January 3, 2012

Waiting to Be on the Phone for the THIRD TIME Today

I lay awake last night going over and over in my mind all the unpleasant hurdles I was going to have to navigate in order to get the new UTI treated. First: do I make an appointment, or do I try to get the doctor to call in a prescription? I'd prefer the latter, but it means dealing with attitude from the receptionist; and should I give her attitude back? what KIND of attitude would be most effective? (Effective = makes her burn with shame at the way she was treating a patient, followed by making her eager to appease me by helping me---as opposed to riling her up and making her accidentally drop my message into the wrong pile and/or into the trash.) Let's rehearse all the attitude-giving options here, in my mind, in the dark, at 1:00 in the morning.

Then, if the doctor is willing to call in the prescription with no appointment, there is often a many-hour wait before he or she DOES SO (once it was 2:00 in the afternoon, when I'd called at 8:30), so that in the past I've decided I might as well just make the appointment because it's FASTER.

But if I get an appointment, they will rebuke me for taking the Azo painkiller, which dyes the pee so they have to diagnose me through traditional methods (i.e., letting me describe my Absolutely Classic UTI Symptoms) instead of by dipping a strip of paper my insurance will charge me $20 for.

Then I will have to be firm about them NOT sending the pee away for $450 worth of lab work, which my insurance charges me $140 for---and even when I have been firm in the past, I have lost. So I will have to be firm far beyond the natural limits of my temperament type, which will make me cry.

The whole thing will end unpleasantly no matter what, and I'll be exhausted from having to struggle so hard for a treatment plan I consider reasonable, over a treatment plan I consider an excellent example of why heath care costs are so crazy. It COULD be a bladder/kidney issue instead of a UTI, I realize, and it COULD be a UTI that's resistant to the antibiotic they prescribe---but I am youngish and healthyish, and I have had these many times before, and they can FULLY COUNT ON ME to call back if I don't feel better or if I get scary lower back pain or ANYTHING.

(Perhaps you are even now scrolling down to the comment form to suggest I switch practices or doctors. If so, I think you are overestimating the size of my town and underestimating my ability to think of easy solutions.)

By this morning I had decided on the following things:

1. I would make an appointment.

2. I would not take Azo, despite the suffering, so that they could do their strip-dip.

3. I would not, however, pay for lab work. I would continue to say, "No, I'm sorry, but I can't pay for that" as many times as necessary. I would patiently endure their disapproval, and store it up to feel angry about later.


I called, and at first it felt as if things were going the most perfect way they possibly could: they didn't have any appointments today. They had me speak to the nurse, and they used the word "instead." I spoke to the nurse, who said she would speak to the doctor and see what they could do, and then call me back. I was going to get my prescription called in, without even having to fight with the receptionist first!

I was of course Theoretically Annoyed. Oh, I see, when _I_ ask for it to be called in, it's impossible and unreasonable and I'm trying to get away with something, but when THEY'RE busy and it would be more convenient for THEM, suddenly it's a good plan. But not VERY Theoretically Annoyed, because of being Actually Hugely Relieved. Plus, I could take Azo, so I did!

Then the nurse called back. The doctor there today is the one who previously insisted on sending away the pee sample for lab work despite my repeated protests, and assured me that insurance WOULD cover it. I was so thrown by this claim, and by the failure of my repeated protests to accomplish anything, that she won that round. And now, today, she declines to call in a prescription. She will need to see me, and she has no appointments until 2:00. Does anyone have anything earlier? No, that is the only appointment available in the entire day with any doctor.

I told the nurse that I had taken Azo, and she said that was fine because they could still send the pee for lab work and get a result that way. I said I would not have the lab work, because it was $140. We both said "Hmm" a few times. She said she'd run this new information by the doctor and call me back.

So not only am I waiting for a phone call (my THIRD in one morning), but I'm CHEESED OFF. I get these several times a year, and have for years and years. I have never been wrong about it, NEVER. A $450 set of tests is ridiculous for a routine UTI with no worrying symptoms. I wasn't trying to get out of needing an appointment, but I DON'T need their ONLY appointment of the day, if they won't be able to do the strip-dip OR the lab work, and if it's 5 hours from now.

