If I wasn't laughing I'd be screaming: Trying to get treated at Kaiser Permanente (Part II)
If I wasn’t laughing, I’d be Screaming
The difficulties in trying to get treated as a patient at
READ Part I
The following continuation of a story illustrates how difficult it is for a patient to be treated at Kaiser Permanente.
Patient has a prior hip injury, and 3 years later is re-injured and tries to a) determine the cause of injury and b) seek treatment.
Three years had gone by since I’d torn the acetabular labrum in my hip. Since it had slowly improved over time, the orthopedic surgeon (Dr. #2 from Part I of this saga) had not recommended surgery at the time, but recommended open debridement with possible osteotomy. The only reason I know his recommendations is because I order copies of all my medical records and get copies of tests if possible. You will see why this is a wise thing to do if you keep reading.
I did get PT with an excellent physical therapist (PT #1). I only got two visits though.
Over the course of 3 years, the pain was largely gone but many exercises aggravated my hip and I would go through periods of pain. I noticed that yoga and deep stretches made the problem worse, as well as squats and anything with a large ROM on that side.
It was in April of 2008 that it came to a head. I had been doing deep squats in a fitness class; I told the instructor they hurt my hip but she told me I was probably just doing them wrong (I wasn’t). She told everyone that. I’ll know better next time to listen to my own body and stop despite what someone else is telling you.
I had been taking the class for 2 months. One week, I went for a 5 mile hike in the mountains with some friends. One dance class later and I was in a world of hurt. My non-Kaiser chiropractor who had been previously helping with Active Release Technique, suggested that I might have re-torn the labrum.
I remembered what Dr. #2 had said 3 years ago, to come back if the pain got worse. I called and told Kaiser what he had said and asked for an appointment with him. He was no longer with Kaiser, they said, and they couldn’t tell me where he had gone. I Googled him and called his new medical office to ask for OS recommendations, but he never called back. Amazingly, I was able to request an appointment with an OS I found on ratemds.com over the phone by leaving a message with my Primary Care Physician. This was a new PCP for me by the way; I had to leave the old one because she was making up diagnoses and leaving them on my health record, part of the reason I got denied when I tried to switch out of Kaiser to another provider.
So I was surprised when I was able to get an appointment with a specialist without seeing my PCP in person. It had to have been some sort of miracle.
Kaiser told me to come in locally and get x-rays. This time I had done more research and when the technician told me she was only going to take the AP view requested by his office I asked her to do lateral and frogleg views. She reluctantly did frogleg but not the other views I asked for. I’m pretty sure it was unusual for the patient to ask for a different view. You have to look out for yourself in Kaiser though.
A short week later (another miracle) I was in Dr. #3’s office in Facility #3, armed with pen and a list of questions. He did some orthopedic tests and looked at my 2 x-rays on his computer screen. He promptly told me I had a cam impingement. I asked him to look at my previous labrum tear from 3 years ago and he said he didn’t have access to it. It turns out their computer system only shows them data from the last 3 years and it had been slightly over 3 years. I asked him if he could request it, and he said curtly, “What would be the point?” To compare it to a new one? I actually had the MRA disc at home and asked him if I should bring it in, but he wasn’t interested. He wanted to try PT and a cortisone shot first before any procedures.
He also declined to look at some x-rays I had brought with me, which included multiple views taken the previous week and 5 years previous (all non-Kaiser films). I looked at them with my chiropractor later and he pointed out to me where the cam impingement was 5 years ago, smaller. Many people had missed it, so I was impressed with Dr. #3 for at least finding it, if other aspects of the visit were frustrating. For example, he wouldn’t write a note to drop my fitness class or write me a prescription for pain. (He told me to stop using a crutch and I said I needed something for pain in that case.) I was supposed to see my PCP for these things, apparently, another trip out with my injury, and a $50 copayment.
Meanwhile I couldn’t exercise the leg muscles because of the pain, so I was losing a lot of muscle. I figured if I had torn the labrum (no MRA so I didn’t know for sure) that the inflammation needed to go down and exercising would just exacerbate it.
Obviously I had questions. I emailed Dr. #3 but he didn’t respond thoroughly at all, so the next time I wrote, I capitalized the word QUESTION, and had to send him 3 separate emails because Kaiser had a character limit. He still glossed over them and said we would need to talk in person for so much detail.
