Friday, June 04, 2010

as if i never said good-bye

I am having trouble adjusting to being north of the border.

Thursday morning was a perfect example.

One of the down sides of Coumadin is the amount of time needed to find and maintain the proper level of medication.  In my case, I have been visiting the Coumadin clinic in my doctor's office once or twice a week.

A prick on the finger.  A drop of blood on the tester.  A quick explanation of what I need to do before my next appointment.

Each appointment has been for a specific time.  And each time, I have sat waiting to be called.  Up to a half hour after my scheduled time.

Getting specific appointment times was a shock.  After a year in Mexico, I am accustomed to simply driving over to my doctor's office to see if she is there.  Seeing her immediately if no one is waiting (the customary experience).  Waiting if she is with another patient.

In the rare instance when a specific appointment is set, I have almost always been seen as early as I arrive.

But that is not the American system.  We like to give the impression that our appointment system runs as efficiently as Mussolini's trains.

But it is an impression.  Appointments are more like guidelines.  And it is not just doctors.  I have seen the same indifference to time by a number of professionals -- including barbers and head waiters.

The last time I went to the clinic, I told the nurse that I was a bit disappointed with her tardiness -- without an explanation why I was forced to wait.  She apologized and said it would not happen again.  She was on the telephone and had not noticed the time.  That was last week.

Thursday morning I showed up at the clinic about 20 minutes early.  I brought work to occupy me until my appointment at 11.

I finished the work a bit after 11.  And sat.  And waited.  And watched the minute hand march down the face of the clock.

Twenty minutes late for my appointment, the nurse I saw last week came by to tell me that if the other nurse did not see me in 15 or 20 minutes, she would be back to test my blood.

I asked her if that constituted being on time, as she had promised last week.  She offered to see me right then.

As we walked down the hall, I asked her if all of my appointments would be that late.  She said that most patients are seen 15 or 30 minutes after their scheduled times.

Reaching for humor, I told her that I could easily just show up 30 minutes late if that would be easier for her.  To which she responded: No.  You can't do that.  You have to be here on time.

Now, several witticisms flew threw my head, but I decided on the direct approach that the system seems a bit rude to the patients.

That must have hit her patience point because she responded: Maybe it's you who is being rude.

About every ten years or so, I get angry.  Red in the head angry.  I guess Thursday was just my time.

That's it, said I.  This appointment is over.

It would have been a dramatic exit line -- if I could walk.  Instead, I fumbled around for my crutches.

But leave I did.

When I was in private practice, I had a policy if I did not see my client at the appointed time, I would not charge the client for the services.

The only asset in life that can never be recovered is time.  When it is gone, it is gone.  Wasting people's time is wasting their lives.

I suspect the nurse may have been a victim of the clinic's own scheduling system.  Trying to eke as much money out of employees and customers is an age-old employer practice.  Sometimes, The Man is to blame.

But acquiescing to it will not fix it.

Of course, not having my Coumadin levels monitored will not fix it, either.

I am looking at some alternatives to testing.  Self-testing through an online service looks interesting.

Of course, if I had stayed in Mexico, none of this frustration with the American medical system would have occurred.

More importantly, I have only five months left before I can return home.  With no further need of Coumadin.


Anonymous said...

Bravo for leaving.

What makes me see red (and walk out) is when I (and others) am on time for a meeting, and the one facilitating it says that some people are late, so "we'll wait a bit before we start and give them a chance to arrive....". ??? To me that's very disrespectful of those that made a point to be there on time.

At that point, I leave.


NWexican said...

Then again, if you had stayed in Mexico your nurse may have showed up the following day or not at all :)

- Mexican Trailrunner said...

How rude of her! Unfortunately, that attitude is more the norm than not in the American medical systems.
Steve, don't jeopardize your Cuomadin treatments or blood level monitoring tho. It's important. Only 5 more months to go and you'll be well, walking, and back on the beach.
There may have to be a lot of grinning and bearing it involved in order to live in America again. . . however briefly. Good luck!

Felipe said...

if I had stayed in Mexico, none of this frustration with the American medical system would have occurred.

Your comment is my comment.

Chrissy y Keith said...

My Pastor had a clotting issue a couple of months ago. He self monitors now, so I will ask him what he uses.

Mike Nickell, Sitka and Cynthia Johnson said...

