An alien in health-care land

In the wonderland of United States medicine

I have had some amazing experiences with doctors in the USA and I
am eternally grateful to those wonderful human beings and
professionals for their healing and life saving efforts as well as
contributions to me and mine. As I relate these experiences, I am so
grateful that these shining exceptions came into my life and adopted
me. The words that follow do not apply to them. I know that they and
the members of their staff are outstanding exceptions to what I write
below.
I believe that most US citizens are the victims of a systematic scam
perpetrated upon them by a large number of insurance and
pharmaceutical companies, doctors, other medical professionals and
pharmacies working in tandem.
Let me tell you what led me to this belief.
Having spent almost 50 years in another country, being cared for by
medical professionals who are members of my family, I am somewhat
spoilt, and perhaps innocent about the ways of this brave new world.
My wife works for an organisation and so we have health benefits.
The fundamental benefit here is that we do not have to stand in line to
have a sum of approximately $ 75 deducted from every one of her
paychecks to receive these benefits. We live in Tampa, Florida.
My saga begins with problems with my eyes and a pain in my
shoulders. I called an individual who is designated as my Primary Care
Physician, let us call him Dr. PCP.
The woman that answered the phone asked me if I was a new patient.
I confessed to being one such. Then, I was asked what insurance I was
on, rather than what my problem was. I said that my carrier was
AvMed. This did not soften her attitude any. She put me on hold
several times during the conversation. I was unable to get an
appointment with the one supposed to care for nearly a week. I could
only be seen during the period Monday to Friday. In other words, I had
to take off from my working hours to make the appointment. Doctors
have yet to learn to work when their patients dont.
On the appointed day and hour, after spending half an hour looking for
the doctors office, we called them, only to find that they had moved

some time ago to a new location. The receptionist had taken down my
insurance information since I was a new patient but had omitted to tell
me the new address or offer me directions. Neither the AvMed
directory nor website had the new address. Since I was late for my
appointment, I would have to wait for an opening. The doctors office
was beautiful, but the reception area was bereft of a TV set, coffee or
water fountain. There were several magazines.
I was not deprived of human company however. Plenty of people were
waiting to be seen. Periodically a name would be called and a relieved
person would spring out of their chair and run for the door for fear of
losing their chance.
A wait of one hour is normal and to be expected in medical
establishments, even if you have an appointment, I was told. The time
of appointment is the time you are expected to arrive and meet the
receptionist. Know well that the doctor will not see you then. Each of
my visits to a doctors office has taken up at least half a working day.
A name was announced and I could not recognize it as being mine.
Since my name is arguably the most famous human name in world
history and was the title of a movie that won several Academy awards,
I expect a reasonably close interpretation or rendition of it. I
mistakenly expect people to have learnt it during school. When that
unintelligible name was called again, I decided that this might just be
my opening and if it was not my name, I could always come back and
sit down. The chart showed my name and I crawled through my
opening.
No, that young woman was not the doctor. She unsmilingly took my
blood pressure, weight, height and pulse. She noted down my
symptoms with complete detachment and departed saying, He will be
with you shortly. In the meantime, I found out that the rest room was
spic and span and even fragrant.
By and by, the doctor arrived and examined me thoroughly. He
promised to refer me to an eye specialist and offered me all possible
help. He asked me to exercise my arms to reduce the shoulder pain.
He was unhurried, solicitous and charming. I wondered what he had
done in life to be punished with staff like this. I informed him that I
conduct management training and offered him all my help at no cost.
He promised that we would sit down some day. Three months later,
the opportune day is yet to arrive. Most people do not know that they
have a problem till something blows a gasket, I suppose.

I have two kinds of eye problems. Glaucoma and corneal opacity.

