Random Stew It seemed like a good idea at the time.

16Dec/080

Of Broken Noses and Health Care Systems

As I wrote a couple of weeks ago, I've been training hard in preparation for a black belt test scheduled for this Saturday. Thursday night, I sparred with several visiting black belts who had graciously agreed to participate in my testing. Unfortunately, one of them caught me with a punch that broke my nose.

"Yet who would have thought the old man to have had so much blood in him?" - William Shakespeare, Macbeth, 5.1

So, Friday morning I call my doctor to see about getting my nose fixed. Unfortunately, my doctor was moving his office to a new location and could not see me. So I ask the receptionist if the doctor can just refer me to an ENT specialist.

"No, the doctor cannot give referrals without seeing the patient first. You'll need to go to Urgent Care."

"Can you make an appointment for me at one of your practice's other locations? With another doctor?"

"No, we've already booked up all the other doctors with referrals today. You'll need to go to Urgent Care."

Instead, I decide to call my insurance company to see if I can just make an appointment directly with a specialist, cutting out the middleman as it were. Yes, it turns out I can "self-refer" to a specialist as long as they are a participating provider.

So, I call the ENT and spend the next 30 minutes arguing discussing whether my insurance will allow self-referrals or not. Finally, they call my insurance company and find that I was indeed correct.

"Our first appointment for a non-referral is December 23.", I'm told.

"That's 11 days from now! I'm self-referring; what do you mean by non-referral?"

"You don't have a referral from your doctor."

"If I had a doctor's referral when could I be seen?"

"In 3-5 days, when your swelling subsides."

Arrrggghhhh... I feel the rabbit hole open up beneath me.

I give in and go to Urgent Care. After only two hours, I'm seen by a doctor. I tell him that all I want is a referral to an ENT. He says he can't give a referral without a diagnosis and he needs X-rays to ensure I have a broken nose. He ignores me as I volunteer to ensure a broken nose by punching myself in the nose.

So, I have X-rays and, yes, my nose is broken into 3 pieces (surprising given that I don't think it's that misshapen). The doctor says he will give me a referral to an ENT. Great, I think, I'm on my way.

The staff member charged with dismissing me tells me that I'll need to take my X-rays to the ENT when I see them. So, I ask if I can just have the X-rays right then to save a trip later.

"No, you must have an appointment with a specialist before we can release your X-rays." he says with a kind of sigh that tells me the he's been down this road before.

"But they're my X-rays! Why can't I have them? And once I have an appointment with an ENT, how are you to know whether I'm telling you the truth anyway?" I argue with him.

"I know. The system is screwed up isn't it? All I can tell you is that you need an appointment first."

Whatev.

I walk out of Urgent Care and call the ENT, hoping to get an appointment and immediately pick up my X-rays. The ENT has not received the referral from Urgent Care. I'm amazed that such things aren't automated, but apparently Urgent Care usually faxes referrals. The appointment manager at the ENT tells me that Urgent Care is usually prompt with referrals and since it's now late Friday afternoon, I should call back Monday morning for an appointment.

Monday morning comes...still no referral from Urgent Care. Monday noon comes...still no referral from Urgent Care. I call them and am told that they're running behind from the weekend and will fax the referral shortly. Monday mid-afternoon comes...still no referral. I call again and ask if I can pick up the referral in person to take the ENT. Of course not.

Tuesday morning comes...still no referral from Urgent Care. Tuesday noon comes...you guessed it, still no referral. Finally, the ENT staff has pity on me, calls Urgent Care, and has the referral faxed immediately. I wish they had done this yesterday.

So now I can make an appointment with an ENT. Unfortunately, the earliest opening they have is at 3:15pm on Wednesday at their office on the other side of town. Oh, and they'll be "working me in" so I may have to wait a while. Want to bet that they look at my nose, confirm that it's broken, and schedule another appointment to fix it?