Asking for directions


I have to tell you about this chicken.

A few weeks ago, our kid’s new kindergarten BFF invited us over for a play date. BFF’s parents are far more worldly and sophisticated than we are. They speak about 72 languages combined (or something thereabouts). And they served us this CHICKEN.

The chicken was soaked in magic and rubbed with ambrosia and rolled in fairy dust, before being grilled to perfection by a team of trained unicorns, probably. We ate all the chicken we could eat, licked our plates, and then promptly proceeded to get a little obsessed. Okay, more than a little. We begged them for their secret.

As it turns out, the Secret of The Chicken involved driving just 10 minutes into the Portuguese part of town. They gave us the name of the deli-turned-restaurant and we assumed we’d be set. “Surely, they make nothing but the magic chicken! We’ll just walk in, look at the first person who makes eye contact with us, and say the word ‘chicken’. Maybe we can even add what sounds like a question mark at the end, thereby convincing them that we’re in need of their pity, and their chicken. FAILPROOF PLAN.”

What we didn’t realize is that the deli-turned-restaurant was actually some sort of wormhole/portal directly TO Portugal. The menu was entirely in Portuguese, which is close enough to Spanish to make you think your distant college-level foreign language requirement will come in handy, but just different enough to be useless. We walked in there and felt utterly lost. We sort of tried to pretend like we knew what we were doing (“Chicken?”, paired with lopsided smile and uncomfortably loud volume), but we were fooling nobody.

We went home with the wrong chicken.

I was thinking about our unfortunate Magic Chicken journey as I was reading an article about how easy it is for patients to lose their way when it comes to navigating our crazy, convoluted health care system. In summary, the author proposes that there are a few areas where patients need a little more guidance and thoughtfulness from their health care providers. His list of problem areas includes insurance coverage and cost, scheduling appointments, communication between team members, and management of transitions between care settings. In response, I say: Yes, yes, yes, and yes. All that and more.

What our patients really need is a guide. An empathetic advocate who happens to bilingual in both medical jargon and their language of choice, and who knows the geography and arcane rules of Medtopia (Healthland? Careifornia? What’s that, please stop?) that only the locals seem to know about.

My patients are pretty smart cookies (most of them). They’ve passed a bunch of tests to make it into college. They have a shelf full of participation trophies at home. And they have the consumer-based retail world down cold. But the medical world? A total mystery. All they know is that when they’re experiencing some sort of discomfort, they can come to us have it evaluated. Perhaps various tests and treatments may be ordered, and ideally that discomfort will eventually go away, maybe even because of the care they received.

But how are those tests paid for? And scheduled? Do they need to ask someone for permission first? Will their insurance pay for this prescription? Will their parents find out? How can they be sure they need these tests, and not others? Is their birth control pill considered a medication? How about that sketchy energy supplement? Donde esta la bibliotheca??

What I’m saying is, this stuff is seriously, impenetrably, mind-numbingly confusing. It’s like when my CPA tries to explain my taxes to me. Except worse. Terms like “referral” and “out-of-network” and “co-pay” and “deductible” and “crappy insurance that covers nothing” tend to cause most people to nod automatically while their eyes glaze over, until the bill arrives containing a seemingly endless string of zeros.

It’s not that we HCPs don’t know this on some level. Health literacy is the center square on Medical Buzzword Bingo (right between “shared decision making” and “medical home”). But it’s easy to get caught up in the daily hamster wheel of 20-minute appointments – hellohello, history, exam, plan and thankyouverymuch, please schedule your next appointment on your way out – and before the patient knows what’s happened yet another appointment is over, and they don’t feel any closer to understanding what’s going on inside their body than when they arrived.

So they need more than to be handed over to a dozen other different people who will each then manage a tiny fragment of their care (appointment for mammogram, desk 1. insurance questions, desk 2. specialty referral, desk 3). They need someone to be their guide – to lead them through town, explain where the important stuff is, act as translator when necessary. As their HCP, as much as it may feel overly onerous (ugh, beneath my extensive training and fabulousness, ugh), we really should be that person – especially since we did, after all, order all those tests/treatments/referrals that follow (OWN IT).

So even if this feels like yet another thing to be delegated away, it’s worth it to spend the extra minute or two at the end of your visit to be sure the patient knows their way around.

Because everyone deserves to know how to get the Magic Chicken. Everyone.


2 thoughts on “Asking for directions

  1. YES.
    I spent 20 minutes on the phone with my husband and his insurance company trying to figure out why he was billed the way he was (and I am a nurse practitioner, and I work in the SAME practice as the doctor he sees: i.e. WE BILL THE SAME(ish) WAY). The degree of complexity involved here is dizzying, and increasing exponentially by the day. Now we are expecting patients to be “informed consumers”? If I didn’t already know this field, I would run and hide.

    • Seriously. Patients ask me questions about their coverage and costs I SHOULD be able to answer. And I can’t. I truly can’t. Not because I’m uninformed, or lazy, or dumb, but because the information is nearly impossible to track down until the care has already been provided and a bill has been generated. It is INSANE. Cost standardization and transparency need to happen; until then, any truly substantive reform is impossible.

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