Thinking about my adventures with the medical trade, I sometimes fail to think about the good experiences. I have been, since this whole HMO thing started, been fortunate enough to have an outstanding primary care physician (PCP). When I first met Dr. Atlas (became his patient), he gave me a physical, drew blood and made a follow-up appointment.
He’s the one who decided I should go see a urologist to find out why I was having some elevated sugar counts in my blood. Dr. Atlas is not a Family Practitioner (to read more about family practitioners, I heartily recommend John McPhee’s The Heirs of General Practice); instead, he’s an internist. He regularly, now, shows up on the list of best internists in Texas though he discounts that as a kind of popularity contest.
About Internists
Internists in HMOs are worth their weight in gold. They are highly trained, do internships and residencies, and are frequently admitted to practice to hospitals. They save insurance companies and Medicare/Medicaid a fortune each year by screening out patients who really do not need to go to specialists. In exchange, they are among the least well-paid of all doctors and work harder.
At any rate, Dr. Atlas wanted to find out why my blood sugar was elevated and sent me to a very fine urologist. The urologist did a lot of lab work plus a sonogram and that’s when he told me to focus on my “tumor” instead on my diabetes. Okay, two shocks at once: I had a tumor and I had Type II diabetes. Life is full of little side trips!
Diabetes and Glandular Center
I’ve already written about my nephrectomy and the complications that arose from that. So will skip ahead from raving about my internist to complaining about my insurance provider. A couple of months after I got out of the hospital, Dr. Atlas referred me to San Antonio’s Diabetes and Glandular Clinic. That clinic was superior! I went in once a month, got my blood tests and the three month average, visited with a specialist nurse-practitioner (a wonderful innovation in nursing that must now be 25 years old or older), and saw my gastroenterologist. Listen: once you start knowing the names of all these specialties, you are getting a bit long in the tooth.
My lovely insurance company decided (through its private, capitalistic death panel and not through some mythical government death panel) that once a month was too often and that I really needed to see the doc only twice each year. They further decided that all those labs cost too much and that twice a year I could go to a lab that was not a part of the Diabetes and Glandular Center. The Center decided it knew more about controlling diabetes than did the insurance company and fought with them for two months. Now, no one, well, hardly anyone, wins a fight an insurance giant, so I had to find a new diabetes doctor. In a later blog, I’ll tell you about further arguments with Aetna’s private death panel.
Uh, that colon thing
Two words that should strike fear into the hearts and minds of everyone reading this: “flexible sigmoid.” I had one of those: a flexible tube with a little videocamera and light inserted far enough up one’s posterior to check for problems in what is called the lower intestine. It is done while the patient is awake and lying on his side. My urologist and his very female nurse pumped air into me (thus promoting irrelevant flatulence) and observed what I looked like inside. The doctor did a running commentary for the nurse and pointed out a few problems. He decided that I should have a full colonoscopy.
Dr. Atlas, my sterling PCP, knew that my family has a history of colon cancer, and had already decided that I should have a colonoscopy, but my insurance company’s death panel had insisted that I first undergo probing by the flexible sigmoid. Do not worry: I will not go into details about the preparations for my colonoscopy. I managed to lose a few polyps (careless of me, no?) and returned to work the next day.
My friend, the doctor
Let me add that I consider Dr. Atlas a friend. He buys all my books and I probably wound up buying him a car or two over the years. The nurses hated that my appointments usually stretched out a full half hour so we could just chat about politics (he, too, was a liberal Democrat). At one point, though, his HMO was taken over by the Methodist Health System (probably the best health care system with clinics, transplant centers, cancer therapy centers and hospitals in the city). Almost simultaneously, my university switched its health care provider to Pacificare. Methodist would not work with that company (I think it was Pacificare) and I had to switch to a new PCP.
Two years of lousy medical care before we switched to a different company. And then, when I called to set up an appointment with Dr. Atlas, I was told he had not been accepting new patients for more than a year. I asked the appointments clerk to tell him who was asking and he accepted both Susan and me back into the fold. That was a relief. It’s my considered opinion that he has kept me chugging along very nicely when others might have let me slip away!
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