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Tuesday, March 9, 2010

How to navigate the healthcare maze

I'm such a pro at this! I've been in healthcare for over ten years (Yikes! I'm getting elderly!) and now I know all the tricks. Today I broke down and saw a prescriber for my miserable infection.
You may feel free to use my visit as an example for yourself.
First, I went to a nurse-practitioner clinic that my insurance covers for $5. Now I'll be up front with you. As a pharmacist, I see a LOT of errors from nurse practitioners. In fact, in the past I'd vowed not to ever see one for myself. I'm not trying to be too hard on the NPs, but there is something lacking in the training. So unless you are willing to take total control of the situation, I recommend an MD. There. I said it. Now people will probably send me hate mail. Sorry. I went to an NP because I figured I could sort of guide him along (and I'm cheap. My copay is five freakin' dollars).
Now there actually wasn't anyone ahead of me because I went right before school let out. All parents are currently driving to pick kids up. All kids are currently at school, unless they were sick, in which case they probably went to the clinic that morning and are safely home in bed eating ice cream and watching movies. If there had been a line, I would have used my fool-proof tactic to get seen first: gag or wretch a little in the waiting room, preferably while filling out paperwork for the triage nurse. Nobody likes to clean up vomit.
Next, and this is very important, you have to let the professional have their say first. It might be wrong or stupid, but you have to let it run its course or you'll irritate them. For example: "What are you here for today?" "Sore throat, malaise, aches." "Ah! Sounds like allergies! 95% of New Orleanians have allergies!" I didn't say peep because I knew when he took my temperature (which was 103, nicely cooperating) he'd change his tune.
Then you have to sort of lie in your medical history if you have gaps or problems. For example, he asked about my most recent pap and hey, none of my paps could even remotely be considered recent! But I told him last year. Yes I know. I'm a bad patient, and I'm lying to my health care professional. Now don't do that when you come into my pharmacy of course. But you can do it to your doctor to speed things up, if you know enough to differentiate between "this matters" and "he has to ask this so I won't sue him later". I just didn't want to distract from the situation on hand: the golf ball sized swelling on my throat.
If you are doing a follow up from a visit to another practitioner - ie, you called your friend for an rx last time, but you got sick again, like me - don't tell them that if you can't go back to that practitioner. Don't. They will send you back to the last person you saw, and probably charge you for the visit anyway. So I told Mr. NP that I took some doxycycline that I had "laying around".
Ok. So all that preliminary stuff is done. As far as the exam goes, be the model patients. Mention all your signs and symptoms, when you experienced them, how long they lasted. If he skips something, point it out ("Could you check my ear, too, please?"). When the initial allergy comment was thrown out I knew my fever would change his mind, but I also mentioned associated symptoms: that I had heart palpitations when the fever was high. Sure enough, my pulse was double my baseline.
Now comes one of the most important parts. HAVE YOUR DAM' FORMULARY WITH YOU. Your insurance only covers certain drugs. These drugs are listed on your formulary, usually along with your copy. So when MR.Np suggests an rx for Levaquin 750mg, you can politely tell him that it's not covered and costs about $200, how about a generic drug? Then he can switch it for you. Then you will not end up at the pharmacy and find out you can't afford your meds.
Then you have your prescriber call, fax, or email (E-scribe) your rx in to a pharmacy near your house - which already had all your insurance info and other data on file - and tell them you'll be there in about an hour. In about an hour, go pick it up. Easy. Convenient. Fast.
Eat something yummy, take your antibiotic, go to bed.

1 comment:

  1. You are too funny! Thanks for the lesson. LOL Hope you feel better SOON!