Because of this dual problem, I need a corneal super-specialist and a
glaucoma super-specialist. These doctors see no cases other than ones
in their super-specialty.
Armed with advice from the doctors I have mentioned in the first
paragraph, I found a corneal super-specialist who was in the AvMed
provider directory and website. His business office steadfastly told me
that they did not take AvMed. I called AvMed, who asked me to use
the magic words Primary Plus. This whole process took nearly a week.
I used the mantra and the doors swung open into a large, mostly
tightly run, efficient and friendly organisation. Doctors respond to
messages on the same day, are cheerful and uplifting and patiently
answer all questions.
A laser surgery was the best alternative and the insurance company
promptly refused to pay for it. After an alternative surgery costing four
times more was proposed to them, they asked the doctors office to
send the bill to them. The business office did not call me back with this
news the same day and I could not schedule myself for the surgery
which takes place only twice a month, thereby wasting a precious
three weeks.
Whether the bill will be paid or not, remains to be seen. Three weeks
after the surgery, they sent my wife a document wherein she was to
certify that I was not covered by any other insurance.
I did undergo the surgery. More time was spent on signing documents,
than the surgery itself. I signed away most of my rights. For example,
legal problems with this doctor will go for arbitration and not a jury
trial (Juries consist of patients!). If I die on the operating chair, my
living will, if any, will be ignored and I will be resuscitated or put on a
life-support system and dropped off at the nearest hospital. I do not
know whether Dr. PCP will be there signing referrals.
Irrelevant as this may be, I am slowly recovering from the surgery
which was quick and painless.
One of the drugs I use is Muro 128 ointment, manufactured by
Bausch and Lomb. The tube contains 3.5 grams of medication and
costs nearly $20. Its 3.5 grams include inactive ingredients: water,
lanolin, petroleum jelly and mineral oil. The active ingredient is 0.1525

grams of Sodium Chloride. Also knows as common salt. Talk about

profiteering.
Pharmaceutical companies here must make incredible profits, since
their profit margins are unchecked. So do retailers or pharmacies,
since they can sell any medicines at any price they like. The same
medicines are available in many other countries at a small fraction of
the cost.
After much research, I have concluded that there is no board certified
Glaucoma super-specialist accepting AvMed or Primary Plus in the
Tampa Bay area. In private conversations, other doctors have told me
that this insurance company is notoriously slow in making payments
and they prefer not to work with them.
Did you forget that I have pain in my shoulders and arms?
A friendly doctor and her spouse, a one-time orthopedic surgeon (Yes,
two of the first paragraph doctors), suggested that I had probably
developed rotator cuff tendonitis, but that I needed to undergo an MRI
to rule out anything else.
Dr. PCP being the funnel, I called and asked for a referral and got one
for a plain, vanilla flavored X-ray! A note on the referral said, An X-ray
is needed before I can order an MRI. Another wasted half a day. Two
days later, I was told that the X-ray was negative but Dr. PCP would
need to send me to an orthopedic surgeon since only he could ask for
an MRI. Wonder why that was not done in the first place?
The shoulder pain continued.
This new worthy is a Dr. Richard Gray. I called immediately to schedule
an appointment, It was almost 5.00 PM. I was asked to hold, she hung
up the phone on me and when I called right back, I got the answering
service.
The shoulder pain continued.
I called again the next day and found out that this able professional
only worked twice a week in Tampa. I was offered a date and I
requested that I be given a moment to check my schedule. I was
promptly cut off. Now, the foregoing saga may have given you the
impression that all I do, all day, all through my life, is seek healthcare. I am sorry but I do pursue a profession to put bread on the table

and sometimes it calls for travel. For the next two weeks I could not
give Dr. Gray an appointment. So, I called back and got my
appointment on a day two weeks later. This receptionist was trained in
the same school as Dr. PCPs rece[tionist. She got all my insurance
data but left it to me to discover where they were located. When I
asked, she gave me the street address but when I asked for the
nearest intersection or some landmark, she hung up.
Three months into the pain, I managed to meet the doctor.
I, at least, am not surprised that there are so many lawsuits and so
many judges and juries willing to award millions of dollars in damages
against the health-care profession. I know that I would, if a half
decent case were to be presented to me.
Perhaps most patients do not have similar experiences and I am
unfortunate in having them. For the sake of all US citizens, I sincerely
hope so.