An Adventure in Basic American Healthcare

A few months ago I noticed a small red area on one of my legs.  It was about as big as my thumbnail, was painless, didn’t itch, and otherwise was fairly easily forgotten about if I didn’t look at it.  Every couple of weeks it would almost fade away, then come back.  I hadn’t made any changes to my routines and habits, medications, clothing, soaps and detergents used, etc, which could explain it, but while I was curious about it I didn’t see any need to seek medical attention.  About a month ago it started to itch shortly after getting wet in the shower and for a few minutes after that, and at roughly the same timeframe the spot began both to get larger and new spots, smaller than the original one but otherwise similar, began to appear both on the original leg and the other one at nearly the same location.  I had a scheduled appointment with my doctor a few weeks after that cycle began to go over a follow-up lab result for a different item, so I decided I might as well mention it to him at that point and see what he thought. In the meantime, I tried the usual over the counter medications and / or skin creams with none of them having any noticeable effect.

5 days before my appointment I received a phone call from his office that he wasn’t going to be in that day.  They offered to reschedule me for his next available slot, which I figured would be a couple of days later, but it turned out to be 6 weeks before there was an opening.  When I mentioned that that wasn’t acceptable for me and I had a rash I had wanted him to look at during the appointment, they offered to have one of the other physicians in the group take a look at it, but I’d still need to reschedule the original appointment with my doctor. Figuring that that would be the easiest way to proceed I agreed, but out of a group of over 10 physicians the earliest one could get me in was 4 weeks away.  At that point I decided that there was no point going that way either, so I told them to just have my doctor call me if any of the lab results were not what he was expecting.

I spent a couple of days basically deciding just to wait whatever it was out, but then decided instead to go to one of the walk-in medical care clinics in the area. I went to my insurance website, found one that was affiliated, and stopped off on my way home from work on Friday.  The waiting room was packed with people, many of whom were coughing or otherwise looking potentially contagiously unwell, and after finding out from the receptionist that it would probably be a minimum of a 2-3 hour wait I   decided that I would try again later.  When I returned a few minutes after they opened on Saturday morning, I ended up being the second on the list behind a person who needed a basic physical exam but who also wasn’t able to get an appointment with their regular doctor in a reasonable timeframe.  We figured we should be in and out in a matter of a few minutes….  but we were mistaken.

It took around 5 minutes to fill out the stack of forms, and about 15 minutes after that the first patient was called and disappeared behind a door.  A few minutes later they came out and it was my turn, and I discovered that it was only to have my vital stats taken by an assistant – height, weight, blood pressure, pulse, review of prior history and medications, and then back out to the waiting area.   Roughly 45 minutes later I was called back and directed to an exam room, then told the doctor would be in shortly.

About half an hour later a doctor did indeed appear, asked to see the rash, and before I had even uncovered the extent of it (and while he was still standing about 10 feet away) he had started writing a prescription for a general purpose rash reduction steroid cream.  I asked if he wanted to look at the rest of it and he said there wasn’t a need to, and if after 10 days of using the cream the rash wasn’t getting better then to come back.  As he left the room he said he’d electronically send the prescription to my pharmacy and they would probably have it in 10 or 15 minutes.  And that was that.  After waiting for the better part of 2 hours I had had an encounter with a doctor lasting less than 2 minutes, and to get a prescription for exactly what I would have tried before seeing a doctor if I could have bought it without a prescription.

I then headed to the pharmacy, but when I got there they hadn’t received anything for me.  They took my phone number and said they’d call me when it came in to let me know when they would have it ready, but after about half an hour they called and said nothing had come in yet, and they asked which clinic I had been at so they could follow up. Shortly after that I received a call from the clinic saying that I needed to go there and get a paper copy because something wasn’t working with the electronic system. With no other real option I headed back to the clinic, got the paper, went back to the pharmacy, and found out they didn’t have any in stock and wouldn’t be getting any in until Monday.  They were able to find another pharmacy with it in stock, but it was a half hour drive away so I opted to just hold off until Monday.

Nearly 4 hours after I left for what I anticipated being able to do in under an hour, I returned home empty-handed and no better off than I was when I had left. I had a $25 insurance co-pay before I ever saw the doctor, and based on the last time I was at a similar clinic a few years ago I’m expecting that in a few weeks I’ll probably be getting a bill for about $50 – $75 more. As my health insurance carries a $2000 annual deductible which I have barely touched, they won’t cover any of it.

I contrast this with the last time I had a rash which required medical assessment.  At that time I was living in Germany as a graduate student and was covered by a branch of their national health coverage for resident foreigners.  I didn’t have a doctor at the time, so I stopped in one of the clinics near my flat.  I recall at that time being impressed that I saw a doctor within minutes of arriving at the clinic, and a swipe of my insurance card gave them immediate access to my information so there were no forms to fill out.  Not only did the doctor there do an exam and diagnosis, but also took samples for a follow-on lab assessment to confirm that diagnosis.  That clinic also had an affiliated pharmacy, and in under an hour from stepping inside I left with the medication in hand and a follow-up appointment set.  And all of it was fully covered.

Best health care in the world?  Certainly not in my part of the United States.


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