Specialist Limbo

So I’ve been dealing with a persistent ear infection thing for the past 10 days. Started while I was sick, but has lasted long beyond the other symptoms, which have passed. Scarily, it has survived a round of antibiotics without diminishing. Feels like a knot of something behind the inner ear – either a vacuum or a clod somewhere in there, leaning against the cochlea maybe. My hearing in the left ear is diminished by about 50%, and there’s a persistent ringing. My voice reverberates in my head, as does my every footstep. It’s uncomfortable and scary and leads to hypochrondriacal thoughts about tumors and other dangerous nasties – not typical thoughts at all for me, but its resistance to medication and unrelenting nagging at my state of being is doing a number on me.

My M.D. has run out of theories and has referred me to an otolaryngologist. Here’s where my patience with the medical system runs into a brick wall. When you get referred to a specialist in this country, you go into this double limbo state. First, you’re given a list of doctors covered by your plan. In this case, I had 18 to choose from, with zero criteria to use in choosing one. Throw a dart at the wall and see where it lands. No Consumer Reports for medical specialists, no user rankings, no anecdotal assistance. Just pick someone at random to entrust with your most critical needs.

Fortunately, I did have one criteria: I needed to see someone yesterday or today, because I fly tomorrow to Austin for a week at SXSW/Interactive. That’s where you hit limbo state #2. Started calling names on the list, only to find that earliest appointments were three weeks out. If you need to see someone soon, you’re directed to the emergency room — where you end up not seeing a specialist, like your doctor ordered. These are your choices: wait weeks (while more damage is possibly caused, depending on the malady), or go to the E.R. where you’ll wait all day and see someone who doesn’t specialize in the problem (gee, isn’t that why my doctor sent me to a specialist to begin with?) If you’ve got something that needs rapid attention, you’re S.O.L. What really weirds me out is that when you try to talk about this paradox with nurses and receptionists, there’s zero sympathy. That’s just the way the system works, and my goodness, aren’t you a weird one for bringing attention to it?

Finally did find someone with an appointment for today (a cancellation), but it took hours out of my work day yesterday, wading through phone trees, waiting on hold, waiting for call-backs, having the same conversation over and over again…

Everything – everything – is wrong with this picture. The idea seems to be that medicine somehow stands apart from the free market. I would expect that there being more demand than supply would result in there being more practices. But it’s not even about that. A lot of the offices I spoke too said things like “We only see patients Tues and Thurs mornings.” Huhn??? If you’re setting appointments three weeks out, why don’t you work more hours?

Every time I’m forced to deal with Medicine in America I feel like I’m walking on a strange planet where the rules of reality are in permanent suspension. None of it makes any sense.

Update: So it looks like I’ve contracted a form of virus that attacks the inner ear. Unlike bacteria, virii aren’t addressed by antibiotics (which is why there’s no antibiotic for colds or AIDS). There’s really no treatment, except to wait for the body to deal with it, which it probably will on its own. There is the remote possibility of permanent hearing loss, but so far it looks good – he tested my hearing and I actually haven’t lost nearly as much as I thought. It’s common for people to overestimate because the sensations are so weird. The “reverberations” are from a phenomenon called “autophony” — hearing yourself — also common when the cochlea is filled with fluid. Just in case it is a strong bacteria and not a virus, he’s put me on a stronger course of antibiotics, just to cover all the bases.

Music: Johnny Cash :: Guess Things Happen That Way

15 Replies to “Specialist Limbo”

  1. Is the specialist you’re trying to see an ENT or head-and-neck surgeon? The reason they only see patients on (for example) Tuesday and Thursday morning is because the rest of the time they’re in surgery or treating surgical patients. ENTs and other surgeons work very limited clinical hours.

  2. He’s an ENT. I understand about how they’re in surgery or doing other things the rest of the time, but that doesn’t make the problem any better for consumers/patients. No matter what the reason, if it takes three weeks to get an appointment for anything, then clearly there aren’t enough specialists.

    FWIW, Amy is going through a very similar situation right now, and is equally frustrating.

  3. I went through a similar situation with the insurance company trying to find a doctor. I got a list from the insurance company of dozens of doctors. I asked them how I could evaluated them. The person on the phone gave me a verbal *shrug.* At a 24 hour urgent care (psuedo-ER) I asked the doctor who treated me the same kind of question. Who do I pick? How do I know who to pick? He couldn’t tell me either.

    The best resource I can find is Public Citizen’s Health Research Group

    Specifically their state medical board information (find out if that doc has been disciplined):

    It isn’t the positive evaluation system that I think we all want, but at least it is the “stay away” information.

    Lazyweb idea: doctor and doctor office ratings like reseller ratings.

    Let’s see if the spam filter picks me up because of my links :c)

  4. Ok, I Googled “doctor ratings” and found:


    It looks like it is either the same people who do rate my prof. or they use the same system.

