Archive for the 'treatment' Category

At the RMV

August 17, 2013

This is my little contribution to the reality of getting all those government-issued cards — IDs, driver’s licenses, learner’s permits, etc.

Jordan and I went down yesterday, at his request, to the Registry of Motor Vehicles, and it was crowded.  His wait was said to be one hour and 50 minutes.  We settled in, prepared to complete the transaction.

Well, the window he needed to use was proceeding s-l-o-w-l-y.  There were about 21 people ahead of him in his category when we came in, and after 45 minutes, I realized they were taking over 10 minutes to process each person’s transaction.  I did the math, and the wait for us would be about 3 hours at that pace at that point.

But a woman dressed in a pretty flowered dress and classic cardigan sweater, wearing an ID, had come in.  She addressed the crowd from the front of the room.  She apologized for the wait, urged people who could do their business online to leave and do that instead, and encouraged those of us whose business wasn’t urgent, to consider taking a “no wait” card and coming back another day.  She was the Registrar of Motor Vehicles in MA, Rachel Kaprielian.

At first Jordan didn’t want to take a rain check, but when I pointed out the slow pace at his window, he decided to go up to where he could get the “no wait” card.  And while he was on line there, the window he would have needed to use seemed to shut down entirely — its screen went dark and no one new was called up to it.

Apparently the problem yesterday at the Watertown RMV was staffing.  Yes, it was the busiest RMV office that day, but the difference from usual was that they were short-staffed, we were told.

What made me urge Jordan to take the rain check was my realization that we could wait three hours and be told he wouldn’t be processed because time had run out — I don’t think they were making sure they could accommodate everybody they were allowing into the various queues.  When I came once with Jonas years ago, they weren’t going to give him his card, until I intervened — he had all the necessary documents, they just kept giving him a run-around.  When I went up and said I was his mother and what was the problem, suddenly there was none.  I had a similar pattern with him at a hospital ER — he wasn’t examined until I insisted, everybody else in the waiting room who had been there when I had left to pick up Jordan from school had been seen, and he had had a neck injury.  Small white woman walks up and cross-examines them with some intensity and all of a sudden the African-American young man gets the service he was entitled to in the first place.

So this is part of why I personally don’t see voter ID cards as a neutral thing.  Getting a card from the government, I believe, can be difficult for some people, through no fault of their own.  These systems don’t always work as advertized, and it can take multiple tries and much effort to accomplish what it is said should be easy to do.

What to post

March 22, 2013

I was writing a post yesterday about what happens when life’s excessive difficulties result in a person’s implosion or explosion instead of a “faith experience.”  I called it “Foxholes,” in reference to the old saw, “There are no atheists in foxholes.”  (I think there are.)  After reading David Brooks’s column about foxes and hedgehogs, I didn’t want to post something called “Foxholes,” even if I had written most of it before I read his column.

So I’m going to add a little here about my adventures Wednesday night with our medical system, which I mentioned in a reply to a comment to Timothy Egan’s column on The Five Guys restaurant and its relationship to health insurance.

I had been taking an antibiotic, and after taking a dose, a short time later I felt awful.  Waves of chest pain, nausea, retching, a red itchy rash on the back of my neck and shoulders, including a couple of hives.  The antibiotic was minocycline.  I think what I had was probably a side effect reaction, not what we call an allergic reaction.

I’ve had allergic reactions to other medications, as well as side effect reactions to both meds and vaccines (or their bases, or both).  I was once told by a Dr. Melchinger, who was an internist in New Haven Willy and I both used, that I apparently have a body that will eventually if not sooner react negatively to medicine, and that I should not take any unless absolutely necessary — to save my window of tolerating them for when it’s especially critical.  So I’m a veteran of medication reactions.

I would have called the pharmacy, but they were closed.  I called the prescribing doctor, tried to page her, didn’t hear back, made some other calls, one of which told me try a local hospital and that they should have a nurses line to advise me.  They didn’t.  I tried the nurses line on my health insurance card.  They told me to go to the ER as I might be having a heart attack.  I didn’t think I was, and I thought an ER visit was “overkill” and a waste of resources (including my time and energy).  I tried paging my doctor again, then eventually I went to bed.

At 6:34 a.m. the next morning my doctor called me in response to the pages.  (The second page had been at about 11 p.m.)  To make a longer story shorter, she told me to come in at 11:30 that same morning, at which time we agreed (for slightly different reasons) that I shouldn’t continue taking the minocycline.  She made a new diagnosis and gave me a topical medication.  When I went to fill it, the pharmacist chatted me up, and when he heard its relationship to the minocycline Rx he had filled for me before, he seemed to recognize the reaction as one associated with minocycline and said immediately that I should avoid the med in the future.  It helped to hear that from him.   (Of course, he and I are old chums after discovering our mutual affinity for the Stop & Shop Friday special on rotisserie chicken.)

I am underwhelmed by a health care system in which even when I have good insurance, I can’t get helpful advice in the situation I was in.

When I told my mother about my adventure the next evening, she said she thought the hospital ER would have gotten excited over the heart attack idea and run lots of tests and even insisted on keeping me overnight.  I hope they could have done a differential diagnosis better than that, but who knows.

I’ve had the opposite experience, though, which was even worse: knowing I was seriously ill and being refused an examination, despite multiple requests.  It turned out to be a post-partum infection and the consequences were terrible, both short term and long term.

So the other night’s adventure was, to be sure, unpleasant, but not horrible.  I write about it mainly to point out that we use the ER in inappropriate ways not just when someone is uninsured — it’s as if it has given us an “out” in all sorts of situations, kind of like that Life cereal commercial in which the older kids have Mikey taste it:  “I know, we’ll just send the person to the ER,” as if there were no downsides to that approach.  And I also wanted to point out that having good insurance may be necessary but insufficient to gain access to appropriate care when necessary.  The system does not work as advertized.  Some of it is less-than-stellar implementation, some of it is structural.  Paging systems break down, 24-hour “urgent care” is not available, a patient’s history does not produce adequate planning for pretty predictable negative outcomes, etc.

Instead of patient satisfaction surveys, the system needs a feedback mechanism to transmit more complex information from people with actual experience of the system.  Actual care providers may have this complex information, too, but I suspect both experts within the private system and policy experts in the public sector don’t.  I sometimes think they want to solve the problems they want to solve, not the real problems that actually exist.

Protesting and the next person

November 11, 2011

The Penn State scandal and the failure to protect subsequent boys by pursuing earlier cases sufficiently reminds me of a situation I encountered about five years ago.  I didn’t realize at the time what I was up against, which was probably a good thing.  I pursued investigating the system’s (lack of) compliance with its own rules, and redressing the particular shortcoming in its provision of services that had come to light.  I did finally get someone to pay attention, a couple of vice presidents in the administrative structure I think responded to my written complaint, although the remedial actions consisted of a long and drawn out process which ended up meaning that by the time the remediation of the underlying problem was agreed to, there was no time to implement it — the calendar said time was up.  But besides feeling that I had done all that I could, I did also feel that what I had done also meant that the next folks who came along would start off in a slightly better position, because one result of the investigation was that the institution was now going to follow the already existing requirement that they present a written treatment plan to families at intake.  Of course, I also know from experience that the existence of the document does not assure that it is followed, but at least it’s better than having no document at all.  Small incremental steps.