Those who know me personally have heard my various stories about my, ahem, continuing fight to ensure that Ballad (once Mountain States and Wellmont, respectively) honors its stated non-discrimination policies. You can easily read them posted on the wall of any (former) Mountain States facility you visit. This particular incident took place at a (former) Wellmont practice, though. The more I’ve reflected on it, the more perturbing I found it, so I did my research. Here’s what transpired:
The neurologist I had been seeing at Wellmont Neurological Associates had prescribed a VERY old (but most importantly one I had never tried) anti-epileptic. He mentioned that it might be sedating. So I filled the script and got back on the AED merry-go-round. I began noticing as I titrated slowly to my therapeutic dose that I was feeling wired, like I had had 5 cups of coffee and two energy drinks. No sedation, though I read up on the med and given its profile, I should have definitely been feeling a lot less ancy, tense, and hyped up. AEDs are always tricky and sometimes unpredictable in their side effects, but I was having a paradoxical reaction (indeed). I won’t go into the other side effects, only to say that it is just a brutal drug.
So per protocol I send my neuro a message about this through the patient portal. A week goes by. No response. Finally I get a call from his nurse, who is calling to remind me that the doctor said, “it might be a little sedating.” I tell her (politely) that that is the opposite of what I said in my message and reiterate for her the effects it was having. In addition, I asked her to request that the doctor (or whoever does this) to send me a message through the patient portal explaining exactly how titrate down from the former AED. (He had rushed through this explanation at the office visit. There was so much we needed to cover I didn’t have a chance to take notes.) She said she would get back to me THAT AFTERNOON.
After two weeks had passed with STILL no response from his office, I decided that, given that this physician and I did not seem to be communicating well, I would change to a different physician in the practice. (Forget communicating, actually. He man-splained, cut me off in mid-sentence, and overall acted like a jerk. But I was willing reluctantly to put up with his delusions of grandeur, i.e. that he is a god-physician, IF HE SEEMED TO PROVIDE GOOD MEDICAL CARE. But the communication problem is a medical issue. So.)
I called the office and told the gatekeeper (unsure of her title-but you go through her for everything) that I wished to change to a different doctor in the practice and gave her the name of the one who had been recommended (by another one of my docs). First reaction: She was SHOCKED- shocked, I tell you!-that I had the audacity to make such a request. (Surely I’m not the first person in the history of this practice to have done this?) Second reaction: She absolutely did not want to facilitate my request. First she told me I had to go through the patient portal. I informed her that 1) there was no means to do this via the portal and 2) my messages to my current physician were getting extremely misconstrued.
Here’s the kicker: When she FINALLY agreed to do this, she informed me that BOTH doctors would have to agree to this transfer. I was rather dumbfounded at this, having never heard of a physician having “veto” privileges over a transfer. I could understand having to check with my proposed doctor, to ensure he had room in his practice, treated my particular neuro subset of ailments, etc. I told her to please expedite this matter and let me know what transpired. Just to cover my bases, I sent a formal request to my then-neuro asking the same. (And in both I was as always very polite and civil.) I got a call from her the next day saying my transfer had been approved but that I could not get an appt with the new guy until August.
The more I reflected on this, the more disturbing I found it. Under common law, based on court decisions, all patients have the right to choose the physician of their choice, if the physician agrees to provide services. But I am also a Medicare (traditional, no so-call advantage plan) recipient, so there are specific Federal Guidelines that state that a patient’s choice of physicians must be honored. I believe that this is covered by U. S. Code>Title 42> Chapter 7>Subchapter XVIII> Subsection 1395a:
(a)Basic freedom of choice
Any individual entitled to insurance benefits under this subchapter may obtain health services from any institution, agency, or person qualified to participate under this subchapter if such institution, agency, or person undertakes to provide him such services.
Though the outcome was ultimately what I wished, I believe I might have a talk with the office manager at my next visit. I want to find out what their exact policy is. (I’m also consulting with a lawyer friend beforehand. not b/c I’m taking any action, just to ensure I have my facts straight regarding this.) But if what the gatekeeper said is true, then I believe this practice is engaging in FOC violations, functionally (b/c not everyone will be as persistent as I) and certainly at least skirting the edge of violating it, if even by ignorance by the gatekeeper. (And if you work in that job, you should know what you are doing. This sort of thing could open the practice up to all kinds of trouble.)