Begging for health care

I sigh heavily as I take the card from my wallet and pick up the receiver. It’s time to play California’s most common game. No, it’s not the California Lottery, even though in this game the odds are also against you. But the stakes are even higher. It is a game that I call “Begging for Health Care,” a game that happens whenever I call up my HMO and try to convince them that I need to be seen by a doctor.

HMO, Health Maintenance Organization. According to my dictionary, one of the definitions of “maintain” is to “keep in an existing state.” My HMO is not in the least bit interested in my existence, but only in the premiums that are paid monthly by me and my employer. I don’t know whose health they are maintaining, but it’s certainly not mine.

I was calling my HMO to request a new doctor, hoping to be assigned one that I could actually see. I hadn’t seen my last doctor in over three years. And that was his choice, not mine.

When I was plagued by migraines so severe that I was unable to work for several days, he refused to see me, but called in a prescription for a medication that I had previously rejected because it made me disoriented. He had also given me a medication that caused me to gain 20 pounds in one month, not a good thing for a middle-aged African-American woman. When I asked him about it, he admitted that he knew about the side effect. When I asked why he hadn’t told me about it, he just shrugged.

Recently my OB/GYN told me that another medicine that he had prescribed to me reduced the effectiveness of my birth control pills. Good thing that I was only taking them to control heavy bleeding and was not sexually active, or I guess that my doctor would have just shrugged at an unplanned pregnancy too. This is Health Maintenance in California.

I finally get through the voice- mail maze and talk to an actual person. I tell the HMO representative what facility I would like to be assigned to and request a female physician. She gives me a list of names. I am not told anything about these doctors, and the only thing that the litany of names tells me is their nationality or the nationality of their husbands. Do they have specialties? Are any of them familiar with chronic migraines? Do any of them have any complaints on record against them? How long have they been practicing medicine? I’m given about a minute to select my new doctor, the person that may someday hold my life in their hands. I pick a name at random.

And now the real game begins. I ask to see this new randomly selected physician. I ask for a diabetes test. Diabetes runs in my family, and both my birth mother and adopted mother died from it. At 13, I saw my adopted mother lapse into a coma and never come out. I have seen other relatives have amputations, go blind and slowly die from this disease. I try to get tested regularly, so that I don’t meet with the same fate.

I ask the representative if I can be tested because of certain symptoms that I have had recently and I also ask about another health concern. Just trying to maintain my health, ma’am. She assures me that the doctor will get back to me within 24 hours. Three days later, I get a call from the doctor’s assistant. She addresses the other concern, but no mention is made of my request for a diabetes test. I don’t know whether to swear or cry. I wonder if my medical file is flagged in some way, if I am labeled a hypochondriac or if all of my symptoms are judged to be in some way “premenopausal.” The fact that I know when my own body is not right means nothing to the health-care “professionals.”

It seems like most HMOs do not want to see patients unless they are forced to. Last year, an article in The Sacramento Bee indicated that one major HMO advised its Northern California doctors not to see patients, but to just prescribe more medication for them. For a reasonably healthy woman of 45, I have an arsenal of pills larger than what my father was taking when he died at 75. And I wouldn’t be surprised if each pill counteracts the other.

When I called my HMO to request to see a psychologist, I was told that the only way I could see one quickly was to attempt suicide. Is that why they give patients so many pills? The only time that I got quality care from my HMO was when I went to the ER complaining of chest pains. They took me right away, and monitored me all day. I guess that they were afraid of a potential lawsuit if I croaked in the waiting room. So health is only a concern when it may be too late for it to be maintained.

I am not alone in my experiences. Everyone that I know has an HMO horror story. One friend nearly died when a condition that ultimately required major surgery was dismissed as indigestion. Another is facing amputation of her foot after spending over four months in the hospital because of a botched surgery. And the rich and famous are not immune either. I recently heard actress Fran Drescher on a talk show saying that complaints about her health were ignored and that her doctor would not do the procedure that would have detected her uterine cancer earlier.

Another definition of maintain is to “preserve from failure or decline.” How many of us are declining, as we wait by the phone, hoping that we will be granted the chance to be seen by a doctor, to have medical tests, to be diagnosed with potentially fatal diseases? Millions of dollars in premiums are paid to HMOs each year, but still we wait.

So we play the game. It is a game of chance, a lot like Russian roulette. But for many patients, the bullet is in the chamber, and death is the result. Then the headlines report about the unfortunate patients that fell “through the cracks.” In 21st-century California, there shouldn’t be any cracks. The maintaining of health should be a right, not a reward to the most persistent patient.