If they think I'm getting too many of these (which they DON'T, despite me suggesting it seems like QUITE A FEW), or if they think there is something alarming that needs looking into, in THAT case I would be happy to cooperate with lab tests for further exploration of the problem. But $450 (plus the $20 strip-dip, plus the $130 appointment) to determine (1) that I have a UTI and (2) that it is not resistant to the prescribed antibiotic (test results back in 48 hours, by which time TRUST ME I WILL KNOW if it is not responding to the antibiotic) is WHAT IS WRONG WITH THE ENTIRE WORLD. Global warming? Due to unnecessary lab tests. Pollution? It's all the unnecessary lab tests. Crime and violence? PEOPLE ENRAGED BY UNNECESSARY LAB TESTS.

[Edited to add: I called my GYN, just to SEE. What I did was, I first made an appointment for an annual exam, because I'd rather go there anyway than to my primary. THEN I sprung my question. They only treat UTIs for women who are pregnant. So. Good to know, anyway.]

[Edited to add more: The doctor insisted on seeing me. I left with a prescription, and I refused to have the lab work done. She prescribed me an antibiotic my usual doctor says is not as effective; it would not surprise me to find that she is hoping I will be taught a lesson, since she kept mentioning that without the lab work she really couldn't make decisions for my care. So as usual, the whole thing ended up unpleasant no matter what: I'm glad to have successfully declined the lab work, but I'm upset and discouraged about everything else, and already greatly discouraged/upset in advance about the NEXT time this will happen, and about how very little control/choice patients have.]

56 comments:

Melissa said...

I tweeted to you about this the last time you had a UTI - have you tried calling your OB/GYN to see if they'll call it in. In my experience, the primary care drs want to see you and get the labs done, where the OB/GYN knows that you KNOW what this is. I'd still try to call and see if your GYN will call it in for you. Think of the satisfaction you'd have if you got to call this doctor and cancel that appointment!

Melissa said...
This comment has been removed by the author.
Swistle said...

Melissa- I've been getting my annual gyn exam done at the same time as my physical---so I haven't seen my OB/GYN for a couple of years, maybe three years. I think it would be a really good idea if I were still going there, though.

vanessa said...

Just READING this made me so angry I was tempted to start throwing things, and in fact I did curse loudly several times. Do you have a Minute Clinic in your town? Every now and again the Doc in a Box is better than the Doc at a Clinic.
but UGH. let's TRUST THE PATIENT SHALL WE.

I might passive aggressively donate to the practice a book or 2 by Atul Gawande, on making medicine run more effiecently, and bookmark several pages that discuss trusting the damn patient.

Anonymous said...

How about a walk-in clinic in a drugstore (CVS, Kroger come to mind but I know there are other chains out there - ?Walmart or Target) in your area? I've been to the one at my local CVS for UTI symptoms and it was quick, painless and cheaper than going to the doctor. Added benefit - no appointment needed and I got the antibiotic prescription filled right there. Does your health insurance plan contract with one of these types of places? I hope you feel better soon!

lucidkim said...

I know my experience isn't necessarily universal, but I worked for a group of 21 physicians and no matter how nice any of them might be (mostly not) or how good of a doctor, they were ALL about the bottom line. Yes, part of insisting a patient come in is CYA - but mostly it is about money. If they call you in a prescription they aren't going to make any money. You have insurance, they have an opening = cha-ching. With any luck they can discover a new problem and while you are there get you to make an appointment to come back to look into that (because handling more than one issue at an appt is still: money lost). The better your insurance, the more likely they will need to run all kinds of tests, "just in case."

Beth Fish said...

Shoot, I was going to suggest the OB/GYN too. Mine is far more cooperative about "here is a prescription call back if it isn't better in three days" when it is one of those nearly-unmistakable ailments.

Swistle said...

lucidkim- This is simultaneously discouraging and heartening. Discouraging because of course. But heartening because it makes me feel less crazy for FEELING like this is the case.

Swistle said...

I called my GYN, figuring it couldn't hurt to TRY---and they said they only treat UTIs for pregnant women.

liz said...

Does your insurance company have a nurse line that you can call? They may be able to facilitate this delicate negotiation with your doctor's office.