One of the questions I had written was whether I should do his recommended PT before or after the cortisone shot because I was atrophying but couldn’t do much without pain. He wrote back that PT would not help the cam impingement (it is a bone growth). Helpful!
So I knew I needed some time with him in person before he did the cortisone shot. I called his office and asked if my visit would include some time to talk to him first. “Of course,” the woman replied. “He’s not just going to come in and start doing procedures on your body.” She said I had 2 appointments scheduled for that day, one with him and one with x-ray, and I should come to his office before going to radiology. I told her I needed at least 20 minutes and asked how long the appointments were . 30. Great! Out of curiosity, I asked her what happens if you go over and she said that’s life, sometimes you go over.
While I was waiting for the visit, I went to see my PCP for the vicodin. It’s a Schedule III drug, so you can’t have someone just get it for you. More painful walking and a $50 co-pay. The first thing he did when he walked in was apologize for the co-pay. I was shocked. I explained what was going on, told him what a cam impingment was (a lot of family doctors don’t know), and asked if he could get me an MRA. No, he could only schedule MRIs. The surgeon would have to do that. He seemed a little out of it but he was really nice.
What’s funny is that several days later, I got a radiology report in the mail. It briefly said everything was normal. Attached was a note from him saying “Bones look ok.” That’s what passes for a radiology report these days at Kaiser? I’d even explained that a cam impingement was a bone growth, obviously not “ok”.
I also saw a new PT at Facility #4 (PT #2 as opposed to the one 3 years ago). Like nearly all PTs at Kaiser, she was excellent. She wanted to know what the surgeon’s plan of action was because she had read our emails (I guess they’re not private after all), and saw that he’d said PT wouldn’t help a cam impingement. She said he was known for hips. She was not surprised I had had a bad experience (mis-diagnosis, rudeness, pain) with Dr. #1. She gave me some exercises to try and asked me to call her when I learned the Plan. It seemed to straightforward and simple. Of course, it wouldn’t be.
I wanted to re-schedule my cortisone shot sooner because it hurt so much but I had already re-scheduled twice and I didn’t want to piss of the OS or his staff. My partner drove me to Facility #3, over an hour away. My choice; I picked the surgeon. The pain was so bad that I grabbed the wheelchair I saw sitting in the hallway. Ortho there was on the 2nd floor at the end of a long hallway. The chair had no leg rests so I had to tighten my leg muscles to keep my feet from dragging, more pain at the hip.
After I had paid my $50 copay for the office visit (yes I did just say that), the woman told us to go directly to radiology. No, I insisted, I had an appointment with the OS first. "I don’t think so, I’ll check.... Go talk to those people over there." After some explanation and low murmuring among themselves, they told me to wait.
I was grouchy; my pain level was an 8 out of 10. After 5 or 10 minutes, we were taken back to an exam room. Dr. #3 entered in a few minutes. I explained the weird visit issue because he said he had several patients. Like everyone else there, he seemed inconvenienced, but curtly asked for my questions. I told him my pain and atrophy was increasing and wanted to discuss surgery with him. (Cam impingements, I had learned, do not go away. They are a bone growth that keeps growing, and destroying cartilage, leading to pain and early osteoarthritis.) He said he wouldn’t even consider surgery until we’d waited 2 weeks to determine if the problem stemmed from inside or outside the hip joint. I explained my concerns about my schedule. I was just accepted into a competitive program that started in several months. I had a summer class and 9 free weeks for surgery recovery. He was unsympathetic. He said I had an unusually high level of pain for this diagnosis. No one else was unable to do these exercises because of pain. I was overly emotional and likely to have a bad surgical outcome because of it. “People are not cars.” Very true. At Kaiser, we’re cattle. Overall I was quite upset but also a little impressed that he didn’t want to rush into surgery. I would have been more impressed if he hadn’t been a Kaiser doc though. Surgeries are expensive.
He was good during the actual cortisone shot procedure; he seemed careful and compassionate, asking if he was hurting me. I was surprised after his curt office visits, but I guess some people are just like that. Oh, and I paid $10 for the test; definitely not that $50 I had paid for an office visit I supposedly didn’t have.
After the shot, I kept a pain log for the OS. The pain took 2 days to start reducing, and I’m not sure if it’s because of the shot or because I’m walking around less than I was the last 2 days. I will keep you posted.