Jun 23 2010

How I Ended Up Without A Primary Care Physician And The Worst Hospital I’ve Ever Been In

I haven’t yet posted why my original 3-4 week Arizona vacation turned into a 6 week plus adventure.

There’s some backstory here that needs ‘splaining. First of all, let’s get the planned itinerary out of the way. I left on Mar 28th and arrived on Mar 29th. On Mar 25th, I got notice from my insurance (Tricare Prime) that I needed to find a new primary care doctor by April 1. The letter was dated several weeks earlier. 

This pissed me off because on March 22, I’d seen my primary care doc and got a bunch of blood tests done pertaining to a chronic problem. Had I known I was about to be “dumped” from treatment at the MTF (which I’d been coerced into 4 years before) I would not have bothered.

Anyway… with little more than five days notice, I have to find another primary care physician. First, I contact the physician my husband has used for years. That’s a no go. Then I find the largest group practicing near my home and affiliated with the hospital nearest my home. I contact them and am told that each physician decides whether to accept new patients and their insurance. After a few denials from specific physicians in that group, I’m finally informed that none of the 13 will take me on.

By this time, I’m in Arizona. So, I search again and this time find a physician who will take me. I fill out the paperwork and am informed by Tricare that if the paperwork is received before the 2oth of April, the assignment to the new PCP will be valid on May 1.

That’s wonderful and I make an appointment with the new doc for May 6. I plan to be home on April 28th… exactly a month after I left. Except for the perhaps wasteful blood tests, everything is good.

Except… on April 25th, I am running a fever and have stomach pain. Monday, April 26th, the pain is worse, the fever a bit higher. Since I don’t think I have a primary care physician to call for a referral to an urgent care clinic, I call Tricare directly. I am informed that since April 17th when I submitted my request (that I was told would be effective May 1) I do have a PCP and that I must get any referrals from her.

Unfortunately, she hasn’t seen me before and ethically can’t make any referrals. (This is another topic…) and therefore I can’t get a referral from anyone. I am advised that since this is the case I should go to the ER since that doesn’t require a referral. However, it’s been pounded into me that using the ER for routine care is a bad, bad, wasteful thing and that Tricare might not cover it. Since I don’t think my problem is an emergency, I’m not that thrilled with that advice. But I’m also worried that I won’t feel like driving 1200 miles unless I get feeling better.

So I go to the nearest ER which is less than a mile from my daughter’s house. Why I should have chosen an ER much further away may be the subject of another post. Let’s just say that the close hospital didn’t have a great reputation. But… I was only going to probably get a prescription for an antibiotic and a suggestion I follow up with my PCP when I get home, right?

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Apr 03 2009

My Favorite Primary Care Physician

Tag: health,TricareDonna B. @ 11:19 pm

I only get to see this guy when my assigned PCP is overwhelmed at the MTF (Military Treatment Facility) to which, as a Tricare Prime patient, I am enrolled.

I want to make it clear that any of the following which might seem derogatory toward military health care is derogatory only toward SYSTEMS. The people involved are wonderful and trying their very best to be the best medical providers. What I criticize are the rules/regulations/etc.,  and the hoops they and their patients must jump through.

This guy is good for me. He’s emotionally and professionallly honest with me. He calls me on my bullshit, but doesn’t make me feel like a moron. This is probably personality more than medical training — but we are able to communicate with each other.

This ability is priceless. MasterCard, Universal Health Care, Electronic Medical Records and all the other technological advances in medical care cannot replace the physician/patient relationship.

My MTF assigned PCP has this ability too, but she’s restricted in her ability to follow-up and follow-through with her patients. It’s just too damned hard to get an appointment with her and she has as little input into the availability of appointments as I do. This is a system failure, not a physician failure.

I got lucky. Through conversations with the non-MTF appointment person and billing agent, I learned which hoops I needed to jump through within the MTF referral process. Oh yeah, the MTF appointment clerk I worked with after learning the right words — ie, words she could “respond to” without repercussions led to EIGHT (that’s right, 8!) referral numbers, each with four authorized follow-ups. Folks, that translates to almost unlimited access to this non-MTF physician.

This freedom of medical treatment comes at a price. I must pay $12 bucks each time I see my new favorite PCP. (Please don’t tell Congress or the DOD that I consider that one fantastic deal.)


Jan 23 2008

To Believe or Not Believe in Fibromyalgia

Tag: health,TricareDonna B. @ 12:25 am

My first diagnosis of fibromyalgia was in 1992. Antidepressants helped, I sort of “got over it” and went on with life. I still had those “trigger points” in the shoulders, knees, shins, ankles, etc., but as long as nobody pinched or pressed there I was fine.  Then, in 2000, my PCM of the day, said (when I winced at her pushing on my lower shins and said that one doctor had said that was from fibromyalgia) that she didn’t “believe” in fibromyalgia. End of discussion. I’ve tried not “believing” I felt pain, but dammit, the pain was still there, as was the overwhelming fatigue. Since I was first diagnosed with it in 1992, the only thing I’ve found that really relieves the pain is a combination of Strattera and Lexapro.

