Gimp Rant #57 – A Healthcare Vent

This isn’t going to be a lengthy post. This isn’t a post about the Affordable Care Act. This isn’t a post about President Obama. Nope, this post is much simpler than all of that.

This post is about putting the “care” back in healthcare.

Now then, before I go any further I should tell you that I actually do like my primary care physician. In fact, if I didn’t like this physician I’d have been gone long ago because I find the Community Health Network a maddening and non-user friendly experience despite their efforts to develop electronic records and to tie all of their various campuses and networks together.

Community Health Network is a Central Indiana based network of hospitals, clinics, pavilions, etc. with over 200 sites of care throughout Central Indiana. It has been recognized for its integrated health system and, indeed, its computer network is impressive and has helped me hang on for as long as I have given my own physician’s comfort with technology and its utilization as part of primary care.

From its own website, Community Health Network labels itself as “Central Indiana’s leader in providing convenient access to exceptional healthcare services, where and when patients need them—in hospitals, health pavilions and doctor’s offices, as well as workplaces, schools and homes.”

Now then, this is complete crap.

As someone who has played a central role in planting a web-based church, I wholeheartedly believe in the power of technology to create networks, increase efficiency, improve lives, and create another vehicle through which we can reach out and help people who all too often fall through the cracks. However, when we allow technology to dominate our systems of care we have failed those we serve. When we allow our structures to dictate how we serve, then we’ve removed the “care” from healthcare.

Unfortunately, it seems as if this is the direction that Community Health Network is heading.

A few years ago, or not long after I started working for my current employer, I decided it was time to get re-established with a healthcare network having mostly gotten by for years with occasional visits to specialists and, to be honest, spending more time responding to crises than actually investing myself in preventative care. As an adult born with spina bifida and also being a double amputee/paraplegic with a mild brain injury, I’d long ago given up on the idea of maintaining my healthcare like I did in the days I was on Social Security Disability. I spent nearly 10 years after college graduation working for an inner city hospital that was a wonderful employer yet not exactly equipped to deal with serious health issues like my own, but having gone from life on Disability to life among the employed and utilizing commercial insurance I’d quickly figured out that it was nearly impossible to balance fiscal responsibility and meeting my healthcare needs. So, for many years I just sort of got by and did the best I could.

While Community Health Network isn’t exactly known for its work with birth defects, an initial meeting with a former doctor impressed me enough that I decided I would go with her practice and maintain myself within this healthcare network for as long as I could or until such time as I truly needed expertise in spina bifida. After 2-3 years, this originally chosen physician left the practice and I was “assigned” to a new doctor within the practice.

I was skeptical, but I have to be honest and say I instantly found her to be fantastic. While she wasn’t exactly familiar with spina bifida, I was impressed with her openness and her comfort with the knowledge that she did possess. Like me, she possesses a quiet humor and bluntness that simply works well with this jaded, burned out on healthcare soul. She initially struck me as overly cautious, but over our first few months we simply clicked and I thought “Okay, this is a doctor I can really work with.”

I even found myself appreciating the fact that Community Health Network was growing into its utilization of electronic records, a utilization that created opportunities to actually connect with your physician (or their nurse) when it was needed. This computer network also makes it possible to better manage one’s own health records, keep track of labs, keep track of medications, pay bills, and much more. I found myself hopeful that this network would improve an already positive working relationship with my physician.

Now then, I have to be honest and say that I don’t completely understand how the entire electronic network ties together, but over the past few months it has become apparent that it is fractured, non-communicative, and rapidly causing a decline in the personalization that I have valued so highly from my physician and her practice.

When I message my physician through the network, I can most certainly still get a response and she continues to respond in a way that is respectful of my situation. Yet, and I may be wrong, it feels as if the network itself has been divided into different points of entry for different concerns.

I find myself wondering “When I send a message to get an appointment, do I even get the office? Do I get a different office that now handles scheduling concerns?” It’s not completely clear, but it’s VERY clear that they do not know me and they are more concerned with structure than service.

It seems like, and again I may be wrong, when I send anything from the various options available through their computer network that it goes to a different area and, for the most part, it nearly always feels like they don’t communicate with each other at all.

It’s very frustrating.

While I have great difficulty using phones during the day due to the nature of my employment, several months ago I began balancing my attempts to contact by electronic messaging with contacting my physician’s office by phone. I began to notice over time that even utilizing this more direct method of contact seemed to be met by more layers akin to trying to call Comcast and having to go through four layers of hell before you reach a human being who has a clue.

Again, it’s very frustrating because in those times when someone has the insight to speak to my physician’s nurse or even my physician it seems as if whatever need has arisen is addressed in a timely and effective manner. Otherwise, it was nearly always a case of structure before service.

Then, “it” happened. It’s the latest craze in Indianapolis and maybe nationwide – “same day” appointments.

Ugh. I hate it.

My physician, who already doesn’t have any hours outside of my work hours, suddenly was becoming even less available because of some idiotic and misguided mandate that the network would offer “same day” appointments for primary care, a service that seems to be occurring in most of Central Indiana’s major networks. If it works in the other networks like it does with Community, I’m surprised that there hasn’t been a mass exodus.

