By Steve Kelman

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A good experience with the U.S. health care system

Shutterstock image: monitoring factors of healthcare.

This is the only post I am writing this week, and it is coming very late. The reason is that I have been grappling with a health problem that has dominated my past week. I still don't know exactly what is causing it, but I wanted to report on my experiences with our health care system in trying to figure out what's going on.

Having a health problem to worry about is unpleasant, to put it mildly. But I must report that my actual interactions with the health care system -- from which I largely have been spared for a long time except for routine checkups -- have been amazingly good.

I first noticed my problem a week ago Sunday. I had thought there was something a bit off with the vision in my right eye, so while reading the newspaper, performed the simple experiment of putting my hand over my left eye, and discovered that vision out of my right eye was extremely blurred -- I could not read at all.

By coincidence, my annual physical was scheduled with my internist for the next morning, and of course I raised the problem with him. After looking at my eye, he said, "You need to see your eye doctor as soon as possible." I called my eye doctor (I had had a regular eye check with him in mid-November, which had been completely normal), and was told to come in Tuesday morning.

The eye doctor looked at me Tuesday morning, and said, with determination in his voice, "I need to get you to a retina specialist today." (He suspected a detached retina.) He proceeded to call the doctor he said was the best retina specialist in Boston, whom of course I had never dealt with before. That doctor returned his call within less than five minutes, and said I should come to her office at 6 p.m. that same evening.

I got myself to her office, in another part of the city, and around 8 p.m. she was ready to see me. (The patient sitting next to me told me the doctor usually ran very late, because she was so thorough with patients.) Almost two hours (!) later we were done.

The specialist said I definitely did not have a detached retina, but I had very serious inflammation in my right eyeball. I needed to see a subspecialist as soon as possible, the next morning hopefully. She said she hoped she could reach the world's leading expert on inflammation of the eyeballs, who ran a research institute in Cambridge. It was after 10 p.m., so she left messages on both the doctor's voicemail and his wife's. She had no idea if he was in town, she told me, and would need to find somebody else if he was not, because I needed to be seen soon.

A bit after 11 p.m., the retina specialist called me to say she had heard from this doctor, and that he would see me at 9 a.m. Wednesday morning.

I spent almost two hours there. They did one set of tests that turned up nothing, then blood work that wouldn't be available for another week. I was told to contact the doctor through his personal email with questions or if my symptoms got worse. Meanwhile, he would schedule a just-in-case surgical diagnosis in case the blood tests came back negative, so that I would already be on the calendar.

A few days later, Sunday afternoon, I perceived that my symptoms were getting worse. I sent him an email, and he told me to come in on Monday. Looking at me, he said he wanted to move up the surgical test to Friday (that is, today), doing it on a day he didn't normally do surgery. Then Wednesday morning I got a call from his office, saying he wanted to squeeze in the time to do the surgery that day at 4 p.m.. (I should add that meanwhile the original retina doctor was calling me almost every evening, typically around l0:30 p.m., to find out how I was doing and answer questions.)

I still don't definitively know my diagnosis. But I believe the health care system has performed just amazingly in trying to help me. Three doctors saw me in two days, setting up essentially immediate appointments. Two of them I had never dealt with before. Yes, I wait three months for an appointment for an annual physical like everybody else, but in this case of an urgent through not emergency-room situation (e.g. heart attack), the system was able to move very, very fast.

Some may say that as a Harvard professor I get unusually good health care. Yes, Harvard does give faculty and staff generous insurance coverage (though recently some Harvard faculty, not including me, have protested against the introduction of modest deductibles and coinsurance). And Boston is well served by an amazing range of good doctors and teaching hospitals. But I participate in an ordinary HMO that is open not just to Harvard employees, but to lots of others in the area. So I maintain that the service I have gotten reflects something good about our health care system that seldom gets attention.

Although my regular internist and eye doctor were wonderful and extremely hospitable, I would like to give in this blog a special shout out to Dr. Delia Sang, the retina specialist, and Dr. Stephen Foster (the eye inflammation specialist and the founder of the Massachusetts Eye Research and Surgery Institute), for service above and beyond the call of duty.

Meanwhile, wish me luck getting better.

Posted by Steve Kelman on Jan 16, 2015 at 8:22 AM


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