Weekly Roundup: Your Permanent Record Edition

The envelope from my orthopedist could have contained any number of things which would have in no way surprised me: a treatment summary, an appointment reminder, a “balance bill” for the additional X-rays I had this past Monday morning. This is what it actually contained: the half-completed “Medical History Form” that I’d passive-aggressively shoved into the hands of my X-ray tech on the way back to the machine. There was a Post-It attached.

“Fill this in the rest of the way and bring it with you next time, or mail it in.”

At my age, I have to be grateful for each and every genuine surprise, even if it is unpleasant. I clenched the folded eleven-by-seventeen and summoned up my best Sean Connery voice:

“Then the game is on.”

Strictly speaking, the game had started on Monday when I’d fetched up at my ortho’s office with photo ID and current insurance card in hand. This place, by the way, has swollen like a Connecticut tick over the past few decades to the point where I’ve now had two surgeries, with anesthesia, right here on the premises. When I met my bonecutter-of-choice in March of 1988, he was a late-twentysomething who shared a hospital broom closet with an older and profoundly unpleasant fellow. Then he got an office of his own, then a practice of his own. Now he has thirty-ish surgeons doing work in a bespoke outpatient facility with a waiting room the size of an elementary-school gymnasium. Setting an appointment with the man himself requires the patience of Job; he only comes in once or twice a week and he cherrypicks his procedures. My broken leg of 2015 got re-bolted by one of his many associates; the fractured arm and torn rotator cuff in 2017 he examined personally.

Our current subject of discussion is a radial meniscus tear in the right knee, coupled with various degenerative diagnoses and some frustrating femoral edema. I’ve been limping around ever since I tried to show my son a 360-degree spin at a skatepark only to stop abruptly at the 330-degree mark. Now I can barely get my bike off the ground, and every landing feels like I am using stones to grind the insides of my knee. This directly affects my last remaining personal goal in life, which is to ride BMX and mountain bikes with my son until he turns thirteen, at which point he’s going to want to ride with his friends and not his lame old dad. I don’t care what it costs or how painful it is. I don’t really care what the long-term consequences are, up to and including amputation. All I want is to have these few years, stored like dried provisions in the attics of our minds as a bulwark against the conflicts to come. My narcissistic little theater-in-the-mental-round has created a play in which someone offers my seventeen-year-old boy crystal meth or black tar heroin or Cole-Haan shoes and he Just Says No because he can remember a tiny piece of desiccated wisdom about “being true to yourself” or something like that, delivered and received on the top deck of a quarter-pipe somewhere, father to son.

Stress and nervous tension are now serious social problems in all parts of the Galaxy, so I’ll mention up front that my current treatment plan, as delivered to me after a bit folksy catching-up on the part of my venerable old ortho, is that we have to let the swelling around the femur end die down a bit before we undertake any further surgery. The problem with this is that the ski lifts are about to open for this year’s downhill MTB season, so I will no doubt have more swelling, not less, when we have the follow-up. The alternative is to just stand there and hold the camera like the rest of the middle-aged fathers, which is the same as being dead.

In order to get that cautious diagnosis, however, I’d had to run the gauntlet of the various administrative personnel manning the front lines of the orthopedic practice. The first one I’d met had grudgingly accepted my ID and insurance card before saying, “We need to get a complete medical history on you before we continue.”

“Nothing’s changed,” was my deliberately chipper response. “The last time I saw a doctor besides my annual checkup was… right here.”

“Well, we still need a new one.”

“How old is the last one?” She’d poked at her keyboard and her annoyance had echoed with every click.

“July of 2017.”

“Well there you g—”

“So we need another,” she’d growled, before shoving the paper at me.

“Let me get this straight. You have a medical history of me from the last time I was here. Nothing has changed. I’ve been a patient of Dr. So-and-so since 1988. Your own records are going to be more accurate than my vague recollections. Why am I doing this?”