I have been trying for no less than three months to schedule an appointment with my physician, including three times when I have contacted by phone.  I have contacted multiple times by message through the Community Network and, in almost all cases, have inquired about specific days, times, or blocks of time. In nearly every case when using messaging, I’ve gotten an e-mail back saying “She doesn’t have anything available then. I’ve set you up for this time.”

“Um, that’s not what I asked for. I can’t make it then.” So, we’ll end up going back and forth multiple times and, on almost every occasion, I’ll propose alternatives and will get back another scheduled appointment.

It’s maddening. Yes, I’ve used that word twice in one post.

After finally catching on that either the scheduling was going through an outside office or there was simply no communication going on, I finally resorted to actually calling.

The first time? Okay, only a couple days’ notice.

The second time? Two weeks’ notice.

The third time? One week’s notice. This most recent time when I inquired about a specific day where I knew that I would be off work and available the entire day, I was informed “She’s entirely booked except for “same day” appointments.” But, now here’s the catch, they couldn’t go ahead and schedule “same day” because, well, it wasn’t the same day.

WTF?

So, an established patient with known chronic health issues has to wait because your system prefers to service individuals with faux acuity who, in actuality, simply haven’t planned their lives very well? When I mentioned a couple of my issues, one of which I knew would qualify as acute, I was informed I could be seen for the “acute” issues but the preventative ones would need a different appointment.

I’m sorry Community, but that’s just plain fucking stupid.

If you are more attached to the rules of your structure than actually serving your patients, then you don’t deserve to call yourself a healthcare network because, quite simply, you don’t really care. It is 100% unacceptable that I was put off in this situation. I realize that my physician has become more established and is scheduled out farther than in the early days, but please don’t pretend that you are providing “convenient access” when in truth it appears that only your convenience matters.

Here’s where you have a chance to truly put the “care” back in healthcare and to truly prove yourselves to be a network that cares about the individuals you serve more than the structure that you’ve built.

Make it happen. Yep, that’s right. It’s that simple. I realize that there will always be exceptions to the ability to “make it happen,” but under no circumstances should it take multiple months for an established patient with known serious health issues to make an appointment with a physician when you’re sitting around spouting about “same day” appointments. There are those of us who live in the real world and can’t just drop everything “same day” because it fits better with your screwed up system. There are those of us who can’t just leave work whenever we want because we have obligations and commitments and because we take our jobs seriously. So, when we call you a few days or a week or two weeks in advance and give you an entire day when we really need to get in then it’s up to you, if you’re a responsible provider, to actually make it happen.

It’s truly that simple. “Same Day” is meaningless marketing crap and destined to fail. You want to prove that you’re a system that truly meets an individual’s needs? Listen to the individual and adapt your system to the needs of the individual.

That’s healthcare and that’s service.

Otherwise, you might as well give up your non-profit status because you clearly care more about the almighty dollar than you do the people you serve who, by the way, are the source of those almighty dollars.

I have to be honest and say that I’ve been looking around at other networks and other providers. I’ve been looking around, but the truth is I don’t want to look around. I like my physician. She’s taken the time to get to know me and, maybe even more importantly, I believe she actually cares.

But, the simple truth is that as an adult with serious health issues I need for those who are providing my healthcare to truly be accessible when it comes to meeting my needs. What’s it going to take? Does your computer system need to better identify your most vulnerable clients? Do you need to tweak the way your network communicates? Do I need to do something or say something differently?

Now is the time for you to live into that very first core value that you list on your website – “Patients first.” I need for you to live into that value with everything you have. I need for you to make sure that this “structure” you’ve built and designed to improve the patient experience doesn’t dominate the patient experience. I need for you, more than anything, to make sure that you’re putting the care into healthcare.

The Gimp Goes to the Dentist

Business Name: DentalWorks – Castleton
Location: Castleton Square Mall (Inside Sears, 2nd Floor)
Date: March 28,2013

• Accessibility- ***
• Performance/Reliability: – **1/2
• Problem-Solving/Conflict Resolution: **
  
• The Intangibles- **
  
• Overall Experience- **1/2

I’ve concluded that there are certain experiences in my life when I simply shouldn’t go it alone. After a recent visit to DentalWorks on the Northside of Indianapolis at the Castleton Square Mall, I’m adding “going to the dentist” to the list of things I simply shouldn’t do alone.

I’d been contemplating a change in my provider for quite awhile. It’s not that I didn’t really like my previous dentist, but what had previously been a convenient location that afforded me the chance to get dental work done on a lunch break had become a tremendously inconvenient effort now that I work in downtown Indy and seldom leave the office before 4:30pm. I’d largely stuck with my previous dentist for one big reason – the hygienist. When I first started seeing him, he had a simply extraordinary dental hygienist who tapped into all my anxieties, fears and insecurities about dental work. She was comfortable with honesty, had a soothing touch and a way of making the most traumatic experience tolerable. While my teeth have always been a mess, this hygienist helped me improve them dramatically and got me to the point that I began addressing serious dental needs. Unfortunately, she eventually left and while things weren’t disastrous they did start to downward spiral. I had some concerns with billing, while also experiencing a couple particularly traumatic extractions. Then, when my office moved, I suddenly found myself having difficulty scheduling appointments in their fairly strict business hours.

