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Oh Lovely Progress
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Mar. 26th, 2008 @ 11:06 pm
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Two weeks ago I finally and at LONG last got to see an orthopedic doctor. The diagnosis on my knee was...healthy. The MRI, beautiful! Every layer of cartilage and each ligament and tendon exactly where it should be and whole. No instrument is made which could measure my relief at this news. The whole scope of what I faced changed from life-altering forever to a manageable drag which will go away.
My injury was obviously causing an issue but wasn't in the joint. Now I had pointed to a spot on my leg starting at the first visit way back when but nobody had anything to say about it. Nobody except the chiropractor. When I told the orthopedic Dr. that my chiro had assessed something around the fibula and the associated ligaments he agreed that it made sense given my pain patterns. OK. The orthopedic Dr. supported me going back to the chiropractor and to physical therapy now that we all knew there wasn't anything like torn cartilage that could be worsened by movement. It would have been nice to have that information much sooner so that I wouldn't have the string of secondary issues going on and a long rehab period. Anyway, long story shortened a little and it turns out I had a slightly dislocated fibula. OUCH! It has now been put aright as of one week ago and the difference is amazing. I am still tilted and have to walk with a cane but there is measurable progress in just one week.
On the insurance end, I have had two letters from Kaiser apologizing and telling me that my feedback is so very important. Honestly, if my feedback was that important they would have returned my calls in the first place. I can't wait to be done with them. I will wrap up my disgust at their various fumbles and misrepresentations with a letter nicely formatted on my company's letterhead. But first I must recover which requires its own brand of persistence. |
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Tiny Steps
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Feb. 27th, 2008 @ 04:10 pm
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How I am walking. Also how this is progressing.
The latest:
On Feb 21 I spoke with the Kaiser imaging department appointments desk about scheduling an MRI and they typed something into a computer, took my info, etc.. Just today that information made it to their subcontractor, Epic Imaging. 4 Days. Now I wait until 3/5 for an MRI.
*Edit*
I just spoke with orthopedics and for some reason my case is still "pending." I do not actually have access to a doctor yet. They said, last week, that they would be done with this on Monday, so I got through to the orthopedic nurse's desk today and left a message asking them to account for the delay and call me right away. 2 extra days of waiting so far. Ridiculous.
I also spoke with a friend who is a chropractic Dr. He was horrified to hear that I haven't gotten care and is going to see me on Monday to do a basic evaluation and get me referred to an appropriate specialist. At this point I do not have any significant trust in the quality of/access to care with Kaiser; this person will expedite communications with any other doctors so I can get a second opinion. At this rate it will likely be the first opinion. |
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Christopher Wren (Back to architecture...)
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Feb. 25th, 2008 @ 03:24 pm
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On today in history one of the more influential Architects died in London. Sir Christopher Wren was instrumental to the rebuilding of London post-fire and was the designer of St Paul's Cathedral yet it seems he labored under similar conditions as today's architects. This quote is from the Wired article posted today:
"He was knighted in 1673, but for all this work, he was paid only 200 pounds a year ($56,000 in today’s money) and was summarily dismissed in 1718 amid a dispute over the speed of rebuilding." |
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Buck-Passing and Kaiser's Corporate Culture
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Feb. 21st, 2008 @ 04:12 pm
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This morning I got a call from our HR/benefits woman. She had spent literally all morning on the phone with various people at Kaiser. Benefits Woman (BW) reported that the big K wanted me to call the non-responsive director of nursing myself. Said director is the woman who had the "member concern" form sitting on her desk since the 15th; the Kaiser machine reported that they would respond to that "concern" by the 19th they failed to do this so BW called again on my behalf. BW told them absolutely not; that the entire issue stemmed from their lack of communication and that they needed to rectify that immediately. Lo and behold I got a call fairly soon thereafter.
