From Afar

By John Hutzky

My primary concern

Of all the proposals that have been put forth to cure the delivery of medical services, I have yet to hear anyone talk about the infamous primary caregiver, primary doctor, primary gatekeeper or any one of several similar euphemisms. Every presidential candidate has his take on how we can cure what ails our health care system. I have a suggestion that will cut the health care bill in half and still deliver the whole. Let's do away with the primary caregiver, which is simply a gimmick of the medical community to provide work for more physicians.

Does anyone remember the family doctor? He or she could be found in every community and was available just about anytime of the day to treat your medical problem, whether it be the common cold, headache or gastritis. Unfortunately, they no longer exist. The medical schools are now turning out primary caregivers to fill their HMO quotas. Try and get into an HMO or similar health plan without designating one-it won't work! It doesn't matter whether or not your problem is eczema or emphysema-you have to choose a primary caregiver.

Once chosen, you are locked into the medical merry-go-round. If you choose the right one for your particular ailment, you might be in luck, but heaven help you if you have an ailment outside of his specialty. The usual answer you will get from your primary caregiver is that you need to see a specialist in whatever field it is that's not his or hers. In spite of the diplomas hanging on the walls, it's a mystery as to what field of medicine the primary caregiver specializes in. Then, if you're lucky enough, the specialist will see you in a month or two for a consult.

Following the consult, there is a need for further data gathering before an opinion of any kind can be expressed in some semblance of understandable laymen's language. Therefore, the specialist must contact your primary caregiver to approve the next phase of your diagnosis. Once given, then the primary care facility must be contacted to schedule whatever tests the specialist orders. A day finally arrives when you show up at the "facility" but you must pass another litmus test before gaining entrance. Regardless of whether or not you have health insurance, Medicare, Medicaid or just plain cash, you have to tell them who your primary care physician is. It makes no difference that he or she may be able to interpret any of the test results; they are still entitled to the information.

Now this can lead to another can of worms as I recently found out. Prior to my annual visit to my urologist, he ordered a series of tests to be done at my primary care facility. Naturally, on the date of the tests, I had to indicate who my primary caregiver was so that they could receive a copy of the test results. It made no difference that maybe only the specialist could interpret these results. The medical law is the medical law.

I had the tests and was awaiting my visit to my urologist when I began to receive frantic messages from my primary caregiver. Whatever it was that he saw in the test results, he insisted that I have more tests, preferably an MRI. A little annoyed by all of this, especially since I had yet to be seen by the urologist that ordered the original tests, I called his office for guidance only to find out that he didn't have the results. Why was it more important for the primary care facility to see that my primary caregiver got the information before my urologist? He finally got the test results and in his opinion, I didn't need an MRI. You would think that since he was the specialist that ordered the tests in the first place, then his word would be law. Wrong. That's not the way the medical community works.

Less than 24 hours after being told that I didn't need an MRI, the specialist reversed himself. My primary caregiver convinced him that I needed the MRI and he caved in. Once the MRI had been scheduled at a primary facility, I reluctantly showed up but insisted on the non-invasive one. Once ensconced within the machine, I listened to country-western music for the next hour, as I would rather hear them singing about their miseries than think about my own.

Several weeks later, I finally got to see my urologist. With trepidation, I expected to hear the bad news about that part of my anatomy in which he specialized. He went about his routine in his usual cheerful way. His lack of concern alarmed me. Was I being set up? He concluded that my equipment was all in working order and that I was good for another year.

Stunned, but extremely relieved, I asked him about the MRI results. "Oh, there wasn't anything there that I didn't know about," he replied. "Then why did you go along with the MRI?" I asked? He smiled and said, "That's between you and your primary caregiver."