In other words, it was time to look around. I wasn’t looking forward to this, because I knew that I had some major dental work that needed to be done including anywhere from 4-6 extractions and potentially a partial or implant of some sort. I found it all rather terrifying, and the thought of starting it with someone new gave me tremendous anxiety. Then, you toss in the fact that my dental plan from work is significantly limited and my anxiety was going through the roof. As a sexual abuse survivor, I already have anxieties about touch and people hovering over the mouth. When I have surgeries, for example, I give clear instructions that the mask is not to be put on me until I am knocked out. Psychogically, I simply can’t handle it. It sends me into a flashback that can go on for an extended period of time.

But, I really needed this work. So, I decided to begin exploring. What are the odds of finding a gentle, compassionate and affordable dentist with a sense of humor? More importantly, it needs to include a really terrific hygienist because they’re really the ones who do a lot of the work. I don’t want to be ridiculed. I know my teeth suck. There are some legit reasons for it (abuse, hydrocephalus). There are some non-legit reasons for it (self-care issues). Regardless, I can’t even look at my smile in the mirror without getting nauseous. I don’t need a hygienist or dentist reinforcing the negatives.

Yes, it happens. Before I found my last dentist, I briefly went to what is now the “Brightnow Dental” on Emerson in Indy. This old school dentist thought it appropriate to say “Your breath smells like rotting flesh.” (Which my friends have assured me is not true despite my crappy teeth). I wanted to look at him and say “Yeah, well you’re fat and you dress funny.”

I refrained.

Actually, I just never went back.

While I had issues at the previous dentist, they were top notch in the respect department. While he never did attract a hygienist quite like that first one, it was still a place where I felt fairly safe and seldom left having a flashback.

I stumbled across DentalWorks in Castleton Square while picking up my glasses at Sears Optical. DentalWorks is part of a national chain of dental clinics with 150+ locations in 14 states. I believe there are two in Central Indiana, with the other being in Washington Square on Indy’s far Eastside. They are guided, or so they say, by this corporate philosophy –

• At DentalWorks, we believe changing needs call for a smarter approach to dental care.

• We believe in taking the time to listen to your concerns and answer your questions.

• We believe our schedule should be flexible even when yours isn’t.

• We believe our prices should not exceed your ability to pay them.

• We believe in giving you options, not excuses.

• We believe in treating you as if you were our only patient.

• Because when all is said and done, we believe nothing should come between you and a healthy smile.
  (Taken from the DentalWorks website)

They offer a pretty impressive array of dental services for what is a fairly small clinic involving four practicing dentists. Services include general dentistry, crowns, custom dentures, custom partials, cosmetic dentistry, orthodontics, periodontics, implants and emergency dental care. Being that I was particularly concerned about their hours, I was relieved to see that they offer both evening and Saturday appointments. As they advertise, they truly are on most dental plans including mine. There was one statement on the website that soothed me quite a bit “Do you dread visiting the dentist? Has it been years since you’ve even seen one? Relax: DentalWorks provides caring dental services in a calming environment with no shame, no guilt and no judgments. We just want to make your teeth look and feel their best.”

So, when I went to Sears for my glasses I made a point of stopping in to DentalWorks to get a feel for the place and to speak with someone. I spoke with a technician whose name I can’t remember, but I was impressed with her knowledge of the practice and her presence. I went home, looked up the website and my dental benefits to make sure. I also noted that the website spoke of a “free initial exam and x-rays.” While I have dental benefits, I thought this would be a terrific way of getting a consultation and then freeing up my benefits to get the work done. Eventually, after stalling for a bit, I called a toll free # which apparently does go directly to the individual practices during business hours. I should add that you can also schedule appointments online. I thought about going this route, but I wanted to speak to someone in person and decided to honor my concerns about trauma and request a female dentist (They list having two at this location).

I scheduled an appointment during a week I’d taken off specifically to get some rest and schedule some badly needed appointments.

There’s certainly practical aspects of accessing DentalWorks in Castleton that make it a terrific choice for someone with a disability. Because this is a shopping mall, accessible parking is plentiful. While the Sears doesn’t have automatic doors, the two sets of glass doors are fairly manageable. If you do need the automatic doors, I’d recommend using the mall’s main entrance. It’s a longer trek, of course, but it’s a smooth path the entire way. Once inside, the clinic is located on the second floor and there is an elevator to get you there. It’s back in the section that houses the photography studio, hearing clinic, optical department and now dental clinic. As you approach the clinic, there’s a desk at the front and a small waiting area to the left. There’s a pretty good chance that if you’re in a larger chair you won’t want to bother much with the waiting area because it’s fairly confined and the area around the desk is pretty narrow. I noticed this moreso as i was leaving, because I had to wait for one customer to finish his business before I could exit the clinic. That seems like odd, but not particularly surprising planning.

I arrived about 10-15 minutes early since this was my first appointment so that I could complete the paperwork. For one of the very few times in my history, I actually wrote down my diagnosis of “Post-Traumatic Stress Disorder” while acknowledging its lingering effects. After a few moments, I was escorted back and was pleased to find that the tech who would work with me first was the same woman who’d talked to me about the clinic during my drop-in visit. She would be the one who took my x-rays. It only took me a few moments to realize I’d gotten pretty spoiled at the previous dentist, because he had more updated equipment and also laser dentistry abilities. DentalWorks in Castleton isn’t antiquated, but even with the x-rays I was feeling it. Fortunately, this tech seemed to gel with my personality and she made the experience more tolerable even when we had to redo a couple.

