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It’s better than nothing…

March 12, 2013

Yesterday I had a visit with my cardiologist at the Brackenridge Specialty Clinic, here in Austin.  I go to this clinic because I am uninsured and low enough income to qualify for the Travis County Medical Access Program.  I am quite fortunate to have this safety net which provides some access to doctors and other medical services and pays the bulk of the cost of my medications.  Still, the limitations of this system are frustrating.

My experience at the Specialty Clinic, while it has its annoyances such as long waiting time and staff that sometimes act like you should be so grateful to be there you shouldn’t complain about anything, has been far better than at the primary care clinics run by CommunityCare.  I was pondering what the difference was yesterday and decided it is the quality of the doctor I see that is the difference.  The cardiologist, Dr. David Hayes (and sometimes Dr. Paul Roach), is attentive, understands my condition, and manages my medications appropriately.  Visits with him generally feel productive and successful.  This is despite the severe limitations of treatment at this clinic.  For example, I had contacted the Texas Heart Institute in Houston, Texas, regarding the possibility of participating in studies relevant to my condition if such were being done there.  I received an email requesting I have my cardiologist contact them.  Because of the time constraints and lack of access to a full medical record at the Specialty Clinic, Dr. Hayes told me he would be unable to do that for me but encouraged me to pursue it on my own.  Ironically, it is because of the lack of resources available in the MAP program that I was seeking studies to participate in.  My doctor said (of the MAP program), “It’s better than nothing…but not much.”  We both laughed.  What else can I do?  If I don’t keep my humor and optimism, it would be easy to sink into despair.

When I first saw a primary care doctor at CommunityCare almost one year ago, I requested referral to cardiology (for near constant angina), orthopedics (for knee and ankle arthritis that flares periodically), and pain management.  I was informed MAP does not cover pain management and that CommunityCare lacks resources to manage pain medications. (I now pay out of pocket for my pain management doctor visits, but that is another long story.)  I would be referred to cardiology but was warned by the doctor that she had no control over getting me an appointment and she had no idea how long it would take.  She did not order EKG or lab work.  Ortho didn’t even enter discussion.  So, the way I got my cardiology appointment was yet another emergency hospital admission complete with EMS limo service plus crying pitifully while telling my story to the poor, kind, inexperienced intern at the hospital.  I finally got my ortho referral after five months of showing up to clinic repeatedly complaining about my pain.  My appointment is next July, a grand total of 15 months from my initial request.  Meanwhile my current primary care doctor, Dr. Nagavarapu, seems to believe my primary health problem is arthritis.  I think she actually knows next to nothing about my cardiac condition.

I now avoid the CommunityCare clinic as much as possible.  The clinic itself is actually quite nice.  It is in a brand new building, with lab and radiology services under the same roof.  It is clean and well appointed, with nice furniture and huge flat screen TV’s in the waiting rooms.  The staff are generally very nice, though obviously overtaxed.  The waiting time is highly variable with a visit averaging 2 hours.  One time I actually slept for over an hour precariously curled up on one of those exam tables with the little section at the end that pulls out if you need the patient to lie down while waiting for the doctor to come into the room.  I was too fatigued to sit in the chair all that time.  Every time I go to the clinic now, I have chest pain and develop migraine headache.  I think it is because visits to this clinic are generally unproductive and frustrating.  I leave feeling like the doctor has no clue what is going on with me and that she discussed the limitations of what she could do more than anything else.  It has gotten to the point that in my mind the name of the place is *expletive*ing-CommunityCare.

A friend in Australia wrote me this week comparing care options:

We have ‘public’ clinics at some of our big hospitals too. They are terrible – staff treat you like rubbish, long waits in uncomfortable settings and no choice of doctor. Often you are seen by registrars. If you get to see a specialist they are usually good but the whole thing is very demeaning.

This pretty much sums up my experience.  I have complaints, but the sad truth is I have much more available than most uninsured Americans.  I’d like there to be improved access for everyone, but living in a state whose governor seems to take great delight in turning down federal funds to help more people get Medicaid, such hope seems fruitless.  Yes, I’m talking about you, Rick Perry.  The previous link is the self-aggrandizing campaign website for the governor.  For a more balanced account see NBC’s take on the governor.  For the critical version, see Huffington Post’s info page.  I am lucky to live in such a liberal bastion here in Texas that actually tries to help low income people get health care, even if the quality is not so good.  All I can say is I am looking forward to the start of my Medicare coverage in April 2014.  As my cardiologist said, it will open a lot more doors for me.

One Comment leave one →
  1. Beverly permalink
    March 12, 2013 3:28 pm

    Will you pursue the Texas Heart Institute studies on your own? how? I have always thought I’d like to be in a study, even if I’m on the placebo side of it, just to help science along. I hope you can to it (and be on the non-placebo side). Good post.

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