I’ve not mentioned “fibromyalgia” to any other doctor since the one who didn’t “believe” in it because I don’t want to be classified as a nut case or drug seeker. Also, I do not believe that fibromyalgia is the cause of all my pain. I think I also have a pinched nerve or something that causes sudden, extreme, but thankfully short-lasting pain in my legs.

My main problem – as mentioned in “I am my own PCM” is the lack of opportunity to discuss multiple aches, pains, symptoms, etc., with my doctor in one single visit. Appointments are generally limited to “what, specifically, is bothering you today?” That really doesn’t lend itself well to “well… several things and could they possibly be related?”

I do have a verified diagnosis of arthritis and I wonder which pain is caused by that. I classify my wrist, shoulder, knee, and ankle pain to it… but shin pain? I dunno… and apparently neither do most doctors. Why does the shoulder and knee pain differ when somebody squeezes either body part (a typical occurrence at Southern family reunions) from the more ordinary “oh god, I’ve overused this joint today” pain?

Bottom Line: I don’t know what the hell’s wrong with me, but articles like “Drug Approved. Is Disease Real?” don’t help answer the question. Note that the addition of Straterra to my normal drug regimin has almost eliminated the need for Tylenol and Naproxen. The only drawback is the tendency of Straterra to cause dizziness. Unlike most folks, I have a benign brain tumor that (though dead through radiation) may cause dizziness.

hmmm…. what side effects of what up with do I put?


Jan 13 2008

Being my own Primary Care Manager

Tag: health,TricareDonna B. @ 2:01 am

A while back I wrote about being my own PCM. There, I implied that was not a good thing. As I think upon it more, I’ve decided I was wrong. Not only am I my own PCM, I darn well should be. Who — besides me — is more interested in my overall health and well-being? I should leave that up to anyone else than me?

No. I have to take responsibility for myself and my health.

As I’ve experienced a few dizzy spells the last few weeks, I’ve decided to take a good look at my medications. There are 8 (eight!!) prescription drugs I take daily. Could it be possible that while there are no “serious” interactions among these drugs, that some combination is causing me to feel dizzy?

My Tricare Prime PCM relies on the computerized comparison of these drugs to determine “compatibility” and, I suppose the MTF pharmacy does also. Yet, my body is unique and may react differently than normally expected.

I’ve decided to do my own research into each drug I’ve been prescribed and then I will go over those results with my PCM, whoever he or she may be at the time I finish.


Dec 28 2007

Still Sick

Tag: health,TricareDonna B. @ 11:14 am

I think I’m getting better. I got an appointment at the clinic yesterday and am on a different kind of antibiotic.

I have a tendency to bash military health care at times, but I have to report two good recent experiences. First, a visit to the Urgent Care Clinic at Moncrief Army Community Hospital, where I was seen quickly, given some relief immediately and sent away with medicine – no extra trip to a pharmacy.

Unfortunately, the medicine didn’t work well enough, or the strain of the 850 mile drive home simply made me worse. So, the day after Christmas I call Barksdale and my description of symptoms (and the fact that they could electronically access the visit to Moncrief) got me an appointment yesterday morning.

I’ve learned that you don’t simply call and ask the appointment person for an appointment. They rarely have any, but they will always get you a call back from a nurse who has much greater appointing powers.

This makes twice, yes that’s TWICE in a row that I’ve seen my assigned PCM! Maybe things are settling down there and she will be around for a while.


Dec 04 2007

I am my own PCM

Tag: health,TricareDonna B. @ 10:44 pm

It’s not like I planned it this way. I grew up with the idea that one had a family doctor they saw regularly for checkups, shots, broken bones, and skinned knees. That’s what I looked for when I was older. I have no opposition to specialists, but I would have preferred the continuity of seeing the same doctor each time I go. I really would like to have a primary care manager.That’s not happening under Tricare Prime. I’m assigned to an MTF (military treatment center) and since I’ve been in the plan – 2 years now – I’ve been assigned to five different PCMs. I had 3 visits with the first, 2 with the second, 0 with the third, 3 with the 4th, and one with the current one. Two of these assignments have lasted less than 6 weeks. Three of these visits were for actual illness, the others were to get medication refills. Each new PCM wants to “see” me before refilling scripts I’ve been on for years, or before putting me on an alternate generic because the DOD has made a new deal with a different drug company.

None of these doctors ever had the chance to get to know me, or for me to know them. The MTF has a nice electronic medical records system, but it’s time-consuming and limiting. The doctor or PA is facing the computer, not me.

Before a visit, I do or consider all the things Christine recommends in Preparing for a Doctors Visit. My list of medications includes OTC stuff, meds I previously took, who prescribed them, why I no longer take them, dates of the above, etc.Not only do I write out questions I want to ask, but I include objectives I want to meet during the visit. Those are most often, get a refill written or get a referral to a specialist. Never have I discussed long-term medical goals with any of them. They know as well as I that we may never see each other again.

The closest I’ve come to having continuity of care is always getting the same internist when I’m hospitalized (luck of the draw) and the ongoing relationship I had with my radioncologist. But who wants to go the hospital or have radiation treatments to get a little continuity of care?This is why I am my own PCM. As Christine writes, “You know your body best, and you need to be your own advocate in the doctor’s office.”