Doctor, Doctor

So I had a weird bump on my shoulder and thought I should get it checked out.  Now I know I need to go to a dermatologist for this, but of course my insurance requires a referral to go to a specialist.  So I need to go to my doctor first so they can tell me I need to go to a dermatologist.  This is an excellent example of efficiency in healthcare.  

So I call to make the appointment with my doctor. Since I'm not sick (I'm just trying to find out if I have skin cancer) I can't get a sick visit and since I need an early morning or evening it's around a three week wait (for any doctor in the practice). I wonder if I have legal recourse if the thing grows in the meantime.  In the interim I get the name of a dermatologist in my plan (from my boss so I know she's a good doctor plus she is in the city so I will have more flexibility in when I can go).   This way I am prepared with the name of the doctor I will be visiting so they can write it on the script (and their provider number, just in case - I am very thorough).

The doctor visit goes as expected. I spend 20 minutes in the waiting room, 5 minutes in the exam room (without the doctor) and 2 minutes with the doctor, who tells me it doesn't look cancerous but I should go to a dermatologist to be sure. By the way this only takes 1 minute of the two - the other minute was asking questions about how I feel completely unrelated to the bump on my shoulder.  I check out and pay the $25 co-pay and ask for the referral.  Nope, sorry, doesn't work that way.  I need to call and make the appointment with the dermatologist, and then call my doctor's office back with the date of the appointment and all of the doctor's information and they will process the referral.  All I know is I better not call the dermatologist and have them tell me they need the referral before they can make the appointment.

So I make the dermatologist appointment.  It's a good thing I have more flexibility on the time since the dermatologist appointment is even harder to secure than the regular doctor.  Plus, as a new patient I have to provide all of my information over the phone so they can create a record for me.  I dutifully call my doctor with my appointment time.  A week later the dermatologist's office calls to change the appointment since she won't be in the office on the day I am scheduled (I am giving them the benefit of the doubt and assuming her schedule changed as opposed to her staff is dumb and made an appointment for when she won’t be there).  I found about this change via a voice mail and it took me three calls back before I got someone who could actually schedule a new appointment for me.  The first two times the person who answered the phone had “too many people there for her to help me” and took my name and number so I could be called back and helped.  You will be surprised to find out I was never called back and had to do it myself each time.  I finally get the new date and again, being a thorough person (my gift and my curse), I call my primary care doctor to tell them the new appointment date for the referral and they tell me it has already been completed and sent over to the dermatologist so they don’t need it.  Since I have a working brain, I can’t help but wonder why they needed a date at all in the first place.  You are really not impressing me insurance industry.  Meanwhile, it has been several weeks since the potentially cancerous bump detection and I have spent more of my time setting things up and paying and providing information so that I can pay than actually seeing a doctor and I still don't know if I have cancer.  It is about this time you start thinking of “if only they caught it earlier” stories. 

Finally I arrive at the dermatologist where as a new patient I have to complete about five pages of information that is exactly the same as what I provided on the phone when I set up the appointment.  What is up with that?  Even if they need it in writing, why can't they give me a printout of what they have to edit or approve? And why do I have to write down my insurance information if they are taking a picture of my card?  I never know what numbers to write - most of the names they have for numbers don't match the names of the numbers on my card ( for example, policy number appears nowhere on my card).  This all seems incredibly inefficient for an industry that claims to have procedures in place for efficiency to improve my healthcare experience (while annually raising the cost of such experience).

Yet once again, the efficiency presents itself when I am faced with the purpose of all of this – seeing the dermatologist.  As with the primary care physician, I spend the least amount of time with her (although a little more than with the primary care since she does give me a full body check to be sure).  I spend about ten minutes with her (sadly part of which is verbally completing the paperwork I didn’t finish in the waiting room).  I then leave and pay $40 for the privilege of this visit.

For any of you keeping track, it has now cost me $65 and probably a couple of hours of my time between making these appointments, travelling to them and actual time in waiting rooms and doctor's offices.  Out of these couple of hours, I spent about 15 minutes of actual time with a medical professional.  So as it turns out the system is incredibly efficient - for the doctors.  It is simply incredibly inefficient (time and cost-wise) for those of us going to the doctors.

And for those of you kind enough to be worrying about whether I have cancer (my snarky self thanks you for caring) you will be happy to know that the suspicious bump is what is known as a seborrheic keratosis (yes, I looked it up after the fact for spelling).  Completely harmless and thanks to the full body check I now know that I apparently have a few others scattered about my body and I can likely look forward to more.  It would seem that they are caused by…getting old.