I periodically post here, on Facebook, or elsewhere about confounding health care experiences. I’m relatively young, relatively healthy, and have very simple care needs. The failures I experience worry me because they imply that people with more complex or urgent needs are likely being even more poorly served. All of my experiences are with managed care providers. The most recent is with Kaiser Permanente.
I had symptoms that presented as a simple stomach ailment. I won’t go into the details because, as you might expect, they are not fun. After 96 hours of being barely able to eat, and having lost over 6 pounds of body weight, I decided it might be worthwhile to call the Kaiser consultation line and get an expert opinion as to whether I should take any further action or simply let it run its course. I was specifically concerned because I was going to need to travel for work, so I thought talking to a nurse would help me decide if the trip should be cancelled.
The phone tree was mystifying, as always. I kept being transferred to the wrong place, but after talking to three people I landed on a pre-screener who asked a few simple questions and, based on the answers, determined that I had no use for a phone nurse but instead needed an in-person appointment. He transferred me to appointments. They told me that none were available, and I should go to urgent care instead. And so off I went.
After the expected hour or so of waiting around and repeating my symptoms to three different people, the doctor gave me a cursory exam and confirmed that it was, indeed, a simple stomach virus which would run its course. He offered to do additional blood work, which I declined, and prescribed some medication to help with symptoms.
This is all fine, I suppose. If someone could make a cheap home combination blood pressure cuff, pulse/ox, and stethoscope that plugs into an iPhone, that would probably eliminate 20% of routine office visits. It’s the 21st century, where’s my telemedicine?
Anyway, the interesting bit is the prescription. You see, modern pharmacies have complex software to check for possible drug interactions. That’s in addition to the job of the doctor and the pharmacist, of course. I’m no expert, but reading the printout that came with the prescription immediately raised alarm bells. Dr. Internet suggests that taking this stuff could be a Very Bad Idea as in some cases it interacts with something I’m already taking to cause fun symptoms like coma. Now, I’m no expert, and I may be wrong about whether this is really dangerous. But yikes!
So I called Kaiser. The pharmacist I spoke to suggested tapering off the other medication while taking this one. I suggested that seemed ridiculous given the other med’s long biological half-life (due to an effect called nonlinear pharmacokinetics). He stumbled around a bit, and said he would have my doctor follow up. Right. In the meantime? Unclear.
Maybe it’s fine. But I’m sufficiently freaked out/miffed that I’m not touching the new stuff, and am just going to have to suffer the old-fashioned way. And I’m concerned about Kaiser’s capacity to effectively treat me while keeping me safe from iatrogenic effects.