“We. Just. Need. It.” she snarled. So I’d taken the form, poked away at it until I got bored, then I’d left it in the X-ray room. At which point someone must have decided to put it into an envelope and mail it to me.

Now, as they say, it’s personal.

The obvious course of action is to fill out the form and send it back. I don’t know if I can do that. It feels too much like what pickup artists call a “compliance exercise”, where you ask your date to perform a few minor tasks on your behalf so she internalizes a bit of subservience nice and early in the relationship.

“Get me that napkin, would you?”

“Look up the hours and make sure they’re still open.”

“I’ll get the car. Here’s my card. Go ahead and pay, then come out.”

Ridiculous stuff, right? Just like the “Best Friends Test” from The Game is ridiculous, just like doing magic tricks at a bar is ridiculous, just like pretending to take astrology seriously during a first date is ridiculous. And it all works. It’s all so murderously effective that near the end of my dating days I made it a point of pride to not do any of it, the same way my son insists on fencing left-handed. So it would mean more when I won.

This, too, is ridiculous.

In any event, I will be God-dammed if I am going to be compliance-exercised by an orthopedic practice. The whole experience of seeing a doctor is one big exercise in psychological manipulation anyway. Until seventy or eighty years ago, it simply didn’t exist. Before then, you either visited the doctor at his home or he came to you at yours. This whole pro-wrestling rigamarole of multiple waiting rooms and endless forms and physician’s assistants and whatnot is a modern invention designed to maximize a doctor’s income. I’m not sure it’s working for anyone, including the doctors.

The entire process has become financialized — from the loans the doctors take out before med school to the tombstones handed out by investment banks when they “assemble the package” for something like my ortho’s outpatient-surgery cathedral. When I pay for whatever surgery I wind up getting, I’ll be using a Health Savings Account, set up to be tax-exempt by lobbyists who envisioned massive interest earnings on the accumulated capital. The actual payment will be processed by Visa, which will take its cut as well. We are all just puppets dancing at the ends of long strings made all the more odious for their convenience.

Back to the form. The worst part of this whole thing is that there is no way my doctor is going to actually use anything I write down. What if I tell the form that I’m chronically depressed, that I’m tired most of the time, that I often find myself frozen in bed because I don’t see the point in leaving the house? Is that going to affect the shape and size of a plastic knee implant, or the volume of the platelets injected between femur and meniscus? I’ve been sick something like a dozen times in the past year, mostly because of travel and various periods of confinement in the flying typhoid tubes operated by Southwest Airlines and Korean Air. Is that going to make my femoral edema easier to understand? (Well, that one might actually be relevant, I don’t know, I’m only a doctor of the human heart.)

Alternately, what if they take it as gospel? I don’t know when my femur nail was removed. I think it was June of 1991, but it could also have been June of 1990. If I put 1991 but their own records from the procedure show 1990, are they going to wipe that out and replace it will my subjective recall? I can’t remember how many surgeries I’ve had on my right knee, either. Why am I being asked to provide this information for the guy who did all the procedures, and who took copious notes besides?

My current thought is that I’m going to mail the form back to them — without completing it. Which is a completely juvenile thing to do. I don’t mind that. One nice part of getting old is the gradual loss of contempt for the attitudes, and behavior, of one’s youth. Even as one gains a greater understanding into what you saw, and heard, and read, as a child. When I was twelve years old, I read Ahab’s line as through a glass darkly:

Talk not to me of blasphemy, man; I’d strike the sun if it insulted me. For could the sun do that, then could I do the other

I understand what the old bastard meant now. Oh yes, I do. If they can mail a form, I can mail it back.

* * *

For Hagerty, I discussed my wife’s latest competitive mishap.

29 Replies to “Weekly Roundup: Your Permanent Record Edition”

  1. AvatarArBee

    Ignore the form, Jack. When you go back, the snarly witch on the front desk will just hand you another one, which you can again forget. They won’t refuse to treat you because of the steady income stream you provide.