Jenny (Bring A. Torch) said...

Yack, I am so sorry this is happening again. I hope you get relief soon.

Misty said...

Of course, I was one of the folks who was thinking, "Quit dealing with these bastards!" But you can't. Or you would have already.

My next thought is: How can you hoard antibiotics to treat yourself? Purchase them over the internets? Ask the doctor to write multiple refills? (I don't think this would work...but maybe?) Get friendly with the pharmacist?

Also, prevention. Is there anything you can do differently to simply not get them (that you aren't already doing, of course.)

My forehead is all wrinkly for you.

Melospiza said...

Okay, I am pissed off for you. When I am pissed off, I want to take action, so I am going to suggest an action. Forgive me. I know you're not asking for suggestions for action, and that, in fact, suggestions for action are maybe the Very Last Thing you want at this time.

But here it is: print out this post, and mail it to the doctor's office. I mean, DAMN. This is EXACTLY the reason health care costs are out of control. If it were me and I were still angry (I can only do these things when I am angry, which is unfortunate, because I don't stay angry very long and move much too quickly into craven apology mode), I would also CC the insurance company, which DOES care about costs, and I would tell the doctor's office I was doing so.

A few months ago, when I took my son to the emergency room for a sprained knee (STUPID), and they charged $2600 (!!) with some $$ taken off for good behavior on the part of my insurance company, I protested. I wrote a letter and said this is what's wrong with health care today. When they called I said that some more, and they lowered the price a little bit. Then they called and talked to my husband, who doesn't move into craven apology mode at all, and they lowered the price a lot more. Which taught me that a) being bitchy usually works and b) all medical prices are negotiable. Also, c) the whole system is totally screwed up and d) the world is probably going to hell in a handbasket and e) it's better for my mental health to use medical services as little as possible. Jeesh.

Anyway. I'm sorry about your UTI and I wish I could come argue forcefully on your behalf without actually making things an awkward mess.

Mrs. Irritation said...

This is so ridiculous! I am so sorry you have to go through this ON TOP OF the UTI. Grrrrr.

I like the idea of a CVS/Walgreens clinic - do you have any?

Anonymous said...

I second the clinic or "urgent care" recommendation. I've gone to those places with UTIs a couple of times and it's usually about $100 for the consultation and the prescription (which is pricey for a ten minute visit, but better than the alternative, it seems). Either way, I'm sorry to hear about all the stress, and I hope everything resolves itself eventually. Hang in there!

amyella said...

I don't know if the CVS stores where you live (if you even have CVS) have the Minute Clinic but they are fantastic. I always go there for my UTIs. Very quick, very easy and they take most insurance.

Also, I take the Azo cranberry pills regularly and it does help with preventing UTIs.

Either way - hope you get RELIEF soon!!

anne nahm said...

This makes my eye twitch just reading it. Hope you feel better already.

Jen said...

I was going to suggest the clinic (Walgreens, CVS, etc) too. Another thing to do, particularly if you have to go in for an appointment? Have the doctor really look at your history and ask for additional prescriptions valid for a year. I KNOW doctors are crazy about over use of antibiotics (rightfully so) but seriously you have a pattern and it's only reasonable to give you a couple extra refills to avoid this BS. Or make them write on your chart *GIVE REFILL IF WITHIN ONE YEAR* just like that so that you can call in and get the Rx.

vanessa said...

whaaat they only treat UTIs for pregnant women? WTF is that nonsense? that makes NO SENSE.

spacy dreamer said...

Do you have an online clinic option? I had an earache, went to virtuwell.com, and they called in a prescrption about an hour later. They billed my insurance for $40, not too shabby.

Swistle said...

As far as I know, we don't have any walk-in clinics. There are flu shots at the pharmacies, but that's it. Just doctor offices and the emergency room.

Corina said...

Just tweeted this at you too, but I know how infuriating this is, so thought I'd double up on the advice. Does your pharmacy carry Cystex? It's an OTC treatment for UTIs. It SAYS it's just for relieving pain before you get to the doctor, but in fact it's an OTC version of the drug that used to be the standard treatment for UTIs before docs started handing out antibiotics for them. It's totally cleared up UTIs for me so that I never have to deal with this hassle. My mom recommended it to me. Since she discovered it, she hasn't gone to the doctor for a UTI. And she gets at least one or two a year. Not a doctor, grain of salt etc. But . . . it's worked for me.