The phone conversation was one of the most frustrating I have ever had. This woman used the word "should" more than once essentially telling me that it's my fault that I didn't get a referral. I said that that was ridiculous. I had gone to the "doctor" (I ended up with a nurse practitioner) expecting and paying for expert care, that this nurse practitioner had walked in and admitted that she knew nothing about orthopedics before even beginning the conversation, that any conversation we had was about potential treatment, that the diagnosis was not addressed but that I was supposed to get some follow up communication including radiology results. Because of the aforementioned lack of knowledge of orthopedics and the promise of follow up, it seemed reasonable that there would be either another opportunity to talk about diagnosis if not a referral to someone who would be qualified to do so. I let this nursing director know that it was obvious that I needed care as I could not walk well and reported that this was (and still is) interrupting my ability to function in all my job and life responsibilities. I emphasized that I am the patient not an expert and that the care provider is supposed to be the expert where I can get qualified care and advice; that I understand that I need to participate in my recovery but that I cannot diagnose myself.
Of course then I went off, telling her that this just adds to other poor quality care I have gotten at Kaiser, that the 'poor care'** criticism had come from Kaiser doctors (actual MDs in their organization) yet I, the patient, have borne the consequences. I said that I will leave Kaiser as soon as it is possible for me to do so and that I can not wait for that day. She stammered a few things but mostly fell back on what seems to be their corporate culture training standard: It is the patient's responsibility to get the care they need by naming the tests and drugs they think they need, and by naming the specialist referrals they think they need. If the patient does not ask for the specific thing they want or think they might need then it is not Kaiser's problem that they are not getting care. Kaiser does not actually offer care or expert information to patients, the organization files paper and creates multiple records with the patient's thoughts noted on them. Now I know why I have always heard such dismal reactions from my non-K doctors at the mention of Kaiser.
After that I was galvanized and exercised the advantage of not taking No for an answer: I called the MRI center way the hell out in the middle of Clackamas (where they referred me) after getting the following response back from the nurse practitioner when I asked her to change the referral, which she could do if she wanted to take care of it but for some reason does not wish or choose to:
"I believe when you call to schedule the MRI you can make your location requests. I'm not sure if the Open MRI is available at all the radiology departments, but you can also make that request when scheduling. If I had know that you preferred an Open MRI at the time I ordered it (2/8) I could have included that with the order but I believe you can still make that request with scheduling."
For some reason she doesn't know or let on to the fact, that Kaiser actually refers to MRI facilities all over the metro area not just their own radiology departments. She also puts the blame for the specifics of the referral in my court. I did not know she was going to send an MRI referral without communicating to me beforehand, so how would I have known to say anything? After her initial problems with referring for one and promises of follow-up, the ball seemed to be in her court to inform me on the process. Here, again, the Kaiser culture is not about offering care and a range of services to patients, rather it's about telling them they 'should have known' to ask. Thrive or else, in other words. I called and requested a location change to be closer to home and emphasized that no, it's not OK for them to order sedation drugs and have to coordinate someone to drive me way the heck out there and to lose a day of work/wages, that they needed to understand that I should 1) have an open MRI since I know it's available and covered, 2) it should be an appointment that will not create a huge disruption in my life since facilities are both available close by and tend to be open longer than typical business hours to accommodate patients and 3) I should be able to drive there and back by myself. Seriously. I let the silence tick away between us on the phone and she relented.
Rawr!
Now I have to call orthopedics where I noticed that there is not one medical doctor listed in affiliation with the location they chose for my referral, nor is there anyone with explicit orthopedic or sports medicine training. It's a fracture clinic. What gives?
**
1) Not ordering a simple lab test that would have determined the correct antibiotic to be used. Months of problems as the result of incorrect antibiotics and a recurrent infection all stemming from the initial failure to order a simple lab test.