    What I hate is when you finally see the doc, and he’s too busy scrolling through his laptop to listen to you. “Doctor, I have this itch…” **Pause** “Now, Mister ArBee, what brings you in today?”

  2. Avatar-Nate

    All this can easily be avoided by going to admittedly hit or miss Kaiser, who killed two of my workmates wives in post op .

    That being said I’ve gotten decent care from them and the botched hernia surgery didn’t nearly kill me, it just left a pint + of blood in the floor and a lifetime of pain .

    I’m amazed you’re still flying CattleCar Airlines (southwest) ~ I’d rather take the bus or ride my Moto through the Mid West in Winter….


    • AvatarDirty Dingus McGee

      Re; Southwest.

      I use Southwest as my primary airline also. Main reason is cost. Air travel comes out of MY pocket and at this point in the year I’ve been on 17 separate round trips. Most are going to look at job sites, or equipment to be moved. As such, I need to bring things with me that I cannot bring thru security, dangerous things like a flashlight, a laser measuring device, etc. As i also have “Pre Check” I don’t want the hassle of removing my boots so they also go in a checked bag.

      But I digress, back to the cost. Southwest will allow you 2 bags checked for free, no matter if you’re A List Plus, or someone who fly’s once every 10 years. Any other airline whacks you for anywhere between $30-$75 each to check a bag. Six or seven trips and you have paid in checked bag fee’s the equivalent of another ticket. You can also get really cheap flights with their “Wanna get away” fare. Yes you will be the last on and end up in a middle seat, but for someone that has limited funds and HAS to fly somewhere, it’s hard to beat.

      Second point; The seats on Southwest are no different than the seats on any other airlines Coach or Economy seats. I’m a bit short for my weight (5’10” 220 lbs) and have no problem fitting. NONE are comfortable, but for 1-4 hours I’ll survive.

      That said, the biggest PITA with Southwest is the lack of direct flights to city’s where they DON’T have a hub. You will often travel to a city far out of the way, to change planes to get to your final destination (ie Atlanta to Chicago to get to Cincinnati)

      I also would much prefer to use my bike for a lot of these trips. Logistics and weather often eliminate that option. If I have a meeting in Louisville Ky on Monday and one in Salt Lake City on Wednesday, in January, the winged bus is my only option.

  3. AvatarWheeTwelve

    I think you’re doing it wrong. Why don’t you ask them for their copy of your medical history, in order to complete the updated medical history form? You are a writer, man! Write a formal request, making it as long and elaborate as you have time for. Sign it, mail it, and see how that turns out.
    If they do send you their copy of your medical history, you can just write at the bottom “nothing to add”, and then mail that back as an updated history.
    Now, you can always mail the current uncompleted form, if you choose to. Or if they don’t respond to your request. But you might as well have some fun first. Mailing the uncompleted form now seems a bit petulant, and I wonder if you may be getting a touch too old for that.
    Of course, it’s your call.

  4. Avataract

    I couldn’t stop laughing at the Cole-Haan line; that whole paragraph is the best thing I’ve read all week. I’m happy you got a cool new job, but I miss the days you wrote more. Anyway, thanks for this.

    • AvatarCJinSD

      Twenty years ago I moved back to Manhattan and various people tried to mentor me in appearing to give a crud about how I dressed. I’m pretty sure that at least one of them recommended Cole-Haan zipper boots. I never got around to buying them. The only clothing advice I ever took involved various suits that cost more than some of my cars and Fratelli Peluso shoes. I will say that women used to follow me around when I wore those shoes, but they often seemed to be looking to see what kind of watch I was wearing. There were always enough women trying to save me from my lack of give-a-crud that I never felt obligated to stop saving 80% of my after tax income every year in order to appear gay.

