Wednesday, June 08, 2005

HMO’S and Managing Care

Yesterday’s posting was about my brother-in-law Jim who diagnosed his own case of Polymyalgia Rheumatica.

There are some other parts of his experience that seem worthy of note.

Jim’s initial pain was concentrated in his right shoulder and hand. The orthopedist ordered an MRI of the shoulder. Before it was taken, however, the left shoulder and hand started to hurt. This convinced Jim that the right shoulder was not the source of the problem and so he tried to cancel the MRI. However, the orthopedist was on holiday and nobody would countermand the requisition.

At one point late in the process, Jim fainted (probably from pain). By this time his orthopedist had returned from vacation. When Jim saw him the next day, he decided Jim’s condition was somehow “systemic” and referred him back to Internal Medicine for evaluation. Jim’s regular Primary Care Physician (PCP) was not available, so he saw another internist who said she thought she knew what he had but wouldn’t tell and made the referral to Rheumatology (giving Jim the clue that led him to the diagnosis).

Jim’s HMO is only now making physicians available by e-mail. His PCP had it but the specialists didn’t yet. On the visit at which Jim presented his own diagnosis, the PCP said he had not realized how much pain he was in and how quickly the symptoms had multiplied, thereby revealing that he (the PCP) had neither read Jim’s recent e-mails nor (apparently) communicated with the other two docs who had seen him four days earlier.

HMO’s are said to be engaged in something called managed care. Jim’s HMO is well known and prestigious, but when it comes to managing care, it has a ways to go.

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