TN Medical Assn.? Besides offering “doctor of the day” volunteers and lobbying for tort reform, I mean. It seems they haven’t spoken up because the just don’t know or don’t care.

I asked my doctor why people in her profession didn’t speak out. And she said it’s because nothing was ever going to change. That was just it, it’s too big, too hard, too controversial. It’s not going to change. I was so outraged. I just refuse to believe nothing will ever change. I said, what if people said that back in the days of Jim Crow? We’d still have black hospitals and white hospitals. Yes, she said. You’re right. And that was that.

It was the most disheartening conversation I’ve ever had. Apparently the doctors just can’t be bothered. I mean, I don’t know what else to say and I’m way beyond needing to wrap this up. But I guess I had somehow thought that doctors cared about their patients’ healthcare. Silly me.

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27 Comments

Filed under abortion, birth control, Blue Cross, health insurance, healthcare, Nashville, women's rights

27 responses to “Guess Who Went To The Doctor Today

  1. deep

    Nah, doctors became doctors because they wanted to make lots of money. Especially the specialists. They find a simple routine that can net them lots of money per procedure and then keep repeating ad nauseum until retirement in the Caymans.

  2. I’m a thousand or so miles away, and I wanted to come and scream at your doctor.

    I know that between their schedules and the demands of CME and committees and whatnot, they don’t really have time for in-depth study of issues, but one would think that at least they’ve heard of the issues.

    I talked up some of this stuff when I was hanging out with medical personnel a few years ago, and hello, blank walls. Do they get hypnotized when they enter medical school?

  3. Kaiser Permanente is a good insurance provider. ( I think )

  4. My insurance policies (United Healthcare and Aetna at different times) cover colonoscopies when the doctor recommends them. I’m a polyp-making champ, so I go every two or three years – the doctor recommended every three, but I’ve gone at two because I make polyps. My wife, who’s a colon cancer survivor, now goes every 5 because she’s clean.

    Al it needs is someone who gets cancer because they followed Blue Cross’s recommendations and files a zillion dollar lawsuit to get that changed. Either that or a legislature with the courage to do the right thing, not that it will happen here, of course. Unless you want to start packing a gun up your ass, that is.

  5. democommie

    I’m on the VA healthcare system. I think it’s like what single payer would look like. Of course there are millions of people who are pissed off that it takes care of lazy people who don’t do anything to earn…oh, wait, the strains of “Halls of Montezumal” or one of the other armed forces ad jingles is wafting in the air. Oh, sorry, “Thanks for your service!”. As if, people who didn’t fight (or at least make themselves available, as in my case, to be sent to a war zone) don’t deserve basic healthcare.

    People I’ve met at the VA, with one exception–an asshole ER doc–have been courteous, polite and professional.

    National single payer healthcare is the only way to ensure that ALL who seek it, get a reasonable level of healthcare.

    Doctors who don’t give a shit about anything but money will always be out there, but they are not, I think, in the main the culprits.

  6. W

    There’s a lot wrong with that conversation, but at least your doctor stayed to talk to you. I have trouble keeping mine in the room long enough to answer questions about my prescriptions, much less have a political/religious discussion about health insurance.

  7. Jeezus Christ. This is damned disheartening.

  8. greennotGreen

    I have (hopefully now it’s “had”) ovarian cancer. I have BCBS Preferred and have been treated at Vanderbilt. I have nothing but praise for the doctors and nurses who have participated in my treatment, and my insurance has been awesome. Except for a couple of times the pharmacy had to wrangle over with BCBS over prescription refills (and why is one of my drugs $100/day? Really, it’s that expensive to manufacture?) I’ve had no problems and have paid a mere pittance compared to the original bills. (My surgery, which lasted over six hours, was over $114,000.)

    And about those expensive drugs: the federal government, in the form of the NIH, pays for the great majority of basic research that goes toward developing new drugs, and then we hand that research to the drug companies for free. And they turn around and charge huge amounts of money and make huge profits. I realize they have to cover research that doesn’t pan out and expensive clinical trials, but huge profits? Shouldn’t modest profits and knowing you’re curing disease and alleviating pain and suffering be enough?

    • Here’s wishing you a full, 100% recovery!

      Don’t get me started on prescription drugs. That was a whole ‘nother part of the conversation that I didn’t even get into here because I was already way past my allotted word count. Suffice it to say, a monthly prescription which was $65 6 months ago suddenly and inexplicably ballooned to $87 (some kind of change in our insurance plan, who knows), then my doc switched me to a “mini” version of the same drug which I was told “would only be $15.” Imagine my surprise when I was charged $70! Better than $87 but still! The pharmacist said “Oh, you know, your doctor probably doesn’t know, it always makes us look bad when they give the price of something over the phone but you probably have a deductible arrgle barrgle co-pay arrgle barrgle insurance blah blah.”

      So yesterday I ask my doctor about this amazing $15 version of my same drug which actually cost me $70. And she said, “Oh you need a card. We’ll get you the card, with the card it’s $15.”

      So this is some amazing card from Novartis that magically makes my $70 drug cost only $15, and you’d think someone somewhere — maybe the pharmacy? — would have seen one of these fucking things before and might have mentioned to “get the card.” It’s pure coincidence that my doctor’s appointment was just two weeks after I’d refilled my prescription, and what if I hadn’t thought to mention it?

      Aaaaaagggggghhhhhh!!!!! I fucking hate this shit.

      THERE HAS TO BE A BETTER WAY. But hey, I’m just a dumb housewife, what do I know.