Leeann said...

I haven't even read the comments yet but I am so eager to join you and rant that I can't wait so I may even be commenting twice.

SO FREAKING SICK OF THE MEDICAL ESTABLISHMENT!!!!

I too have been faced today with making medical calls. that also had me awake and worrying last night.

So today I make my call and leave a message (at least with a person!) in which I give my name, date of birth, phone number, alternate phone number and an explanation of the problem. It's not an emergency so I was told 1-2 business days for a call back.

Fine, okay, no biggie.

Not an hour and a half later, I get a call. On my cell phone, which is in the other room charging.
By the time I get the dog off me and get over there, sure enough, it's on its last ring and has gone to voice mail.

I immediately call back, I'm talking within two minutes of missing the call and I get a person taking a message again. Same info given. Same questions asked. ERGH!! Don't they have a record of this from, like, two minutes ago? Isn't the person who called probably still RIGHT THERE?? HELLO!!

PLUS, I got two bills that are incorrect because I swear they are just hoping I'll pay them so they can just write off someone else's expenses.

See, told you I was ranting.

Oh! BUT! Feel better. I am sorry about the UTI. Those things hurt like a mofo.

phancymama said...

I am so MAD on your behalf. Just so MAD.

Stimey said...

And the really horrible thing about the whole thing is that you could be suffering through a UTI while all this is going on, which is NIGHTMARISH. I'm really glad you have the Azo. I only go to my OB for those. I'm so sorry. Your story is infuriating and UTIs are terrible. PLUS you have to talk on the phone many times about this, which is not the most fun. I hope they figure out a way to be reasonable for you.

Alice said...

i emailed you! i have SUCCESSFULLY TREATED raging UTIs using new-agey homeopathic crap.

(the last time i had one, i thought to myself that antibiotics only JUST were invented, and women must have been getting UTIs for all of history, and probably didn't, like, DIE every single time one occurred, so there HAD to be some way of knocking them out naturally. THERE IS.)

Shalini said...

Oh my GOODNESS is this frustrating. Do you...have a dr. in the family or as a friend? I would hit them up for a VERY LARGE scrip of the antibiotic you need and then hoard them for when you need them.

Erin said...

A friend of mine got her doctor to write her a prescription for a low-dose antibiotic that she's supposed to take every time she has sex (that's apparently her UTI trigger) -- maybe they'll be willing to write you something that can help prevent UTIs if you take the pill whenever you do the activity that seems to trigger them (assuming there IS a trigger)? Although it sounds like these doctors may not be on board with that, it couldn't hurt to ask.

Jessica said...

Yes, this IS what is wrong with the medical establishment, because I had NO IDEA those labs cost $450. My insurance covers 100% of labs, so I never have any idea what they cost (unless I glance at an EOB).

Although, the last time I had a UTI the lab tests DID discover it was resistant to the antibiotic I'd been prescribed. I'm not saying they should always be run (wait and see if the first antibiotic works is sufficient), but I was pregnant at the time and think it's probably a good idea for pregnant women.

It would REALLY piss me off, though, to have to pay $140 for labs on a routine UTI when I wasn't pregnant.

Also, now I am very curious about what Alice in the above comment uses.

Hotch Potchery said...

I am really shocked you don't have "a doc in the box" but you have TWO Targets. We only have 1 Target and 4 Walk in places!!!

A'Dell said...

Agree that you should have a chat with your doctor and/or the office manager so that they understand your specific needs and frustrations. At the end of the day, they might want to cha-ching, but (ONE WOULD HOPE) that patient care comes first and the bottom line is that your needs are being overlooked in favor of The Way We Do Things Around Here. You aren't seeking care because of they way you are treated and that's wrong and sad and very much NOT how they should make any patient feel.

You need like, a special note in your file that says, "Swistle has Special Permission for XYZ."

Also, this might not make any difference TODAY, but it might make you FEEL better: Write your Congressman. Outline the ridiculousness of it and how it is impacting you, personally. Your doctor is playing a game with insurance and malpractice risk aversion and you're playing a game with insurance and your health and these things are at odds with each other, through no real fault of the individuals in this situation.