I should note that DentalWorks in Castleton is basically an “open concept” dental practice. There’s really not much separating the first four chairs other than your basic dental equipment. While it’s certainly not unheard of (though I’ve never understood how that’s HIPAA compliant), it’s a little overwhelming to be able to look at the person next to you and to know they can watch you. There’s a row of, I believe, four chairs then there’s a chair that’s a little more off to the side that seemed to be where the dentists actually did most of their work. If I heard correctly, I was actually sat in a different chair than my dentist usually uses because of concerns about wheelchair access. These concerns were warranted. The aisle was narrow and the spacing was pretty difficult. I could easily see anyone with range-of-motion or limited strength having difficulty transferring. I will acknowledge, on the flip side, that this was the first time I’d gone to a dentist where it was offered that I could stay in my own chair. Apparently, because we were only doing x-rays and an intake exam it would work. As a general rule, they work within the chairs. Still, I thought that was a nice perk and it was good of the tech to think of the option.

After the dental tech, I was informed that I would then be seen by the hygienist, Liz, and then the dentist, Dr. Sonia Alex, who would discuss options and treatment plan. Then, I would meet with administrative folks to discuss the nitty gritty of finances.

Have you ever worked with someone where you just didn’t quite “click?” It’s not that they were necessarily bad at their job, but for whatever reason it felt “off?” Liz was your usual hygienist in terms of having impossibly perfect teeth (Yes, I know it’s possible. I blew it). She was technically proficient and seemed to know her stuff. If you know me, or even if you just hang out with me for a few minutes, you likely catch on that I laugh a lot and I laugh even more when I’m nervous. Humor is a coping skill. This seemed to bother Liz, who on three occasions admonished me for laughing including saying on at least one occasion “Laughter’s not appropriate” as she looked disprovingly at my teeth while announcing “13.” For the record, 13 is not good and I knew that. In fact, everyone in the vicinity knew that since it was an open concept office. To her credit, Liz tried to be gentle and, again, I sure as heck missed that ole’ gentle dentistry. There was an abruptness that was anything but soothing. While I acknowledge that I have a handful of teeth that need to come out (Anyone want to just hit me?), there was something about her announcing “I can’t do anything with these” that felt judgmental and condescending.

By the time Liz was done, and it sure seemed like a long time, my senses had become overwhelmed by the busyness of the office and the exam itself along with that overwhelming sense of judgment.

Fortunately, things improved again when Dr. Alex arrived. While Dr. Alex was in many ways just as blunt as Liz, she had a kinder approach and she seemed concerned. She took a tremendous amount of time discussing with me my anxieties, the options, my financial concerns and even some of my traumatic past. It was the first time I’d ever told a dentist that one of the reasons for the severe damage was an incident of having my face pushed into concrete during a particularly traumatic abuse episode. It not only left me with damaged teeth, but left me pretty much refusing to address any of it until I’ve now reached my 40’s.

Suddenly, now I want to smile and actually mean it.

Dr. Alex was, quite honestly, top notch and for her alone I would almost go back despite my tremendous reservations. She even introduced an option I’d never heard of and explained how it all worked.

Again, DentalWorks, you’ve got a major winner in Dr. Alex.

After two hours, yes two hours, my appointment was done. I don’t think I realized how worn out I was physically and emotionally until I left the environment. As I noted, I had to wait to actually wheel out. However, one of the receptionists did at least try to work with me at a lower desk (it didn’t work). I was a bit bothered by the fact that they tried twice to schedule me during business hours despite the fact that I’d already been clear that I needed evenings or Saturday, however, I became a bit impressed when they tried to squeeze me in again yet that same week when they found out I was on vacation. Unfortunately, because I need a deep cleaning first and the hygienist was booked I left without an appointment. I was promised that I would receive a call the next day either with an opening or to go ahead and get scheduled.

I was a tad relieved that there’d not been an opening, because by the time I left I realized I was in a state of trauma and, in fact, my jaw was quite sore. I was bothered, however, when the next day came and I received no telephone call and, in fact, have not received a phone call to this date in follow-up or to schedule.

While the “fine print” on the website does state that the “free exam/x-ray” cannot be combined with insurance, I’m a bit baffled as to how this translates into “we’ll charge your benefits” even though we call it a free exam/x-ray. While I certainly acknowledge that my appointment was more extensive than expected, this seems to be a point to explain up front. As I was primarily exploring options, this serves to limit my options now for the rest of the year. It also appears to punish those with insurance, though on the flip side they at least did not actually charge the usual co-pay. I’d encourage exploring this issue prior if you have concerns.

Will I go back?

In all likelihood, no. While I really appreciated Dr. Alex, I found the office layout overwhelming and while Liz certainly was technically proficient I simply can’t picture doing what is a vulnerable and difficult procedure for me with her. Whether it was intentional or not, I felt judged and I felt like my way of coping was judged. I left traumatized and the simple truth is that such challenging work can’t be successful under those circumstances. My sense is that if your needs are truly for a more “general dentistry,” then DentalWorks is certainly a good option. Having priced out their treatment plan, I can say that their prices were fair and they were laid out up front. I can’t picture this particular location being comfortable for most individuals with disabilities, certainly not for someone with Autism due to the excessive stimuli and if you’re prone to flashbacks during this type of procedure then I’d recommend a calmer practice with a less “busy” layout.

