Think Of It This Way ....

When I arrived at the lab, in this large new clinic building decorated with spectacular art work, it was 6:35 AM. Many of the chairs were filled and those that were empty were soon occupied by people waiting to be called for their tests.  Six or seven people lined-up at the intermittently-staffed lab reception desk.

You might not recognize this as cost-shifting, but in my opinion, it is.  Clinic management has decided that it is more efficient, in terms of their needs, to keep 18 people waiting for more than a half-hour each, rather than bring in phlebotomists to draw blood and instruct patients on how tests are to be performed.  Those patients, waiting for their blood to be drawn and specimens to be taken, were not at work, were not earning wages, and had just used expensive cars and expensive gasoline so that they could sit and wait and wait and wait.

When government and insurance companies calculate the costs of care, rarely are patient transportation costs and lost opportunity costs (not being at work earning a living) added to the equation. Those dollars come out of the patients' pockets, not the government or insurers pockets.  The cost has been shifted and no-one seems to notice or care.

So think of this as a cost shift and as an uncounted tax that each of us pays.

A Long Day

Because I have been ill, my blogging has been curtailed.  To give you a sense of what has been going on - I'll describe yesterday.

Phone rang once at 5:20 AM. No one there.
As instructed, I appeared ( accompanied by my spouse) at the University Medical Center at 7:20 AM. Confusion prevailed since the department's computer had me scheduled to show up at 9:30, though someone from the department had called the night before with instructions to show up before 8:00 AM.  Sat and waited.

Called into the pre-op room, changed into hospital garb, climbed into the preop "bed,"  answered a lot of questions the answers to which were pretty much in the electronic medical record, though not entirely accurately in the electronic medical record. Nurse was very thorough and competent. Started on IV.  Waited.  Waited. A Fellow appeared and we discussed the proposed procedure, discussed my history, went through a limited physical exam, and negotiated some issues which were important to me relating to lab tests and operative procedure related events. Faculty member came and we had a sensible and appropriate (more mature) discussion of his plans and recommendations, the proposed procedure and the likelihood that my procedure would be significantly delayed because he had to treat a child and we agreed the child should come first (which was the faculty member's plan anyway). More waiting.  More waiting. Reminded nurse that I needed a simple blood test done and it was done. Told that the procedure was going to start soon.  It didn't, but eventually it did. Brought by a pleasantly chatty nurse to a high technology room containing 5 people and placed on a hard narrow table. IV running (fluids, pain relief and sedation). O2 running. Monitors running. Local anesthesia for a biopsy provided. Biopsy done with little pain or discomfort and lots of instruction for the Fellow who was there learning. Off the table to the wheeled transport. To another room for  recovery and two hours of fitful dozing. Then to another room for final awakening and sitting up. Then to a wheelchair to my car. Then home where I arrived after an almost 11 hour day.  Now the wait for pathology and lab results.