  5. AvatarJeff J

    I forwarded your Hagerty post to Garth Stein. His response ‘Well, you know, I don’t think I’ve ever been that close to God in a sentence. Unless that sentence was “Goddamn that Garth Stein.”‘

  6. AvatarScottS

    Lazy, Chickenshit, CYA. When you have a rulebook you aren’t required to think. This is the fundamental problem we “old bastards” face. We grew up learning how to think and solve problems. We are resourceful. We aren’t risk-averse. Five years ago when I finally needed glasses to read I also needed an eye exam. As the consumer and customer, I asked the 20-something receptionist “how much is an eye exam”, to which she replied, “what insurance do you have?”. To which I replied, “I asked the first question”. As it turned out I could pay cash and it would 55% of the cost to the insured customer. However, my copay was $20.00. Now that is a fucking conundrum! The transaction costs for the insured customers include the costs of a lot of snarky bitches that take home a pretty decent paycheck for minimal effort.

    How do you fight this crap? I have to admit there is some satisfaction in being recalcitrant and forcing the snarky bitches to actually do something or at least have to think for a few seconds in order to respond to me. I have just returned home from closing the sale of my late father’s home, and I can tell you, were my brothers not involved, I would have eagerly gone headlong into battle with the lazy, chickenshit, CYA lawyers working for the title company. How those lazy, stupid, mother___rs ever got a law degree is riddle only God can answer. I would sooner put of 45 caliber slug through their empty skulls, but I digress.

    My the force be with you, my brother!

  7. Avatarhank chinaski

    “Hey doc, it hurts when I do this.” Me, I’d pick my battles, and give up the half-pipe for the chance to actually take a walk with any theoretical future grand-children. In another timeline, I’d count on the possibility of a spiffy exosuit or Adam Jensen prosthetic, but not this one, at least not on my income.

    AFAIK, a doc’s income works out to ~10% of all health care expenditures. That won’t change the fact that we increasingly won’t be actually seeing them, but rather their ‘supervised’ midlevel extenders. As for the form, make up some stories about fighting in the Somme or being attacked by a lion. They won’t catch it.

    To ScottS above: You’ve violated Gillibrand Red Flag Bill 3484-54775/33445A. Please deposit all firearms, knives and sharp sticks into the secure storage device at your local law enforcement facility and report for reprogramming.

    Best wishes to DG. Shiny side up.

  8. AvatarShocktastic

    Well, the supremely redundant paperwork is a huge pain in the ass. Given your medical history, completing such a form would drain the reservoirs of 2 or 3 pens and at the very least result in a bad case of writers cramp. But before I give you propofol during your menisectomy, it’s nice to know that you’ve had an MI or a PE or became anticoagulated since your last visit to Orthopedistan. Good luck! I admire your resolve to lead your son by example.

    • Jack BaruthJack Baruth Post author

      I know what an MI is but is a PE a penis extension cause I keep hearing they arent perfected yet…

      (Maybe its pulmonary embolism?)

  9. Avatarjeano

    4 years of undergrad, 4 years of med school and (minimum) 5 years of residency means there are no “late- twentysomething ” surgeons. Think about that.
    Also, something as stupid as not having a recent medical history (or update) is all it takes for some lawyer to make millions. If something isn’t done routinely and every time, something will get missed.
    I’m sure you know all this, at some level

    • Jack BaruthJack Baruth Post author

      It’s possible my dude was a resident at the time. He just turned sixty and I’m forty-seven now. I was sixteen when I met him.

      I understand what you’re saying but let’s just put this in perspective; every time Warren Buffett or Barack Obama sees a doctor, they don’t have to fill out the form.

  10. AvatarShocktastic

    Your PE joke reminds of the time my colleague had an Arab sheik with a bad liver at Cedars Sinai Hospital in LA. The sheik brought a suitcase of cash and his Bangladeshi cross-matched donor. He couldn’t understand the self-righteous refusal by the hospital of his organ transfer request.

    • AvatarRonnie Schreiber

      C’mon, it’s not like they were going to take the guy’s entire liver. Don’t they just transplant a lobe?