 

The Gimp Can’t Pee

Business Name: St. Joseph Hospital/Provena St. Joseph Medical Center
Location: 77 N. Airlite Street, Elgin, IL 60123
Date: October 15, 2010

• Accessibility- **1/2
• Performance/Reliability: – **
• Problem-Solving/Conflict Resolution: *
• The Intangibles- *
• Overall Experience- *

There are very few things worse in life than being a paraplegic in a strange city when, out of the blue, a health crisis strikes. However, one of the things that is worse is being a paraplegic in a strange city when, out of the blue, a health crisis strikes and you aren’t driving your own vehicle and, as a result, must confess said health crisis to a weary professor who has just spent several hours driving your deadbeat ass to said strange city.

What makes it all even worse? If that strange city happens to be Elgin, Illinois. Then, your ass is really screwed.

I left Indianapolis with a couple of classmates and my professor on what was expected to be an inspiring and enjoyable weekend getting to better understand and experience my denominational leadership as they met in Elgin, Illinois for the weekend. Because our entire class was attending, we opted for carpooling and, as such, I attempted to plan carefully for any potential challenge that could strike my always unpredictable body.

D’oh. I missed one.

There are many joys of paraplegia and spina bifida that, for the most part, go unannounced in my rather guarded little world with only a modest semblance of a physical support system. This is equally due to: 1) I am naturally shy (Yes, really!) and not prone to discussing my body, 2) I am a sexual abuse survivor and everything feels “inappropriate” in this area, and 3) I’ve had to be independent most of my life and I have a tremendous fear of appearing “needy.” So there, I said it.

However, anyone who spends any amount of time around me at all knows that daily life is, indeed, quite challenging and tasks that may take most people a few minutes can be long, drawn-out processes in my world. It is not uncommon for me to have to wake up at 5am or much earlier so that I am at work by 8am. It’s simply a part of my everyday life.

However, one of the hazards of having spina bifida is that even the simplest glitch in my well thought out process for daily living can prove to have serious health consequences. In this case, somewhere between Indianapolis (or, more likely, the rest stop where we took a brief break) and Elgin I had the misfortune of losing the absolutely required “catheter.” (It’s okay. You can say “ouch.” If you’re not used to them, they hurt. If you are used to them, well, they kind of tickle). We arrived at Elgin’s Holiday Inn and, as is my usual routine, I immediately headed for the restroom and, within moments, realized my major dilemma. As I prayed the prayer of “Okay God, what do I do now?” said professor just happened to call my room again.

“Um, well. I don’t know how to say this (VERY bluntly was the only choice), but I have a major problem,” which I then proceeded to explain.

While she headed down to search the car (No luck), I looked throughout the hallways (again, no luck). Finally, resigned that it was getting late on a Friday night in a strange town I headed for the front desk and asked them about medical supply places in town or a local hospital. Fortunately, this has happened VERY seldom in my life and when it has I’ve always had the good fortune of finding a nearby medical supply company or a hospital with a compassionate heart willing to simply give a catheter.

I was referred to “St. Joe’s,” or more specifically Provena St. Joseph Medical Center in Elgin, approximately 15-20 minutes away. With professor leading the way (and not complaining a bit…her wondrous gift for her birthday that day was several hours in a car followed by four hours in an emergency room with a seminarian who couldn’t pee…definite proof that God has quite the wicked sense of humor).

We arrived at St. Joe’s, unfortunately passing what we would later learn to be a newer hospital called “Sherman” that would have likely been better equipped to deal with the situation. However, the 3-4 folks I shared this story with from the area all felt like in terms of personal care that St. Joe’s would have been the better option. I’m not sure what this says about the state of healthcare in Elgin, but it ain’t good.

The sparsely lit parking lot led to a small reception area staffed by a sole admissions clerk. While Elgin is certainly not a thriving metropolis, it did seem a tad unusual to be so lightly staffed on a Friday night. Regardless, I explained the situation to the clerk and explained that all I needed was a catheter. I didn’t really need to be seen, as it was certainly something I could do myself assuming I could find the appropriate supplies. I was more than willing to pay for the supplies and, if they were unable to assist, I asked if they could refer me to a local medical supply company that could help me out. Of course, I was given the answers “1) No, we can’t give you a catheter, 2) No, we can’t allow you to buy one from us, and 3) “I don’t know of anyplace you can go get one.” I was further informed that, in order to obtain what amounts to a $3.00 item I would be forced to register as an ER patient and create a huge bill/insurance claim because, of course, the hospital offered no sort of “urgent care” that would have allowed me to register for a simple, non-urgent need. After several moments of contemplation and recognizing what could easily develop into an urgent situation (and at that time not knowing exactly what “Sherman” was), I finally opted for signing in once I’d received assurance that the hospital would have the catheter I needed, which is slightly specialized.