Pretty much every time I encounter a frustration with health care, I lob a note to my Congressman so he knows that it's an important issue to my family. (Semi-remarkably, I ALWAYS get a personal note from either him or a staffer within 24 hours.)

Swistle said...

Corina- I'm going to try that!

Lindsay said...

Just read sundrys post about the FDA and now this and I am seething on your behalfs about the foolish redtApe world we live in that is all supposedly for our own good.

lifeofadoctorswife said...

How MADDENING.

I talked this over with... someone. (Who said if a patient firmly refused lab work, he would try to work with that patient to either understand the necessity of the lab work or work out a payment plan or find a lab work alternative not FORCE her to do the lab work.) And his suggestion sounded workable: Go to the doctor and ask if you can get an "as needed" prescription that you can fill out in future. With the caveat, of course, that you would come in if the UTI didn't clear up.

(He did also say it sounds like maybe you need to consider prophylactic antibiotics, but I know you mentioned telling the doctors that this seems like a LOT of UTIs and them brushing it off, so perhaps this is not workable.)

I also had the thought that sometimes a dentist I knew back home would do a special thing for family members/fellow dentists where she would only accept the insurance payment and not accept any payment from the patient, which may be worthwhile ASKING about in this case. Although it makes me uncomfortable to even suggest it, so it may be uncomfortable to raise as a possibility with your doctor. But there it is NONETHELESS.

Good luck! I hope this comment comes AFTER things have worked themselves out!

Kira said...

I hesitate to share this, because I think I'm crossing the line into "crazy overshare" territory. hmmm.
Okay, here goes: I went through a period of about a year and a half where I got a UTI Every. Single. Month. Gah. It was crazy making.
Then someone told me to get a watermelon, boil the seeds, strain, and drink the water. And maybe it was just coincidence, but I've only had two...maybe three UTIs since. And that was almost 20 years ago.
By the way, when my first husband (then my fiance) brought me a seedless watermelon when I told him my scheme? I should have known then.

Beth said...

Planned Parenthood, if there's one where you are, treats UTIs. I have no idea how they work if someone has insurance, I found this out in my pre-insurance days. But it was fast, easy and inexpensive, they even had the meds right there on-site. I hope everything gets taken care of.

Swistle said...

Beth- Good thought! We do have one of those, and I hadn't thought of them when I was trying to think of other doctor options! They're quite a distance away, but I'm at a different "willingness to consider" point than I was this morning.

Amanda said...

If men got UTIs you know that shit would be an OTC drug.

Anne said...

SO TRUE, Amanda!

Alicia said...

Ditto Melospiza

And Amanda :)

Laura Diniwilk said...

What exactly do they think you are DOING that they can't just call it in? Making Cipro meth???

Hope you feel better soon!

Cayt said...

Between this, and a friend of mine who has to choose between visiting the doctor and buying her textbooks, I'm very glad to have socialised healthcare and don't know why some people think that it is not a better solution. I don't want to get political on you, but really $140 for an unnecessary test is frankly ridiculous.

vanessa said...

Cayt--lots of us really, really, REALLY want socialized medicine!

JackeeG4glamorous said...

Ok, I gotta stick my two cents in. First of all, it's medically incorrect to start to treat a UTI without knowing which antibiotic to use...so you do the dip to see if in fact there is bacteria, blood, etc...then send the urine out for a culture. A culture takes about 5-7 days to grow in a petri dish to find out which antibiotic will actually work on your specific UTI or bladder infection. SO, your doc isn't out of line asking you to come in and give a specimen. I just can't believe your insurance wouldn't pay for the testing...most do. Docs really don't need you to come in just to make a buck...seriously. Take a look around the waiting room, uh, yeah...nope.

hope this helps. Hope you feel better soon.

sara m said...

