The American Healthcare System At Work

One of my favourite movie sequences is from The Twelve Tasks of Asterix, wherein Asterix and Obelix go searching for a form inside a huge Roman bureaucracy entitled "The House That Drives You Mad."

Sample dialogue:

Bureaucrat 1: I can't give you form B, without form C. You'll have to go upstairs for form C.

Bureaucrat 2: They didn't give you form C downstairs? Alright, but first you have to fill out form B. Go downstairs.

And so on and so forth.

Today, I went over to a eye hospital (I'm not saying where) to see if the redness in my eyes was pinkeye or something that required serious care.

Since I can see perfectly, I first go into the huge snaking line downstairs marked "Outpatient Registration." (This is at 10 am, for reasons that will become apparent later.) 5 minutes in, an employee canvassing the line (in order for it to move faster), pulls me aside and says that I should go upstairs to Triage. I go upstairs to Triage, wait in another line for 2 minutes, only to be told that the actual "Triage" section is around the corner. I go around the corner, wait 5 minutes only to be told to sign my name in a book and wait to be called.

I dutifully sign the book and wait 10 minutes for my name to be called. My name is called and I head into a room where I'm asked the standard medical questions (fever, cold, medication, etc.) and have my blood pressure and temperature taken. (Both normal, by the way.) Then I'm told to go into another area and wait.

I wait there for 5 minutes until my name is called. Another nurse collects me and takes me into another room where my vision is checked and again, I'm asked the standard medical questions. She then gives me a set of forms and instructs me to go back down to Outpatient Registration and hand them to the employee canvassing the line.

That's right, literally go back to where I came from.

I give the forms to the employee canvassing the line, who gives me a congenial look that tells me that he was expecting my return. He gives me another set of forms to fill out with a dull pencil. I fill them out. He then announces to the rest of the line: "Ladies and Gentlemen, I'm sorry, but this is an emergency patient and due to hospital policy, he must be served first." I'm subsquently escorted to the front of the line, to do something which I could've accomplished 22 minutes ago.

At registration, I'm asked about my insurance and social status for about 10-12 minutes through a tinny speaker. After parting smiles with several new forms and shiny red card with my name on it, I'm then sent back upstairs to another section, where I wait in line for 5 minutes to give the card and forms to the receptionist. In a bit of comic irony, these vaulted forms are received with a perfunctory "please sit down over there."

And I sit.

And I sit.

And I sit some more.

When I start pondering how insane this system is considering that I've been labelled an "emergency" patient, the receptionist calls my name and has me fill out another form.

I was rather struck by the repetitiveness of the forms. They all ask me my birth date, name, medical provider, and how long I've been having the trouble. Do they not read the forms they ask people to give them? Does one slip of paper have a different meaning than the other? It seemed more like an action to pass the time rather than provide necessary information.

After a 30 minute wait, I'm finally called into a room and meet with an attending doctor who again runs vision tests on me that are the exact spitting image of the ones I had earlier. Then I'm treated to a fresh hell I have never experienced before: having my eyelids flipped. I did not do this as a child and I do not do this as an adult. I don't know if it's the shape of my eyelids, but it was having chlorine rush into your eyes. Painful.

The intern then puts eyedrops in my eyes to dilate them. She chides me for not keeping both eyes open. I have no trouble sympathising with her--since it's clearly evident that everyone there is overworked--but at the same time, it is not the easiest thing to keep both eyes open when someone is dropping something that stings into your eyeball.

I'm just saying.

An attending doctor comes in and does pretty much the same thing: look left, look right, look up, look down, let's flip your lid again.

He then talks mostly to the intern, saving only the same standard medical questions for me. (Don't you people talk about this beforehand?) The intern drops even more dilating fluid into my eyes and has me do the look left, look right dance again with both tearing and twitching eyes open.

Then I'm told to wait outside for 20 minutes for the dilating fluid to kick in.

Oh, joy.

The intern comes and picks me up again and we go into the same examination room from whence we came. More of the look left, look right dance. Another attending comes in and does the same. This one is rather mean because he doesn't even warn me when he flips my eyelids.

The ultimate diagnosis: subconjunctival hemorrage. No need to do anything but just let it clear up, but "would you follow up with us?"

I nod my head because I'm supposed to, but in all honesty, there's no way on god's green earth I'm going to go back there and through that maze for a follow up visit.

So what have we learned here, Charlie Brown?

Well, I reckon it's that the pass-the-buck nature of HMOs and other trappings of American healthcare wherein profits trump people has created a pointless bureaucracy where people spend more time telling others the when, if, and how they're going to pay as opposed to actually getting treated.

Either that or the next time you think you might be sick, just stay at home and wish it away.

By the way, remember that I started this process at 10 am? I left there at 1:59 pm, complete with blurry drunk vision from having my pupils dilated.