I signed in, went through the admissions process (vitals taken), saw a nurse briefly, saw a Physician’s Assistant long enough for her to say “We’ll get you a catheter” and waited for said catheter to arrive. The nurse returned with the standard issue red rubber catheter, which I’d already clearly stated would not work given my physical needs. I was then offered two other options and one, I was hoping, would work despite it being clearly not what I had explained was needed. The other alternative was CLEARLY off the mark. All three were tried and, as expected, all three failed. Heck, I even tried the flimsy red rubber crap. By this time, I was texting a friend of mine back in Indy completely awestruck that I was in a hospital completely ill-equipped to handle a basic issue and stunned that I had signed in and might actually have to leave with the need not being met. Clearly, going to another facility was not an option and I was beginning to consider “Who can I call in Indy to bring me one from my home?”

The staff stated that I’d, at that point, tried all their options when it finally occurred to me (no, not the “professionals”) that if I could actually just get a catheter in I could simply wear it all weekend.  I hated the idea, but I more hated the idea of missing my planned weekend and figured I could live with it for a couple days. The pain was getting severe, and I knew I’d be having spasms all weekend anyway by this time (and I did). While I would never have needed any assistance had they actually possessed appropriate supplies, given the limited options I asked if anyone else could try and then asked “Do you have a leg bag?” “Sure,” was the reply. An hour later, the only nurse who was apparently able to catheterize males (the nurse actually acknowledged this statement) came in, was able to accomplish the task and handed me a “chair” bag (not a leg bag…trust me, there’s a HUGE difference).

I left the E.R. at St. Joe’s pretty close to appalled that: 1) A hospital that openly advertises its charitable and community efforts couldn’t handle a mechanism to assist someone with a simple $3.00 need or provide an appropriate referral to someone who could help, 2) A hospital didn’t have any mechanism for “quick care” or something along those lines, 3) A hospital could not provide accurate accounting of their available stock (The attending nurse actually acknowledged before I left that they should have just brought the catheters out to the admissions desk to make sure they would work) and 4) A simple 5-minute need took four hours.

In their defense, and it is important to acknowledge the positives…for the most part, the problems experienced at St. Joe’s this evening were, in my estimation, systemic issues rather than personnel issues. The service certainly qualified as slow and didn’t quite match up to their advertised “Feel the Difference Faith Makes,” which in this case could explain why church attendance is massively declining.  However, the staff was never less than nice and appeared as equally frustrated by their lack of supply options. The nurse, in question, stated that she would also talk to the ER director as she agreed it seemed excessive to create an ER bill for such a minor issue. The Physician’s Assistant, as well, was nice in the couple minutes I spoke with her.

When did compassion leave health care? How is it possible that in the nation considered to be the most advanced in the world with the most options in the world that a human being with such a fundamental need can’t address the need without lining the pockets of major medical centers? How is it remotely possible that a healthcare center that will likely spend hundreds or even thousands of dollars on community freebies to advertise “We care” can’t back it up when the chips are down and when someone finds themselves in an extraordinary, unusual situation? Had I been a drug-seeker then caution certainly would have been warranted, but such extraordinary measures seemed, at the very best, to be exploitation of the system and completely devoid of compassion.

Following my return home after a delightful weekend of learning and inspiration and many spasms, I was able to address the needs appropriately and, as well, think through the process to ensure such a situation would never occur again. When the initial “bill” arrived, I was astounded to see that my non-urgent visit to good ole’ St. Joe’s resulted in an initial bill of $933.00.

$933.00 for the equivalent of vitals taken, four catheters, a bag, a nurse to help with a catheter (only because they didn’t have the equipment they’d already said they did have) and 2 minutes (at most) with a Physician’s Assistant…no tests, no labs, no doctors.  While I’d resigned myself to a bill, I continue to be astounded. While my insurance will be billed, I am honestly embarrassed that an insurance company will be faced with a bill for what could have been and should have been an easily resolved situation.

In an effort to resolve my concerns regarding the care and the subsequent seemingly excessive bill, I contacted the facility’s “patient advocate” department by e-mail and, just today, received a formal letter in which Patient Advocate Aleta Russell responded to my concerns largely with feedback from Emergency Services Director Lynn Polhemus (who I believe was there that night) with explanations that simply seemed to confirm that: 1) “Nope, we couldn’t sell “or distribute” supplies because we don’t have a license to do so,” 2) “We had a variety of catheters” (Um, it was 3. I remember clearly), 3) “You clearly consented to someone helping you, so of course we had to charge you…silly boy”, and 4) Absolutely no mention of the cost issue (which is still pending insurance) and no actual attempt at resolution. In short, the E.R. director “addressed” the situation and, well, that’s that!

It is still my hope that this situation will resolve itself in a way consistent with quality and compassionate healthcare, regardless of how the insurance situation itself is resolved (As I’ve met my max “out of pocket” for the year, this bill should actually be completely covered). However, even if my insurance company honors its obligations it can’t erase the overwhelmingly negative impact of this experience and, I dare say, that it is situations like this that deserve to be brought to light as it is an unfortunate example of a disturbing lack of compassion and common sense in healthcare. Regardless of how you feel about healthcare reform, situations such as this one simply should not occur and when they do occur we as Americans must stand up for one another and become true patient advocates so that people are treated fairly and compassionately.

The Gimp Gets Rid of His Gallbladder!

