From time to time in this space, I share a personal or family story about encounters with health care to illustrate broader points. Here we go again:
Fortunately, I’m a healthy guy and don’t have too many issues besides high cholesterol. I manage it with a combination of diet, exercise, and medication. I have my blood checked regularly and then see my primary care doctor to check the results and get my medications renewed. Sounds pretty routine, right? It should be.
But my doctor has joined a group practice affiliated with one of the major hospital systems in New York City and things have gotten complicated. They have their own lab and they want to me use it for blood draws. But it is inconvenient and, more importantly, my insurance won’t cover it. So, I need to have tests ordered from an outside lab.
The last time I needed bloodwork, they placed that order. But when I checked my patient portal to see the results, I could tell the most important ones were missing: They had a basic metabolic panel and a measurement of hemoglobin A1C (a blood sugar measure), but the lipid panel was missing entirely. That panel measures stuff like cholesterol, triglycerides, and so on; for me, it’s the most important one of all.
I called the lab and they insisted the test was never ordered. I called the doctor’s office, and they insisted it was ordered, but the lab hadn’t done it. It turned into a standoff, with each side wanting to be right. No one was focused on what I, the patient, really needed — which was actually very simple.
Eventually, I prevailed and the test is being done.
Next, I’ll have to go to my doctor’s office for an unnecessary visit to review the results. I’m not trained as a clinician, but I know how to interpret the results and I’m proficient at using my patient portal. In fact, I keep my own spreadsheet of test results to track my health over time (if any provider needs a new EMR, call me; it could be my side hustle!). The visit is pointless, but the new place insists that they will not refill prescriptions if I haven’t been seen in the last six months. As usual, the visit will consist mostly of chit-chat (“How’s your summer going?!”), and only then will I get my refills.
For me, none of this is truly problematic. It’s mostly annoying.
But what if you are not as well positioned as I am: someone in good overall health, with a high level of health literacy, good health insurance benefits, and a job with flexible scheduling?
What if you don’t have or are not proficient with an electronic patient portal?
What if you can’t understand or interpret lab results, or don’t even know what tests are supposed to be done?
What if you are not actively managing and advocating for your own health, and just trust your doctor’s office to do everything right?
What if I’d simply shown up at the doctor and we had no results to review?
And how much do all these unnecessary office visits end up costing the system (and me)?
Life is full of daily annoyances. We all must sort out bureaucratic slip-ups, resubmit paperwork that got lost, track down shipments, and so on. But the stakes are a lot higher when we are talking about our health. With a sigh and a shrug of the shoulders, I got everything sorted out for myself with no harm done. But it wouldn’t have gone so well for other people. And while these problems were “administrative” in nature and not directly tied to clinical quality of care, they would’ve affected my quality of care had they not been fixed. The little things add up — it’s all part of a whole, and patients need to always come first.
A happy post-script: A family member recently had a surgical episode and spent a couple of days in the hospital. Their care and patient experience were excellent; I was so impressed with the staff, the patient and family communications, and the post-discharge planning. There is hope!