Wednesday, April 1, 2009

The mammogram chronicles – part 5: You’re not our problem

I called the neighboring health care district (Eskilstuna) this morning to see if it was possible to get a mammogram there. I had to wait in the telephone queue (they apparently have no callback system), but it was only a 5-minute wait so that wasn’t too bad.

I explained that I was calling from Västerås (my health care district), that the Västerås mammography unit was backlogged, and that if I could get an appointment in Eskilstuna the Västerås district would pay for it. The nurse, receptionist or whoever it was who answered the phone said Eskilstuna also had a backlog (only a month!) and seemed unwilling to take me.

She asked if this was a routine health check. I told her yes and no - that it had been five or six years since I had had a mammogram, that I had some pain, and that I thought it was time to get another. She asked me my age and pointed out that I should be getting called in regularly for mammograms (the law says about every two years, I believe) in my own health care district.

(Long story here. I wanted reminders for mammograms to be sent to me, but I did not want them to automatically schedule a time, which is standard procedure. If you don’t show up for a scheduled appointment, you’re billed for the cost unless you cancel or reschedule it, which at that time required you to play the “telephone time” game, which I can’t stand. I’d rather call at my own convenience and schedule it myself. I asked if they could just send me a notice without assigning me a time. No, that was not possible. “The computer” was not set up to do that (even though appointments for these kinds of things are often hand-written in the reminders). So in a fit of pique I told them not to send reminders and they obliged. I wonder if they are now “punishing” me for not doing it their way. After all, if a middle-aged woman who is supposed to have mammograms regularly hasn’t had one for five to six years, don’t you think she’d be given some priority?)

She implied that they couldn’t help me since this was a routine health check. I said that it doesn’t really matter whether it is or isn’t since the law says I’m entitled to an appointment within three months of the request, and Västerås has told me they can't honor the 3-month limit. She said I needed a referral if they were to take me. I asked why I needed a statement from a doctor (which I would have to pay for) to confirm that my breasts are lumpy and that they hurt. I already know that. But if I had a slip of paper from a doctor saying what I already know they would take me? I said I didn’t need a referral for a mammogram.

She said that the rules vary from district to district and that women in her district need a referral for a mammogram (since they get mammograms regularly). So, I asked, if I live in Eskilstuna and a year has passed since my last mammogram but I suspect I need another I must have a referral from a doctor? She did not answer the question but said if I had a lump (that magic word again!) they would see me, but that pain is not a symptom.

She iterated that I should be getting the check-up in my own district and I repeated it’s impossible since they can’t meet the 3-month scheduling deadline. I said she could book an appointment with me now or wait a month and deal with my health care district directly when they come calling themselves next month. She took my contact information and said she would check with her supervisor and Västerås, and that she would call me back.

Why, you wonder, didn’t I just tell her I felt a lump? Because it’s too late. They all know me now, and I’ll soon be on everyone’s shit list. And, I must also admit, I'm curious to find out how dysfunctional the system is.

Update: As I was finishing this chronicle, Eskilstuna called me back. The nurse had spoken with Västerås and if I want a mammogram in Eskilstuna, I must get a referral from Västerås. I asked what “referral” means – a promise that Västerås would pay or a referral from a doctor saying I needed a mammogram, or both? She didn’t really know – a referral is a referral. But to me it matters. If I need a promise of payment, I have to nag the breast clinic to provide one. If I need a doctor’s statement, then I have to visit a doctor (or get my own physician to write one for me). Out of curiosity, I asked again if women in Eskilstuna need a referral for a mammogram. She reiterated that women in her district get regular check-ups so, in principle, there is no need. But if a year after getting a mammogram a woman wants another, she needs a doctor’s referral unless she has obvious symptoms such as a lump or discharge from a nipple. She suggested I contact my own district again. (Back to square one).

“I don’t understand why Västerås can’t manage to schedule a routine check-up,” she said. (The million dollar question!) I can. It’s personal – they hate me. But don’t ask me to see a psychiatrist about paranoia – the wait is too long.

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