Business Name: Indiana Surgery Center North
Location: 8040 Clearvista Drive, Indpls. IN 46256
Date: July 9, 2010

• Accessibility- ***1/2
• Performance/Reliability: – *****
• Problem-Solving/Conflict Resolution: ****
• The Intangibles- ****1/2
• Overall Experience- ****1/2

 

Surgery is never a fantastic experience.  It’s physically demanding, emotionally stressfully and financially draining. It’s to be avoided but, unfortunately, sometimes it simply can’t be avoided. Such was the case during a late summer experience that led me to The Indiana Surgery Center for removal of my gallbladder following what felt like a humongous gallbladder attack or child birth or another amputation or nuclear war inside my body.

Okay, it was only a gallbladder attack.

Being born with spina bifida, I am not unfamiliar with surgery. I’ve had over 50 of them, though I’ve had nothing beyond modest dental procedures for the past 10-12 years or so and no major surgeries for the better part of 20 years. Prior to this unexpected experience, I’d never called into work sick a day in my life and took great pride in my flawless attendance record.

Oh well, that one’s gone.

If you simply must have a surgery, however, you’ll be hard-pressed to have a better experience than I had at the Indiana Surgery Center North, a 9-suite surgical center located on the campus of Community Hospital North on the northeastside of Indianapolis and associated with Community Hospitals Indianapolis (I suppose that was probably a Mr. Obvious statement, eh?).

The pre-surgical processes for the Indiana Surgery Center were flawless, with registration paperwork arriving as promised and insurance pre-certification being completed as necessary. While I was in Pittsburgh on the day that I was to call to speak to the nurse prior to surgery, this conversation went off without a hitch (Though I will confess that the conversation went so quickly that I was concerned we’d missed something).

As one might expect, Indiana Surgery Center North is wheelchair accessible with an automatic door easily wide enough for even extra-wide wheelchairs that leads to their first floor suite. The registration desk is lower, allowing for easy visual contact with admissions staff that allows for a more personal approach. I arrived on time and they, in turn, were on schedule for my admissions process.

I entered this experience with quite a bit of nervousness, having not had a significant surgery in several years. While gallbladder surgery is now an outpatient procedure, it is an “all day” procedure typically and can lead to an overnight stay if there are complications. The night before surgery, I’d had a very vivid dream during which I died during the surgery.

I was seriously freaked out.

I acknowledged this dream to my admitting nervous and, quite honestly, was stunned to find it quickly treated with an amazing amount of respect and dignity. Prior to the surgery, both the anesthesiologist and the surgeon spoke with me and my companioning friend to explain the procedure, the risks and to really make sure that I was emotionally in a place to go through with it. When they offered to postpone the surgery, this offer felt genuine. The nurse, in turn, also was tremendously compassionate and checked on me regularly that morning and even would check on my welfare while I was in recovery under the care of another nurse.

The modest snags that keep Indiana Surgery Center North from achieving perfect rankings exist in the slight lack of preparation for dealing with someone who was known in advance to be a paraplegic, yet not really having an appropriate set-up to ensure my everyday ADL needs could be met depending upon my status post-surgery and, perhaps even more odd, a surprising lack of accessibility in the actual operating room that required additional assistance to access the actual table. Had I been given any of the anesthetic medications prior to arriving in the room, well, accessing the table would have been a major challenge.

I’d also explained to the anesthesiologist that due to some past trauma, I would strongly prefer that no mask be used until I was clearly out as it would likely lead to a strong physical reaction on my part. This wish was honored, which has not always been the case.

I awoke post-surgery, the operation having been successful despite a modest complication of a much more infected gallbladder than expected that required an additional incision. I was in the recovery area with my friend already in the room and the nurse right by my side. Poor thing.

If you ever meet me, you’ll quickly learn that I am naturally humorous, irreverent and prone to saying whatever is on my mind (VERY seldom is it negative!). I do gimp jokes regularly (surprise, eh?) and, well, being under the influence of major pain medication only magnified my willingness to go with the flow. My friend who was with me has still not let me forget some of the things I said that day. The nurse maintained her composure and her compassion throughout and, quite simply, was attentive and stellar throughout.

I was sent home with full instructions, all required documentation and a very clear picture of what to expect from recovery and an appointment for follow-up.  Even the insurance follow-up was flawless, with billing being done quickly and effectively and the billing department was courteous and positive when I called with a question regarding payment.

While Indiana Surgery Center North has a few issues with their physical architecture to work out, their staff is exceptional and if you simply must have surgery it’s a facility I’d highly recommend!

The Gimp Goes to the Hospital

Business Name:  Community North Hospital
Location: 82nd & Clearvista Parkway, Indianapolis
Date/Time: April 22, 2010

• Accessibility- ***
• Performance/Reliability: – ***1/2
• Problem-Solving/Conflict Resolution: ***
• The Intangibles- **1/2
• Overall Experience- ***

Shouldn’t a hospital be gimp friendly?

I mean, really?

Before I begin my comments on a recent visit to Community North Hospital in Indianapolis, it is important to acknowledge a couple of things. First, I did not in any way visit the “entire” hospital and, secondly, I did not avail myself of a service that may have made the experience a touch more manageable. I will discuss this second issue in more detail shortly.

Now then, for those of you who know about my recent bout with a rather serious illness, let me assure you that this particular visit was not actually on my own behalf. My purpose in going to the hospital this particular day was for visitation.