Touché! I always try to schedule my medical/dental/vision appointments as early in the morning as possible so that the back-up time is minimized. Can you escalate to the head of the clinic and see if that person is able to accommodate you in a more timely fashion?

1st Mate said...

That nurse, and most of her colleagues, have been performing that way so long, they consider it the norm. I'm surprised she even said it wouldn't happen again.

I had to Google coumadin to find out what it is. Wikipedia says it was originally marketed as a pesticide, so it sounds like something that could present some serious side effects. I hope you can find a way to monitor it for yourself.

I can imagine your blood pressure zooming up at the nurse's arrogance, so probably you did the best thing at that moment by walking (hobbling?) away.

When I know I'm going to have to wait (for a doctor, at the border, in any office setting) I bring a very absorbing book. It's always a guilty pleasure to take time from a busy day to read. Then I actually feel a twinge of annoyance when they're finally ready to see me.

Tancho said...

It is time that people not be treated like sheep. A lot of the Health Care system has done that. I applaud your respect for your time, this how medical thing has gotten out of control. It is simply a "how many can you jam" into a patient block to maximize the profits to compensate for the payment schedule etc.
In Mexico time is not a big deal, and is not expected to have the same BS associated with the lack of punctuality. The system NOB will stay the same or continue to get worse because of whole mess in the HC industry.
As we get older, I find that the value of time is more precious and make it a bigger deal when others waste my time.
Like Barbara too, I find it horrible to cater to the people who didn't plan their meeting time punctuality. That happened many times , sadly I never had the moxie to walk out on the meeting since I was the one who traveled the greater distance to arrive there. If it was now, you bet I would do that!
Hurry back to Mexico where you won't have the same jam the appointments happen!

Anonymous said...

I totally understand your frustration. I think you should ask to speak to the head of the clinic and let then know what has been happening. I think in the future when you arrive they will have the red carpet out. You don't want to risk a problem with your coumadin because of the nurses's shortcomings. I know in your case you have no control over the blood clot but I hope once it has dissolved that you take very good care of your self. Eat well, exercise and try to manage your stress in a healthy way so that you will not be put on medication for issues that you can control yourself. I don't want to spend the rest of my life supporting the pharmaceutical industry. I found some information you might find helpful on self testing. I hope this link works right. Good luck and get off this stuff as soon as you can and then stay away from doctors!! (unless absolute necessary) :)

Anonymous said...

I know the frustration you feel concerning scheduled appointments. I think the reason the receptionist sets the appointments for the doctors, nurses is to be sure they don't have to wait for you to arrive. There are many people that are constantly late for their appointments and for everything else. It irritates me to have to wait for my friends that are always ten minutes or so late.

You seemed to think Mexico was an on time place. One of my Mexican customers said to me one day " when you say you will meet me here at 2:00 pm, you are here". He was not used to that. He thought he could come whenever he wanted.

I think, you will have to swallow your pride and return to get your blood checked. Coumadin is nothing to play around with. I can't help but think of Berneice and the strokes she had when the dosage was not correct. So, please cooperate and dissolve this blood clot and get out of danger.


Anonymous said...


Do what your mother says.

Also, ask to speak with the clinic's patient ombudsman, explaining the problem.

My clinic was wretched two years ago, but when people started complaining to the ombudsman, folks took action to improve.


Irene said...

Good for you walking out but don't jeopardize your health for a principle. In my opinion, once medical care in the US became "the health care industry" all hope was lost. Good luck with your coumadin treatment and with the healing of your ankle.

Anonymous said...

The link I gave you didn't go through. I think you will find some eye opening information on coumadin at Here you will find the results of scientific information. It is an excellent site. Learn all you can about coumadin and any alternatives available that are safer. Fortunately for you your use of coumadin is short term but many people are put on it for years. Many times it is for the doctors protection and it is not necessary for the patient. My interest is all this is because my husband had to take it for 6 weeks after heart surgery and we tried to find an alternative. We were told there was nothing else but coumadin. Had we been better prepared to investigate it at the time I believe we would have found an alternative. However, we made it through with no problems and I know you will too.

Mic said...

My rule of thumb is if something is so dangerous to my health that it has to be monitored, it shouldn't be taken. The cure for it and side effects are more often than not worse than the disease. There are natural remedies for most maladys i.e. Nattokinase for your clot might take a little longer to work (6-8 wks for most herbals) but you don't need clinic appts. to take it.

Theresa in Mèrida said...