2) Inexpert prescribing of another drug which was in their formulary but not evaluated for it's appropriateness to my case. That time the "doctor" who was a PA simply flipped the computer screen around and asked which one off the list I wanted. Even then I said I wanted her *expert* opinion based in empirical fact and data. She failed to give that information. |
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Online Reference Links
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Feb. 19th, 2008 @ 08:16 am
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On Places:
ePodunk, this links to the local airport. Scan down the page where the map is and you can look for other places like libraries and hotels in the vicinity.
On Travel Delays:
The Bureau of Transportation Statistics. A good internet distraction while waiting for your late plane.
From the Research and Innovative Technology Administration.
Academic-ish:
Scholorpedia is another opensource reference site, but here the articles are cared for and written by scholars who are, hopefully, more qualified to wax poetic or scientific on the topic of choice. The articles are of a narrower and deeper ilk than those on Wikipedia.
On Gods and Goddesses:
Encyclopedia Mythica because every day is better with a little ancient religion or folkloric study. |
| » Minor Update |
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In the continuing saga: I just heard back from our benefits/HR person who finally heard back from Kaiser management. There is now something along the lines of a "Patient Concern" form or notice being sent to the departmental supervisor who will follow up with my provider. I am supposed to hear back in three days or less.
Simultaneously, I am searching for a Mr Incredible (if you've seen the Pixar movie...) within Kaiser to help me navigate the system. I got a word of mouth referral to an orthopedic surgeon within the organization who has been helping a co-worker deal with the red tape while they sort out some very complicated stuff for her baby son. This co-worker encouraged me to contact him directly. So I just sent him an email.
Even though I have very dark moments in all this there is a streak in me that relishes hitting them with everything I've got. Not only for me but for anyone else who may need care.
Feb. 15th, 2008 @ 10:40 am
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| » On The Failures of Our Health Care System |
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I went to Kaiser on 2/5 and am now embroiled in trying to get care for a knee problem that has grounded me in the past few weeks. It was one of the most frustrating experiences I have ever had in any health care organization – whether publicly or privately funded. ( If you want to read the whole story... )
Feb. 14th, 2008 @ 12:31 pm
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| » Link and whatnot |
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Found this blog today on home restoration, among other things. Might be interesting, so I'll have to keep an eye on this one.
The Project continues apace - now 66 days past the original date of substantial completion. The second, renegotiated date in the contract was October 5. Didn't make that on either. We agreed to do incremental punch list reviews to help keep things rolling along, but in the last week I have done two and neither time were the locations ready.
On the plus side: The client is pretty happy about things, so we've done a good job there.
Oct. 16th, 2007 @ 03:17 pm
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| » Link - Specs |
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A boring Monday kind of post. This site, http://www.4specs.com/ is really cool. It's about time there is something digital that's easier to use than Sweet's online.
And on a random note, I am trying to figure out why there is a strong smell of baby powder in the building today.
May. 21st, 2007 @ 10:42 am
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| » "Graciously Tough" |
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This is how my PM described my demeanor with our current, beloved client. They are actually beloved, as much as a client can be - many prominent (and I think nice) buildings the evidence of our history with them.
I'm a newcomer to that relationship and recently have been responsible for negotiating a contract and a contract amendment with them (2 different projects). The first contract was fairly easy: A small amount that came as a somewhat natural result of some conversations and a work request from one of the managers. The amendment was not.
Many days, emails, meetings, and even a sort of counter-proposal from the client (weird) were attempts at talking us out of my proposed fee for some picky and drawn-out work we have been asked to do. All while they were asking us to do more of that same work.
The work has been done "at risk" with no contract in place. I find this personally distasteful and to a certain extent unethical. Architects speak for their consultants - we're the stewards of their contract with us and have to act reasonably in light of that. I put my foot down, with behind the scenes encouragement from my PM, and told the client that we would not do this any longer. They are chomping at the bit and I did not relent. One more phone call and a night of them "sleeping on it" and it got approved. Every single bit, including scope I asked them to provide.
Apr. 18th, 2007 @ 03:35 pm
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