  9. kosh III

    Here’s my healthcare stupidity story:

    A few years back my Doctor recommended custom orthotic inserts
    to correct a nerve that was pinched between two toes.
    Aetna would not cover the $400 cost for this but it would
    approve surgery to remove the nerve. Surgery would cost
    thousands of dollars, I would be off work and off my feet for
    4-6 weeks, I’d use all my sick and vacation time plus not get paid for at least half that time.
    $400 vesus thousands for surgery AND my lost pay. Fraking idiots!

    Insurance companies are not for covering health care but for
    denying as much as they can get away with and pumping up profits.

  10. a hip hop artist from Idaho (fka Bella Q)

    You need a new ob/gyn. At least I would. In no known universe would I trust my medical care to such a lazy moron, no matter how much conversation she provided.

    • FCMackell

      Well said.

    • Joey Giraud

      I thought about making the same comment, but after reading where Beale lives I realized she may not have many better choices. A mentally lazy libertarian doctor is better then a gun-packing, evolution-denying, Obama-deranged, prosperity-gospel-believing doctor.

  11. gene108

    What’s funny is, if you think Americans are scared of “socialized” medicine, you really don’t appreciate how scared Canadians are of our healthcare system.

    I’ve work with Canadians, who make sure they keep paying Canadian income tax to stay on the Canadian system – even though they have employer coverage in the U.S. – because they assume it’s (a) cheaper to pay $6k-$7k to Canada than getting sick in the U.S. and (b) the Canadian system won’t kick them out of coverage for getting sick, which they assume the employer coverage would do.

    We really don’t have any perspective on how terrible some things are in the U.S. and how much money we have as a country, to address problems, but lack the will to do it (i.e. right-wing obstructionism).

  12. Brit

    As an expat Brit, I can say without fear of contradiction from someone honest who’s ever really experienced NHS healthcare that your doctor doesn’t know what the hell she’s talking about.

    As someone with a decent but not exceptional job (high 5 figure salary), my “insurance coverage” here is a lot worse than the NHS care I had in the UK.

    It’s depressing that people believe the lies about systems like the NHS…

  13. Seeing/analyzing

    A couple of years ago, I was pregnant with a much-wanted baby. When I woke up one morning with some very frightening symptoms, I called the gyn’s office and begged for an appointment. After spending $60 on my co-pay and spending 2.5 hours in the waiting room while the doctor entertained a raucous drug salesman (hint: we can HEAR YOU through the thin walls!), the gyn sauntered in, said, “Oh, you’ll probably lose it–it’s may not be viable”. I asked if she could at least check with an ultrasound, and she said, “Your insurance won’t cover it”. So, what, I should have asked for an abortion, then “changed my mind” on the table?
    (P.S. For any who care, I went on to have a healthy baby, but not because my medical care was top-notch.)

    • democommie

      What your ob/gyn did borders on malpractice, if not crossing the line. I would have filed a complaint with the bar of medical overseers or whatever other medical watchdog group exists in your area.

      • Seeing/analyzing

        Which act was malpractice? The outrageous co-pay, the waiting for hours in the waiting room, or the fact that my insurance won’t cover ultrasounds? Sadly, those three are all features of any kind of dr. appt. I’ve been at. I have much better luck at the walk-in places that are popping up everywhere.

      • I got a stapf infection in a finger while gardening years ago and went to a doc-in-the-box and he gave me my anti-b shot in the wrong finger. Needle’s going in and he’s going, “oops this is the wrong finger heh heh sorrreee….”

        Gah.

      • Seeing/analyzing

        EEEK! Sorry to hear about your doc-in-a-box disaster. :( A couple of years ago, I sliced open my thumb while attempting to slice a bagel. My doctor’s office informed me their first available appointment was 7 weeks away; did I want it? The doc-in-the-box put in 22 stitches and sent me home in less than an hour. My insurance doesn’t pay for the doc-in-a-box, but they’re my only source of care.

  14. liberal

    “Now, BlueCross BlueShield of Tennessee only pays for one every 10 years if the first one comes back clean.”

    So? IIRC the US Preventive Services Task Force recommends only getting one every 10 years.

    • Well, at my age it would be nice to have the easy, cheap, routine “blood in the stool” test in the interim to make sure something doesn’t “pop up,” especially since I’ve been getting that test every year for 30 years. But regardless, the idea that we’re dispensing medical care based on what insurance will pay for NOT on what a doctor deems necessary is the very picture of “bureaucrats coming between me and my doctor” which Republicans endlessly fearmongered about.

  15. Silver

    Yeah, that Canadian who went to Seattle is probably an overweight 1%er who figured that his knee surgery is more important than a poor person’s heart problem.

    So he went to a place where people think that a rich person’s knee is more important than a poor person’s heart and they took care of it for him.

    I’m a Canadian who’s been living in the US for the last 10 years, and this is one of the little things that drives me into a spittle-spraying rage.

  16. splashy

    I have interacted/talked to people that have been/are in the Canadian, British and Australian health care systems, and they ALL say ours is insane, and they wouldn’t trade theirs for to have something like ours for anything. They think we are crazy to put up with what we have.

    • Seeing/analyzing

      I talk frequently to our British customers, and they’re completely appalled at the American health care system.

  17. evodevo

    On the ultrasound thingy, the reason is to determine exactly how far along the pregnancy is – in the old, pre-ultrasound days, for D&C’s or abortions they used what is called a “sounding rod”, extended through the cervix into the uterus to determine the length/size and thus the actual stage of pregnancy. I live in Ky and you have no idea of the number of women who haven’t any clue as to when the pregnancy started or how far along they are, even if they aren’t lying. (those urban-legend-sounding tales of women who didn’t know they were pregnant until the baby just showed up one day are TRUE)
    The latest Repub-mandated ultrasound stuff, however, is plainly just attempts to throw obstacles into the path of abortion providers, rather than “concern” for the patients.