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Saturday, March 20, 2010

Failing Me

My personal version of Nationalized Health Care, the VA, has failed me; surprise.

I noted on the 8th that they'd be testing me quite a bit. I had a cardiac stress test that week, which I failed, and a pulmonary function which was good, and an echo test, which was also good. So, the following Monday an imaging stress test was done. Radioactive isotopes were pumped into my blood, I ran a treadmill, and then had pictures of my heart taken.

This is where the system failed. I failed the test; bad enough to cause a couple of doctors a lot of concern; but not enough to get anyone to pick up a phone and call me. I was scheduled for a visit on Thursday, so they planned on telling me then, evidently.

The problem is, I had a heart attack (luckily mild) Wednesday night. Thursday I was feeling well enough to call the VA, and notify them I'd be unable to attend my appointment, I was in the hospital due to the above mentioned heart attack, and was going to be taken for a catheterization shortly.

Six hours later (the same person) called back and asked my wife why I missed my appointment, and told her it was really important I see a the cardiologist, there were problems with my stress test. While I know the Internet isn't censored, I'll avoid posting the wife's response out of respect for any nuns who might read this.

Friday, shortly before the cardiologist who performed part of my procedure came to see me; the attending physician who treated me 2 weeks earlier at the VA called. She'd been doing follow up reviews, saw my stress test, and realized I hadn't been to cardiology (there). So she wanted to let me know it was urgent I saw a the cardiologist. I explained what had transpired over the last 36 hours, and assured her, I'd seen one, just not on my terms.

Here's why the VA failed in this episode, and why my government run health care has failed so often in 30 years. The Bureaucracy of the system is the issue. Most doctors other than GP's don't make decisions on their own.

As was my case a cardiology fellow did the (2nd) stress test, and dicated it. But he didn't call me, instead, he sent the dication to a secretary for transcription. It's not her job (nor should it be) to call patients back, so she didn't. The head of cardiology has to review the transcript in a record, and approve of any recommendations. He did, but he didn't notify me, why bother, I'd be in the next day for an appointment. Unless of course I had a heart attack.

Contrast that to how most "regular health care works". The cardiologist orders a stress test, in the case of my first one I failed. At that point most civilian cardiologists immediately admit you, and order the follow up imaging stress test. This is especially true in cases like mine with a family history and basically every bad marker for heart disease.

Then they run the next test and keep you until they have read the images and decide what it says. In my case, it would have dictated an immediate catheterization, so at that point a number of meds would have been started, and I'd have been doing nothing that could cause any stress on my heart until I was on the table getting fixed.

So instead of going from the 5th, when I was first admitted to the hospital for observation, to the 18th when I had the procedure, I probably would have been completely through the test battery and "fixed" by the 10th or 12th. Six days and 1 heart attack sooner.

This isn't to say there is nothing right with either the VA, or the Military Treatment Facility I go to for my primary care. For general care, and preventive medicine they are pretty good. My annual physical this year found that my blood pressure was getting back out of control, and that my cholesterol had jumped back up too high. It actually started the ball rolling on some of this stuff.

But once they get out of that area to specialty care, the wheels fall off. The same physical couldn't find the problem with one of my hands, so off I go to a specialist. Except there's exactly one in a hundred mile radius that will accept the government reimbursement rate to treat it. He's booked until late April. I guess another 2 months (my physical was late February) isn't long to wait.

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