      A couple that I know are both transplant cardiologists. They told me that livers are given to people who’d never meet the criteria for a heart transplant, mostly because of the substance abuse that created the need for a liver transplant.

  11. AvatarAoLetsGo

    Two answers to your two topics.
    As a parent everyone knows you pick and choose your battles. Given your injuries you must pick and choose the activities you and your son do. Perhaps you don’t have to scream down a ski hill on your MTB or show off some old school trick at a skate park. Enjoy some sweet single track through the woods together. It is the father son time that is important not your pride in showing up the other Dads.

    I have no medical advice to give; the whole fucked up process is beyond me. I try and live healthy and stay as far away as possible from the whole medical establishment. It doesn’t hurt that I also have two nephews who are emergency room doctors who will come to my house with their black bag and sew up my bigger lacerations.

  12. AvatarDR Smith

    Wow – talk about timely! Just had a similar experience with my personal care physician (or whatever they call themselves today). Went they for something routine (bad cough due to likely bronchitis, which it was diagnosed – ask to call in a prescription, which he used to do all the time, but lately been making me come into the office) and was asked to fill out a form about their substance abuse policy……god, wish I would have saved that form. If I had filled it out and signed it and turned it in (which I did not) , it gave them the right to randomly urine test me and also count pills to make sure I was not abusing prescribed narcotic pain killers.

    First off, I have been seeing this doctor for over 20 years. Second, even if/when I am prescribed that type of medicine, it is from a specialist for a specific condition (back issue with bad disks I’ve had for 15 years)…I never get them from him directly. It was a big WTF moment…..why are they asking me for this, and why is it so restrictive

    So I did the passive aggressive thing and took the paperwork from the front desk lady, started to fill it out, got madder and madder and stopped filling it out, then torn up the form. I waited to to see the doctor, saw him, got the perspiration cough syrup so I could sleep at night. My doctor is usually a pretty cool guy and a good doctor (once between jobs I did not have insurance , and I explained what was going on and he just charged me the co-pay I used to pay, like $20 , instead of the full $100 office visit) and has always been willing to work with me in the past…so I doubt this comes from him, it is either some new state law or something else a hospital medical group he belongs to cooked up.

    And that is the real issue – regular good guy/gal doctors are being forced to comply with all sorts of things they did not have to worry about just 6 years ago , taking away the flexibility and joy out of their work. I know because I have heard it from a friend in my social group whom heads up infectious disease unit at a local hospital group and he is taking early retirement though he is in his early 50;’s – can’t stand all the crap they have to deal with nowadays….

    • AvatarRonnie Schreiber

      They make you come into the office so they can do a culture and verify what bug you have. The idea is that helps prevent antibiotic resistant bacteria.

      Of course, if you’re certain that what you have is bacterial, you can get most broad spectrum antibiotics from veterinary and pet suppliers without a prescription. Yes, they are labeled not for human use, but do you think anyone is setting up separate factories just to make fish antibiotics? A 100 capsule bottle of 500mg Amoxicillin is less than $30.

    • AvatarRonnie Schreiber

      They make you come into the office so they can do a culture and verify what bug you have. The idea is that helps prevent antibiotic resistant bacteria.

      Of course, if you’re certain that what you have is bacterial, you can get most broad spectrum antibiotics from veterinary and pet suppliers without a prescription. Yes, they are labeled not for human use, but do you think anyone is setting up separate factories just to make fish antibiotics? A 100 capsule bottle of 500mg Amoxicillin is less than $30.

  13. AvatarRobert Evans

    I’m sure this process will be much more efficient once we have government-provided healthcare.

  14. AvatarDirt Roads

    Our primary care physician quit the company he worked with (a conglomerate that was bought out by a bigger conglomerate) and we both got different doctors with the same conglomerate. After having been with them for 10 years, it’s like they have never seen us before. Full medical history, full exam (which we didn’t complain about) and abundant excess paperwork. Someone has to invent some kind of work to keep all those admin people busy 🙂

    It’s fucked up now, and it’s going to get fucked upper as time goes on. Best wishes to all our offspring; “I hope I die before I get old.”

