This other Saturday was blessed by Californian sunshine. Were it not for your pre-school kid that shows signs of a potentially serious infection. What do you do? Despite great health coverage, a visit to the emergency room would set you back by 300 dollars. Your small kids need care quite often and usually without it having to be life-threatening. So you call your pediatrician’s hotline and they recommend to search out an urgent care facility.
There are urgent cares close by, but they are all out-of-network or out of a pediatrician. So you drive 30 minutes to the next city with an in-network pediatric urgent care. Swell. After having waited with a crying kid in pain for a felt eternity (probably short of an hour) it’s your turn. Seems like it could be a UTI, however to be sure they request a urine culture. So far so good, your kid has not been helped in any way, still screaming in pain. Instead, it turns out you and your sick kid are supposed to bring the urine sample yourself to a hospital another ten minutes drive away. In disbelief, you then learn that after driving there, you need to drive to yet another place to pick up the prescribed drugs. What a mess.
This 4-hour intermezzo panned out quite suboptimal, but it’s not over. Two days later, you receive a call by a (different) pediatrician that the culture was indeed positive, but for some unusual bug, and that you should start with the antibiotics. A bit later, the pediatrician who attended to your kid calls, and decides that you shouldn’t give the drugs because the culture was probably contaminated. Since the symptoms were self-limiting, you wait.
As every parent and clinician knows, kids don’t first check whether we’re within the office hours of Monday to Friday before “deciding” that it’s ok to get sick. So as it has be, the subsequent Friday afternoon the same story starts anew. This time you’re more worried as there is a chance that the maybe-UTI last week might have chronified into an ascending infection (pyelonephritis, urosepsis, you name it). This time around (still barely in the office hours) you reached your pediatrician’s office which scheduled a same-day telemedicine visit. The pediatrician recommended to you that you get another urine culture, however for this you would need to go to an urgent care practice.
Trying to prevent another painful drive, you make very sure that there is nothing close-by. For luck, your insurance has a neat web application that lets you find in-network caregivers near to your location. However, while some urgent cares show up as out-of-network, there are others that the insurance database doesn’t know of. Pleasantly, when you call those providers, they either tell you that you’re out-of-network, or they have no way of telling, and suggest that you need to call your insurance.
Ok, so in order to get urgent care, I first need to call my insurance. Sure thing, under the viewpoint of common sense – an utmost rare commodity here – this is utterly non-sensical. Alas, how hard can it be to reach your insurance? The public number was a dead-end as there was no agent in-office at five something pm. For luck, the insurance’s webpage instructs you to call your dedicated number which is printed on your medical ID card. No problem, you check the PDF version of your medical ID card, since the physical card has not been sent to you since you asked for it only five weeks ago. The PDF card says (and this is no joke): Please check the phyiscal card for the number to call.
After hours of calling around, when your voice is starting to feel dry and when you start realizing why mobile plans come with unlimited calls here, you finally find an in-network caregiver within reach. Since your kid has a fever, policy has it that you need to schedule a telemedicine call in which it is determined whether or not you can come in for further testing. “But is there no way that our pediatrician can order these tests to be conducted in your urgent care practice?” you may ask, still foolishly appealing to common sense. No, your pediatrician cannot - he is not in the other practice’s system.
No biggie, you agree to have a second telemedicine visit on the same evening (still no care provided). Unfortunately, there are no appointments available, therefore you are kindly asked to call again on the next day (same-day appointments only). At this point it should be blatantly obvious that there were no slots available on the next day as well. At least, by now your kid is doing better again. It’s mesmerizing how everyone you interacted with wanted to help, but somehow no one helped.
An actually working healthcare system should function as a safety net that catches you when you fall (maybe even literally). For that to work, healthcare needs to be uncomplicated, practical, and patient-oriented. However, this series of exchanges with the local healthcare system here in the US drew a whole different picture. Rather than a net, it felt more like a heavy and scrachy rope that suffocates you more with every move you make. Weirdly enough, the caregivers themselves were kind and professional. It’s just the chaotic systems, policies, and processes build around them which lead to the total fiasco that patients have to endure day in and day out.