One of the challenges we have in workers’ compensation is that we are, in many jurisdictions, held hostage by a medical system that we can neither avoid or control. We are merely customers subject to the whims and quality of those who are serving the workers for whose injuries we are responsible. With medical spend becoming an ever bigger portion of workers’ comp – 70% in some jurisdictions – this is an area of ever growing concern. And yesterday I received just a teeny weeny taste of the frustrations our medical system can serve up.
As I have chronicled here before, this past year my doctor has been trying to find the appropriate medication that will control my high blood pressure while not making my life miserable. He started me on a basic medication, Lisiniprol. While I suffered no side effects, it wasn’t quite doing the trick at the prescribed dosage, so he increased the daily amount. That is when the coughing began. Because the cough was so persistent, he switched me to another medication, Losartan. While the cough reduced over time, it did not go away. During an annual physical several weeks ago, we discussed this, and he switched me to yet a third medicine, Amlodipine. He advised me to continue with the Losartan until our mail order pharmaceutical provider, Optum, sent me the new medication.
That medication arrived last week, while I was at the Comp Laude Gala in San Diego. I switched to the amlodipine Sunday morning.
Tuesday morning, I had a brief but rather intense dizzy spell while in the shower. It passed quickly, and by the end of the day I had not given it another thought. Wednesday morning, however, I awoke to intense dizziness that made it difficult to walk, and impossible to drive. While I suffered a bout of Vertigo a few years ago, this was different. The Vertigo had my head spinning in any position, while yesterday’s issue primarily affected me when standing or sitting. I was fine laying down. Naturally I did what most responsible patients would do; I ignored it for a few hours hoping it would go away. When that failed, I called my doctor’s office to get some advice.
I like my doctor. He is a good man who listens to his patients, and he has treated both my wife and I well in the past. My issue is with his office. He is an employee of First Physicians Group, a very large medical practice wholly owned by our community hospital, Sarasota Memorial. My wife has had problems with this office’s communications in the past. I was about to experience the very same issue.
It was 11:00AM. The woman who answered the call took the information, and advised me that the doctor or a nurse would return my call shortly. I had just a couple simple questions. Is this something that will pass, and should I continue taking the Amlodipine? Or should I switch back to Losartan, and if I do, are there any interactions I should be concerned with?
Two hours later, around 1:00PM, when I had not heard anything, I called again. I was told that the message was “sent back” with high priority, and I should be hearing from someone soon.
I didn’t.
My last call, at 4:45PM, went to their answering service, since they were gone for the day. They asked if I would like to have the doctor on-call paged. Since I had spent the entire day confined to my recliner, hadn’t taken any medication for my blood pressure, and had no clue what I should do, I said yes. She took my information and said she would page the on-call doctor and have him call me.
As I write this at 6:00AM the following morning, I am still waiting on that call.
Yesterday morning my BP was 139/73. This morning it is 168/89. The dizziness has subdued but has not gone away. I will try the doctor’s office again when they open, but I suspect I’ll be given advice from one of my medically educated readers before I hear from that office.
I am actually fairly lucky. I can vent here, and share my frustrations with a few thousand people. That is a cathartic exercise that most injured workers cannot do. After all, like an injured worker, I am dependent on my medical provider to communicate with me when needed. The SEAK Occupational Medicine and Workers’ Compensation Conference might have named me one of the “50 Most Influential People in Workers’ Compensation”, but I am still as clueless as the next guy when it comes to knowing what the proper “next step” is regarding my health care.
I need my doctor, or his office, to communicate with me in order to facilitate that. And communication remains one of our biggest challenges. I recently wrote that there were no billing codes for compassion; I would sincerely hope the problem here is not the absence of an ICD-10 for returning a phone call. Sarasota Memorial Hospital is a good facility, with dedicated employees that truly care. The passion for what they do is somewhat personal, as my father-in-law is a former Chairman of SMH, having spent 22 years on its publicly elected Board of Directors. Still, any organization is only as good as its worst employee, and an office that cannot return a simple yet important phone call certainly should be a concern.
And the lack of communication in medical care is the greater concern for our industry. For me, this was just a frustrating one day event. I will make it back to the office today (aided by curbs and the liberal use of neighboring driver’s horns), and my life continues on. For many injured workers’, at home and in the dark from an informational point of view, this problem could be a daily occurrence. And these occurrences are frustration points that lead to both litigation and poor outcome.
If we in workers’ comp want to avoid those unnecessary hassles, we should be as concerned with the medical office as we are the skill of the doctor. After all, seeing the patient is just half the battle. Supporting them and keeping them informed after the visit may be where that battle is lost.