    Damn, too late.

  15. AvatarBinksman

    I work in the industry- I wish I didn’t but in my small town the healthcare industries dominates the local economy with the public school system being a distant second.

    The suggestion has already been made that you request a copy of the medical records that your provider already has. Ask to speak to the medical records supervisor, explain the issue, and at most they should ask you to write an affidavit that your medical history as they have on record is correct. Their concern is that you received healthcare somewhere else and that you might have a condition or be on some treatment that may cause conflict with your PCP diagnosis or treatment plan.

    That desk nurse is just doing her job. Some higher up made it part of her job to ask you for your health records every year part of her job, and she doesn’t need to take your shit because you don’t want to fill out the paperwork.

    • AvatarNick D

      It’s so sad that healthcare funded mostly by transfer payments is the major industry in many areas these days.

  16. Avatarjc

    All I can say is that if insurance companies and medical corporations (rarely does this nonsense emanate from the actual practicioner) were trying to get themselves and their functions taken over by the government, they are going about it in pretty much exactly the way to make that happen.

    Even my relatively small-scale medical expenses typically involve more than one error somewhere in the chain, which I then have to attempt to resolve with multiple phone calls, dispute forms, etc. A significant fraction of the time I have to suck it up and pay for things that are supposed to be covered by my insurance that my employer and I pay good money for, just due to the complexity and poor design of the whole system plus human incompetence.

    I am not saying that having the government take it all over will be better. I expect it will be far, far worse. But as the public’s exasperation with the process grows, that takeover becomes inevitable. It is absolutely beyond me why no one in the chain seems to understand that they are cutting their own throats by their utter disregard for customer satisfaction.

  17. AvatarShocktastic

    I commented once on this thread but wish to comment again. The amount of waste in US healthcare approaches or even exceeds the waste in the US military industrial complex. In the last 2 months I have had to dispose of $30,000 in medical supplies because they had exceeded their 3 year expiration dates. Biliary stents made of exotic metal alloys, gold fiducial markers used to target radiation therapy, oxygen and suction tubing, and commodity IV fluids like saline and lactated ringers solution. Federal law prohibits me from sending outdated supplies to developing countries. Hospital policy prohibits me from taking any of this stuff home to repurpose or recycle this stuff because of the theft policy. So yes, I had to throw away gold in the sharps container. My hospital only recycles cardboard for fear of patient info ending up in the waste stream. All I could do was add the useful bits to my “toy box” of practice equipment for new colleagues. As outrageous as my equipment anecdote is, the waste on the administrative side of US healthcare far exceeds whatever fantasy US conservatives imagine exists in foreign single payer systems. My penance from working in health insurance for 6 years will be 9000 years of bedside care to avoid demons chasing me with pitchforks for eternity to make up for bad karma. The fears of “government taking it over” make sense because the US is so fantastically corrupt. But other countries make it work for way less money.

  18. AvatarTyler

    Not that there wasn’t plenty of stupid, redundant paperwork in healthcare before, but the thing that could have fixed it, electronic medical records, has exacerbated the problem in a lot of circumstances. A thousand-odd mostly irrelevant line items that could have been appropriately glossed over on a paper form (by someone who could read and knew what she was doing) become forced-entry data fields. New patient history? Red exclamation point. Barack Obama doesn’t have to fill out the form in part because his medical team isn’t trying to shoehorn all of his documentation into a glorified Access database. EMR remains a need, but American EMR is designed to help identify fraud. Optimizing the systems for end-users and better consumer experience is a priority in name only.

  19. Avatartime flies

    “The alternative is to just stand there and hold the camera like the rest of the middle-aged fathers, which is the same as being dead.”

    This is a great piece of writing, thank you


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