    It’s a start…

  5. you make it sound like USA is unique re: this situation. aren’t the countries with socialized medicine even worse in terms of getting timely care with your choice of physician? the advantage we (merkins) have in this situation, is that we have more options by going ex-insurance and paying out of pocket (or sometimes, healthcare plans will reimburse partially for out-of-network providers).

    i seem to remember hearing about e.g., canadians in need of cardiac bypass surgeries coming to the US to get it done because by the time they’d be in surgery under Canada’s system they’d have died already. And it seems to me that the economics of single-payer systems /would/ dictate that the trade off be between timely care vs. care-of-choice.

    anyway, i’m assuming you’re holding other similar industrialized nations’ med. systems in a favorable light when you talk about being frustrated with the system in this country; however, you should keep in mind that they have their own problems born of their particular systems too.

  6. Gilbert, thanks for the links. A start, you’re right.

    Baald, I don’t know enough about socialized medicine around the world to say whether it’s better or worse in general – I’m sure the answer to that varies widely per-country. I know that when I lived in Australia, I paid $8 to walk into any doctor’s office any time, and got seen immediately. And I wasn’t even a citizen. They didn’t care. But that was 20 years ago, and I wasn’t seeing a specialist at that time.

    It would be really interesting to see a comprehensive chart comparing things like “ease of going through a referral process” and “time spent in waiting rooms” and “time spent on the phone trying to arrange appointments” etc. all broken down by country.

    I remember when Michael Moore had that TV show (what was it called?) and did a segment sort of similar to this. In that piece, some “rare” country came out on top and the U.S. was way down on the list, but of course that could be lots of selective attention/editing to make a point.

    Trouble with trying to make generalizations in this territory is that it’s so vast with a zillion variables so comparisons are hard, and can make any point they want to make.

    I really wasn’t making any kind of point about America vs. other countries in my post – just saying that it sucks in America.

  7. Michael Moore’s show was TV Nation.

    And FYI, most *general pratctitoner* appointments here in Montreal get scheduled months out. And it gets worse, much worse, if you need to see a specialist.

    If you think socialized medicine works, it’s because you don’t live in it. ;)

    Grass is always greener.

  8. That’s not the first time I’ve heard about how bad the scene is Canada. But the problem is so multi-faceted. You always have to consider that a bad implementation is a bad implementation, and that health care being govt.-run is a descriptor, but not necessarily the cause of a bad program. interesting piece on how U.S. VA hospitals are an ideal model of how socialized medicine done right can be extremely effective. One of the great strengths is cohesiveness – getting everything under one roof, which includes computerized records shared effectively among caregivers.

    I dunno. This is a huge and complex topic. I just think it’s too easy to throw the baby out with the bathwater and blame government when what’s most at fault are draconian rules, poor integration, and waste. Waste is a big one, and god knows our privatized system wastes like a mofo.

  9. You live in a big city, no? That fact allows general practitioners to stress volume over quality of service (in my experience). That’s the free market in action right there.

    Re: otis media. I’ve had luck with Ciprofloxacin ear drops in the past. Prescribing first-line oral antibiotics for ear infections in adults is just ridiculous.

  10. I asked the doctors about ear drops, and their take was they weren’t effective for inner-ear stuff – only the smallest amount gets through the eardrum by osmosis. But that orals (especially these killer diller ones are effective systemically.

  11. I don’t really have any problems getting GP appointments here in Vancouver, BC, usually in about a week. Likewise there’s a drop-in clinic that my GP also works out of, and if I want to spend about 30-60 minutes waiting, I can be seen pretty quickly and they have all of my info on file already.

    For specialists it can be hit-or-miss: it really depends on how urgent the problem is, and in what field. For critical cases they will bump people back down the waiting list to make room. The only time I have heard of someone having to wait past the life-threatening “OMG you need it now” window is in cases where there’s some $100 million piece of specialized equipment necessary to treat the very few people who have the disease, there’s only one in Canada, one doctor who operates the machine, and everyone who needs treatment is in the same boat… or you can go to the US and pay $50k for treatment.

    In general with our socialized healthcare system, far more people have access to reasonable medical treatment than one has under a private system (where many go without decent coverage). The downside is that on the more specialized/expensive end of things, because everyone gets the same coverage there is a lot more demand, but only so much funding to go around to pay for all of the facilities and salaries.

  12. So who wrote this blog I dont know if the author is who he says he is but this is written really well…
    keep blogging

  13. That’s weird, I’ve been doing the “strange, stopped-up inner ear” thing, too. Of course, I’ve been basically sick off and on from Thanksgiving to now. Haven’t had a small child in the house for many years, but my 18-mo old brings home every virus and bacteria known to man (quite the little Typhoid Mary she is ;)

  14. WWE – Why in the world would I be other than who I claim to be? Anyway, thanks – glad you’re enjoying.

    David – Sympathies, man. I just can’t shake this thing, and it’s driving me nuts. Since Thanksgiving – yuck.

  15. Yeah, just a constant procession of colds, bronchitis, and even one bout of “walking pneumonia.” Been on antibiotics four, different times :P

    Oh, and LMAO at your interchange with WWE :D Yes, we all want to be Scot (cue a take-off on that scene from Sparticus, “I’m Sparticus!,” “No, I’m Sparticus!,”… ;)

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