I had a particularly disturbing encounter with the Harris County Hospital District today.  When I visited the clinic in late December, the physician referred me for echocardiogram and gastroenterology consultions.  The gastroenterology folks called today to set up an appointment.  They don't have anything until March 13.  My appointment with the doctor was made for 1/26, without anyone asking if I had any input on the date.  What is the point of going to see the doctor (and by the way, they scheduled me to see the third different doctor I would see in three visits) without test results?  I asked the woman who called, and she suggested I call my doctor and ask for a provider-to-provider urgent appointment request.  When I did that, his nurse informed me they could do no such thing.  Eventually I got Ask My Nuirse, and she triaged me to see a doctor within 24 hours, and said she was going to call the doctor's office and make that recommendation.  I'm still waiting for the call back.

Now here is why this is so disturbing.  First this entire process took about four hours as I was shunted from one number to another, waiting through long robo-operator menus (which are incredibly oddly organized).  The other, more disturbing factor is that THE MAIN REASON I WAS HOSPITALIZED IN MID-MAY was abdominal distress of unknown causes.  My private rheumatologist,, who is seeing me for very low fees (lower than the bill I got from the Dr at the public health clinic!) thought I might have Crohn's disease, an ulcer or ulcerative colitis.  Since my blood platelets were very low (37000 when normal is 150,000 -400,000+), if an ulcer or a varices began bleeding, I could have bled to death in minutes.  After I was admitted to the main hospital in the HCHD system, did anyone investigate those issues?  As far as I know, they didn't even test for blood in my stools.  They certainly didn't run the gastro test/examination I'm STILL trying to get.  The good news is my blood platelets are up.  The bad news is that they are still on in the 80,000 - 90,000 range, and I am experiencing sudden bruising and what I suspect to be small  amounts of blood in my stools.  I asked  this question:  If I don't have the test until mid-March, and then I won't be able to get the results or treatment of any kind until they manage to find some time to give me an appointment I can make, how is this healthcare?  Their response "go to the ER."  I asked "Will the ER run the gastro test if I make it to the hospital?  Should I go NOW or wait until I'm possibly bleeding out?"  THAT question is what got the nurse to recommend the "within 24 hours" triage.  Half of that 24 hours has passed with no call.  If they call tomorrow, I have no way to get to the Dr's office, since my husband is still working 9-3 at his temporary holiday just above min wage job, and we need the income.

Ron Paul wants religious hospitals and other charity hospitals (like Shriner's) to supply healthcare for the poor.  To him, I'd like to ask this question:  if they have the capacity and manpower to do that, WHY ARE THEY NOT ALREADY DOING IT?  IF they CAN and WILL, why did we ever have to create a public hospital system paid for by taxpayers?  Would it be BETTER?  I suspect not.  

I could write an entire systems analysis report on what's wrong with the HCHD facilities.  From their admissions process to the telephone system.  What's eating the money is not patient care.  It's bureaucracy.  Making an appointment for a patient without any consultation as the scheduling is not only disrespectful of the patient's dignity, but disrespectful of the patient's schedule and life.    I wonder what % of the staff time is spent moving these casually made appointments?  I have been assigned a Primary Care Physician whom I have NEVER seen, and I was not scheduled to see him this upcoming appointment either.   I have to submit a form -- which they do not have online, cannot mail or FAX me but must obtain at the clinic -- to change my PCP.  They have the records of who I have seen.  Surely this could be done over the phone?  As a final example, the robo-operator offers an option for "established HCHD patients."  When I pressed the option, I had to listen to a lengthy recorded set of instructions on what to do if I didn't have a current a Gold Card, and then offered the option to press a number if I had a current Gold Card.  So I pressed the number, only to be greeted by the SAME lengthy instructions about what to do if my Gold Card wasn't current.  Hmm,  I have a current card and pressed the option indicating that I did, so what's the point  of having me AGAIN wait through this and press another number verifying I have a current card?  To put me to sleep so that when they finally pick up, they'll think nobody is there and they can hang up? (Don't laugh, it happened the last time I played "Call the clinic."  Oh and by the way, you cannot change an appointment AT the clinic if the one they gave you is impossible, you have to call in from home.  ::eyes rolling::

With the exception of the nurses on my floor, one admissions nurse,  one medical student, and one nurse in the ER, I am not impressed with the hospital staff.  As far as I can tell, neither of the two hospitals I have any experience with have a rheumatology department, and the staff seemed woefully ill-educated regarding lupus and its complications (despite the fact that their client population is disproportionately African-American, when African-American women have about three times as great a risk of getting lupus as Caucasian women.)   I'm pretty sure the diagnosis of heart failure was incorrect  (the echocardiogram is confirm that.)   As it now stands, it will be close to, if not more than a YEAR between my first symptoms last May and a final diagnosis and treatment.  If I survive the wait.  



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