I experienced the fastest whack of karma this afternoon I have ever known. I read your post and was about to remark that the first time I went to see my new PCP she told me that they understand that women *know* when they have a UTI and just to call in and ask for a Rx, no appointment needed. I wasn't bragging, I swear, more like I wanted to say, "Move here! Be my neighbor!" Anyway, after typing the first two sentences I got distracted by the kids and a few minutes later realized I had to use the bathroom...badly. Odd since I had just gone a few minutes before. As soon as I sat down I felt the raging rush of an infection. I must be incredibly sensitive to the power of suggestion :) Sadly, the doc's office had closed by then so I will have to call tomorrow and see if this offer is actually true. Until then, I share your pain and a glass of cranberry juice. Feel better Swistle!

Maggie said...

Delurking to say, that is super lame & I'm sorry!! UTI's are THE WORST.

Anonymous said...

Someone else already suggested this, but I wanted to say that I recently went to my new doctor for a yearly checkup, mentioned that I get UTIs easily, and she wrote me a prescription for the drugs right there. So I would have them when I needed them. Needless to say, she is my favorite doctor ever now. So it is totally possible to get the drugs beforehand.

Swistle said...

Jackee- In 5-7 days I'll be done or almost done with the antibiotic they prescribed before sending anything to the lab, and we'll know for free if it was the right one or not. I don't see the advantage to the $450 lab tests. Especially if the first antibiotic has worked every time since I got my first UTI at age 13.

Louisa said...

I used to get UTIs all the time. My doctor's PA suggested the antibiotic nitrofur mac. Basically, right after s3x, I take one pill and that's it. I haven't had a UTI since. And the prescription was for 30 or so pills. I definitely recommend it.

Suki said...

Ugh, I once called the doctor's office about a UTI. I mean, I knew I had a UTI, I'm not stupid. I had even looked up the appropriate antibiotic online. I just needed the dip-test. When I called my doctor's office, I was told that the next available appointment was in 2 WEEKS! For a UTI! I told them that in 2 weeks, they could just go ahead and treat me for a kidney infection. No local doc in the boxes would take my insurance without a referal (which I have to get from the PCP with a 2 week wait), and my doctor's office wouldn't fit me in until I threatened to go to the emergency room. Lo and behold, it took me all of a 5 minute appointment and a dip test to confirm that I had a UTI and needed the antibiotics teh internets had said. I'm on the wait list (!) for a new doctor, but have no idea how long that will take. Oh, and it took me 1/2 an hour on hold to make my child's 12 month well child checkup.

Sorry, I guess I needed to vent :)

Tamara said...

Oh god, I am a sister in your UTI pain, I was even sent to a urologist for the worst doctor appointment of my life (hi! let's insert this camera in your bladder, oh shoot your urethra is unusually small! Let's STRETCH IT!), only to find out that I'd been living with a low level anti-biotic resistant infection for ALL of the time that would occasionally flare up. Once they gave me the GOOD antibiotic (that also destroyed my guts) I have been UTI free. But yeah, it is my general feeling that doctors who insist you come in for an appointment are doing it for the money, bottom line.

Josefina said...

I also want to know Alice's method. Additionally, I hope you feel better very soon, and that you'll let us know if the supposedly less effective antibiotic works. This post really made me grit my teeth. Infuriating.

Heather said...

This is completely unrelated...but years ago I joined postcrossing because of you and tonight, I made it to the top ten in all of Australia so I wanted to take a moment to say a great big THANK YOU!

Swistle said...

Heather- YEAH BABY!

Anonymous said...

Is there a naturopath in your town? Once you are through this bout, I would suggest you look at the underlying causes, because I agree with you, its not OK to be having constant UTIs. Not that I think it is SERIOUS :), but wouldn't it be better to NOT have to deal with the added stress of it all. No doubt sleep/stress is a big part of it, but often a good naturopath can help boost your immune system so that it can fight stuff on its own. Fair warning: sugar & caffeine (2 things we mom's use to keep us going) are often culprits!!
I know you don't need one more thing on your to-do list, but you have to take care of yourself to be able to take care of everyone else.
Deep breaths!

amyunicorn said...

Have you tried drinking lots and lots of cranberry juice to keep your urinary tract clear? If I start getting the very first warning signs of a UTI (I have had MANY in my life), I start chugging the cranberry juice and take a bath with white vinegar in it, clears it right up! I also heard you can get cranberries in a pill form from a health foods store that would be even more effective than the juice. GL!