I used to work for a chiropractor. Unlike many other health care providers, our office didn't double book appointments. We also stated to new patients that since we didn't double book, we charged for missed appointments. Our policy was that you bought that time slot. One thing we did was if a patient was late, we took another patient in who was early and the late patient would get bumped to their slot.

Part of my job was to "keep the doc on track", after 15 minutes a discrete knock on the door, after 20 minutes the phone would ring once.

If the doctor had an emergency, we would call patients to reschedule or sometimes if the wait was long, the next treatment was free.

Our experience in Mexico has been that you might have to wait because the doctor spends extra time with the prior patient, but when it's your turn you also have as long as necessary.

I remember a patient calling about 10 minutes before his appt. He said, "I am just coming up to my freeway exit, I think that I might just go home instead of making my appt."
My reply was," That's just fine, Mr. Cotton, but we will be billing you for the appt, not your insurance."
He made it to his appointment on time.

I totally lost the point of this comment, which is that most offices routinely double book appointments because so many patients don't bother to show up. When both patients actually show, they get behind.


Anonymous said...

Here is another solution or take, start billing the clinic for your time! I know people who have, sure does get their attention. Judy

Anonymous said...

This happens much too often. I salute your walking out of the clinic. I once scheduled an 8 a.m. appointment at an auto repair shop. The owner (young) told me they open at 8 a.m. The next day at 8:20 a.m. I left a note on the door stating "I was here until 8:20 WHERE WERE YOU?
Time is too precious to waste, find another clinic or method to treat your condition.

Steve Cotton said...

Barbara -- The late meeting syndrome drives me nuts, as well. I always suggest starting the meeting when the apopointed time arrives. In my company, that is what we usually do.

NWexican -- In driving and medicine, Mexico is a timely country. On other matters -- not so much.

Mexican Trailrunner -- I will find a method to monitor this drug.

Felipe -- That was an easy diagnosis.

Chrissy -- What you can share, I will apopreciate.

Mike and Cynthia -- I use the first appointment of the day method as often as I can. When I rely on the kindness of others for driving, though, I have to take what is available.

1st Mate -- I usually take enough work with me that I do not notice the time. On this trip, I ran out. To the cost of civil peace -- it appears.

Tancho -- This may become my next passion.

Anonymous -- I agree fully on wanting to get off all medication. I was almost there during my first year in Mexico.

Mom -- There are other ways to monitor this nasty drug other than at that clinic.

ANM -- Another good idea.

Irene -- Thanks. I will undoubtedly start a trend -- at least in my life.

Mic -- My treatment at the clinic made me wonder whether I should be taking the drug.

Theresa -- It sounds as if you had a very professional operation in that office. Double booking merely creates a bad environment -- for patients and providers.

Anonymous -- I have thought of that idea. In my case, I have to take time off to go to these appointments, with no sick leave. The problem is that I could never charge enough to balance out the cost of medical services.

Francisco -- I may adopt that one, as well.

mdoneil said...

You might be able to find a better clinic. I go to a concierge practice, I never wait and I get as long as it takes, the doctor is never rushed.

Of course there is an annual retainer, but I find it a substantial ROI.

Howard said...

Hi Steve:
A late comment for you.
I think you know I spent my working life in health care, so I could go on about this at length.
Instead, I want to ask you to consider a topic for your blog. You should probably think about it for a while. I would call it "abuse of power". I know you are a very smart person, so I probably don´t have to go any further with this, other than to say that so many people feel good when they can exercise power over others.

Anonymous said...


Everyone in the USA is afraid of lawyers. Send them a legal letter indicating they have violated the terms of treatment, cite a bunch of legalese, threaten legal action if they don't get their act together and the next time you come in they will roll out the red carpet.

Seriously, if I were a lawyer, that's what I'd do.

Put all those years in law school and legal practice to work for yourself!


Kim G
Boston, MA
Where we'd dearly love to be able to do what we just suggested.

Anonymous said...

I can't believe you used such inflammatory language - you ought to go to re-education classes. And don't bother telling them you don't need to be re-educated; that's just further proof you need it.

Thank you for that special little treat.


Steve Cotton said...

Mdonell -- I will check into it.

Howard -- Great idea. I will give it some serious thought.

Kim -- I have not yet my new doctor. (Mine retired last week.) But I intend to have a conversation with her.

JoS -- I am packing my bag to report tomorrow.