Community North Hospital is part of a rather huge campus on the Northeastside of Indy near Castleton, a section of the city regarded as a rather high-end commercial and business district and, as such, the hospital itself is an architecturally pleasing and comfortable hospitable. The hospital shares a campus with the Indiana Heart Hospital and Fairbanks Hospital, and offers the full spectrum of healthcare services. It is a hospital that has grown massively in recent years, with multiple new additions including the area where I parked and entered on this particular visit which is considered a main entrance and main parking garage for visitors.

It took two drives through the Community North campus for me to gather my bearings and, finally, figure out where I needed to be. The hospital has multiple separate entrances, including those for ER and its Psychiatric Pavilion.

There is a Main Entrance/Visitor’s Entrance marked by a street sign that leads to a circular driveway that allows for drop-off of patients and/or other appropriate individuals. Community North apparently offers “Free Valet Parking,” though there’s no particular signage that actually indicates the particulars regarding this service.  Instead of opting to explore this service, I instead completed the circle and headed into the multi-story parking garage that is offered at no charge (A pleasant change from the complete and utter crap of paid parking at hospitals like Wishard, Riley, IU and Methodist…all, ironically, part of the same healthcare network).

Done venting.

The parking garage appears to be utilized by both visitors and staff, as several staff were observed walking in and out of it during this particular visit. Much like Community North’s campus design, the garage itself required a little getting used to as it winds around just a touch differently from most parking garages. As is customary in hospital settings, there were ample areas for handicapped parking. However, it is worth noting that the spaces themselves felt a touch narrow compared to the usual hospital parking spaces and, most certainly, the clearly marked space I utilized would not have served a wheelchair van appropriately nor allowed for the use of a lift.

As is also customary, the wheelchair designated parking areas are all located near the elevators in the garage. The area is relatively flat with two manual doors to the elevator that are a touch heavy. I will confess that I found it a bit surprising that in such a new garage that some sort of door adaptation wasn’t utilized to allow for an easier entrance/exit.

Elevator buttons are at a decent height, both within the elevator and in calling for the elevator. The elevators are roomy enough to allow for one wheelchair with additional persons or, perhaps, a second wheelchair.

Going down to the first floor, one exits the elevator and wheels across the circular driveway to the main entrance.

This brings me to my first major beef with Community North, a beef that is certainly not exclusive to this facility but one that drives me absolutely bonkers. Who in the heck decided to utilize this bumpy patches of concrete right next to entrances, exits and ramps? What freakin’ genius actually thought this was a good idea? REALLY?

Okay, I get the basic concept…steady, slow path for carts and a textured path that is easier and, perhaps, less slick during winter months and rain. There may be a couple of legit reasons for utilizing these areas (What are they even called, anyway?). But, they suck.

They suck for wheelchairs. If you’re in a wheelchair and you think they don’t suck, then please write me because I want to hear about it. For me, they suck. I hate them. They make me angry. REALLY angry. They are bumpy, uncomfortable and difficult to get across. I’ve fallen on them, I’ve fallen over them and they actually slow me down too much when I have a decent wheeling rhythm going.

Community North utilizes them outside the parking garage, crossing the street, and at its entrance. They suck.

Okay, done venting again.

The main entrance fortunately does feature a power door and the entrance, which looks like it should be in Architectural Digest (HINT: That’s actually NOT a compliment) is all pretty and nice and stylish, but contains almost no signage telling you anything unless you turn to the right and to the left. The elevators are hidden behind a column (I guess they didn’t fit with the style).

I approached what I believed to be an information desk (It wasn’t actually marked, because I suppose signage might actually hurt the style), and despite neither person present actually doing anything was finally assisted with my very basic question of “Where is room ___” after a few moments of sitting there and waiting for evidence of a pulse from either one.

My mother works at one of these desks for another healthcare facility. Isn’t the goal of having this feature to be an inviting, informative presence? Or at least a living one?

Fortunately, the elevators were close by (and again quite appropriate) and I quickly found my way to the appropriate elevator and floor. As one of the newer areas of Community North, this particular area was definitely very wheelchair friendly in wheeling through the hallways. There were no door challenges present and all counters and desks were at a height friendly to those in wheelchairs and included a space where an individual in a wheelchair could actually write. Definitely good planning here.

I’ve always found hospitals to be an interesting experience. They are designed for “sick” people, not healthy sick people. My friend’s room, and is should be noted that she’s not in a wheelchair, certainly featured a bathroom with a wide enough door way and a rather open concept room that was far more pleasing than the old school hospital rooms.  The door to the room was closed upon my arrival, and thus I sought out the nurse and entered with her into the room. The doorways are wide enough, but would be difficult for a person in a wheelchair to manage alone. This room was a single, and the area next to the bed was rather busy with furniture and decoration. I would assume that this could be adapted to suit a wheelchair using patient/consumer. The call button and TV remote were easily accessible and manageable.

While I certainly would not call the hospital rooms perfect, they are a vast improvement over the traditional hospital rooms of yesteryear. The goal of healthcare should always be the healing and independence of the person being served, and the rooms at Community North come much closer to allowing for this to occur.

Kudos to the very helpful unit secretary and a nurse, her name was Katya, who was particularly helpful in accessing the room and during my visit.

Inside the hospital, there are only minor faults to be found with the physical plant of Community North, however, the hospital would do well to explore options regarding better ways to utilize the parking and entrance areas to become more friendly to individuals with disabilities and/or other mobility issues.