Friday, April 16, 2010

A seamlessly smooth system? Not!

“You are not our problem, and lest you forget, we have ways of reminding you.” This is the clear and ever-present message to patients subject to referral between clinics within the Västmanland health care system (Västmanlands landsting) and the Västmanland County Hospital in Västerås (aka Bleak House).

That will be SEK 50, please
I recently had surgery at the hospital and needed to have my stitches, or in my case, staples, removed. I was told my local health care clinic could do it if I wanted to save myself a trip to the hospital. Why not? I thought.

On the scheduled day at the scheduled time, I went to the clinic and presented the staple removal request form I had received from the hospital. “SEK 50,” said the receptionist. What? I have to pay to have my staples removed?

I’ve always thought the purpose of co-payments is to discourage overuse of service. I hardly consider removal of surgical staples a matter of choice. Indeed, I thought it was part of the entire “surgical package,” whose cost is covered by county health care services.

I later learned if the hospital had removed the staples there would have been no charge.

Perhaps my clinic, since it was not responsible for putting in the staples, thought it had no responsibility to remove them, hence the co-payment. But SEK 50 was most certainly not the real cost of the task, and I’ll wager the clinic gets reimbursed by the hospital or county anyway. (I wonder if the clinic deducted the SEK 50 it had already charged me from its bill to the hospital/county? A little double-dipping never hurt anyone, I guess.)

So why charge me?

I guess it was just my clinic’s way of making me feel welcome, and reminding me not to waste its time on things that are not its responsibility.

We’re so busy!
But the urology clinic at Bleak House was not as subtle. Due to a complication during surgery, a tube had been inserted between my kidney and my bladder. It was to be removed three weeks after surgery. The gynecological surgeon told me I would by notified by mail of appointment time in urology for removal of the tube.

I waited two weeks. Nothing. By chance, I happened to speak with the surgeon who asked if I had received a urology appointment yet. Nope. Two days later, a letter arrived with an appointment for the following week. The date of the letter was the same day I had talked with the surgeon.

I should have suspected trouble when I saw that the appointment time on the letter was hand-written – a printed time of 11:00 am had been scratched out and 10:30 am handwritten next to it.

I arrived at 10:30 and signed in. After 45 minutes, I tracked someone down and said I had been waiting 45 minutes. She confirmed that I had a 10:30 appointment (duh!) and said there would be a wait. After another half hour – it was now 11:45 – someone heard me complaining on my cell phone to a friend and debating the pros and cons of leaving.

Two nurses approached me. They told me they were overbooked. (At least the airlines offer monetary compensation!) I insisted on knowing how long it would be before they could help me. They wouldn’t commit. Finally someone said “5 minutes.” I was skeptical, but about five minutes later one of the nurses fetched me. It was 12.00.

Suddenly she was all professional, but I wasn’t buying. She offered no apology so I asked for one. She muttered something, after which I let loose about how "patients are people and not hunks of meat!" I explained the staff should have let me know there was a delay, told me what was happening, and apologized for the wait. So then gave a more sincere apology and I said, “That’s all I wanted.” (I still would have been angry, but less so.)

She said there was a delay because they were fully booked with their own patients, but had been asked to take patients from other units too (i.e. me). The implication was that I had been squeezed in, but not by choice. (How long had they had the referral?)

They removed the tube. I was in and out in 20 minutes.

Apparently my local clinic considered it a burden to remove my staples and felt it necessary to “nickel and dime” me as a result. And apparently gynecology and urology disagreed as to whose responsibility it was to remove the tube.

These are internal fights that I as a patient should know nothing about. Yet here I am writing about them because they have directly affected me.

A seamlessly smooth system? Not.

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