Read Online The Society by Michael Palmer - Free Book Online Page A
Authors: Michael Palmer
Tags: Fiction
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him with a safer home environment, to initiate antidepressant medication, and to monitor his pain meds since one fracture needed to be repaired with an open reduction. I presented the case, including the mental-status exam, which was positive for a profoundly depressed mood, constricted affect, suicidal ideation, substance abuse, feelings of hopelessness and worthlessness, and sleep and appetite disturbances.
“Now, tell me again, the HMO medical gatekeeper asked, how high was the building he jumped off?
“What has that got to do with anything? This kid is hell-bent on killing himself. He needs at least fourteen days in the hospital.
“I’ll ask you again—how high was the garage?
“Two stories, I said. What difference does it make?
“If it really was two stories, he said, I’ll give you two days of initial authorization.
“Two days?!! So if it was three stories I’d get three days?
“Two days is what I can give you. You can call back after that and request approval for more, but I can’t guarantee you’ll get them.
“If this were your son, I’m sure your response would be different, I said. But, then again, he’d probably be dead by now, you Janus-faced bastard.
“The gatekeeper hung up on me. Eventually I got a total of six days for the kid. In the lobby the day he was discharged, I heard his father call him a little jerk. The next day I submitted my resignation from the hospital and started looking for a nonclinical job. Thank you, managed care.”
The ending, tragic though it was, brought sustained applause. The members’ exuberance was born purely of frustration. Every one of them had encountered similar, logic-defying bureaucratic stonewalling of the way they wished to practice medicine.
“You had to have made this up,” someone cried out.
Will shook his head.
“I don’t have that kind of imagination,” he said. “These are real stories from real people. Okay, one more math-and-medicine case, this one a quickie from a surgeon in Worcester. Patient comes to see her with bleeding, horribly painful hemorrhoids. The guy’s done everything his family doc asked him to—soaks, suppositories, stool softeners, rubber donut. Finally, sleepless, in constant pain, bleeding through a pad, and unable to sit at work, he comes in for surgery. The surgeon dutifully calls for the HMO’s preapproval and is stunned to have the young voice on the phone ask how large the hemorrhoids are. Clearly the lad is parroting questions off a computer screen, the surgeon writes. What difference does it make how large or small they are, she asks, THEY’RE KILLING HIM!!! Just say you’ll pay for this man’s care and let me fix him up. Ma’am, I’m afraid I can’t do that, the kid says. I need to know the size of the hemorrhoids before I can approve payment for the surgery. Okay, okay, okay, says the surgeon—on the faculty at the medical school, incidentally—the guy’s hemorrhoids are roughly the size of Nebraska. The lad making medical decisions for his HMO over the phone thinks for a few seconds, fills in the blank on his screen, then approves the procedure.”
The laughter this time was heartfelt, but also a bit edgy. Having medicine practiced over the telephone by HMO MDs or, even worse, non-MDs was a constant sore point for most of the Hippocrates Society members.
“That’s it until next month,” Will said. “Back to you, Tom.”
Lemm returned to the podium and silenced those who were still buzzing over Will’s cases.
“One last piece of business,” he said. “As many of you know, Jeremy Purcell, who was to champion our cause at next week’s forum, has had emergency bypass surgery. He’s reasonably stable at White Memorial but has been absolutely forbidden to participate in the debate. We can’t back out of the deal, so we need to select someone who can face up to Boyd Halliday. Jeremy has promised to make his notes and slides available and to spend time coaching whomever we choose. As
“Now, tell me again, the HMO medical gatekeeper asked, how high was the building he jumped off?
“What has that got to do with anything? This kid is hell-bent on killing himself. He needs at least fourteen days in the hospital.
“I’ll ask you again—how high was the garage?
“Two stories, I said. What difference does it make?
“If it really was two stories, he said, I’ll give you two days of initial authorization.
“Two days?!! So if it was three stories I’d get three days?
“Two days is what I can give you. You can call back after that and request approval for more, but I can’t guarantee you’ll get them.
“If this were your son, I’m sure your response would be different, I said. But, then again, he’d probably be dead by now, you Janus-faced bastard.
“The gatekeeper hung up on me. Eventually I got a total of six days for the kid. In the lobby the day he was discharged, I heard his father call him a little jerk. The next day I submitted my resignation from the hospital and started looking for a nonclinical job. Thank you, managed care.”
The ending, tragic though it was, brought sustained applause. The members’ exuberance was born purely of frustration. Every one of them had encountered similar, logic-defying bureaucratic stonewalling of the way they wished to practice medicine.
“You had to have made this up,” someone cried out.
Will shook his head.
“I don’t have that kind of imagination,” he said. “These are real stories from real people. Okay, one more math-and-medicine case, this one a quickie from a surgeon in Worcester. Patient comes to see her with bleeding, horribly painful hemorrhoids. The guy’s done everything his family doc asked him to—soaks, suppositories, stool softeners, rubber donut. Finally, sleepless, in constant pain, bleeding through a pad, and unable to sit at work, he comes in for surgery. The surgeon dutifully calls for the HMO’s preapproval and is stunned to have the young voice on the phone ask how large the hemorrhoids are. Clearly the lad is parroting questions off a computer screen, the surgeon writes. What difference does it make how large or small they are, she asks, THEY’RE KILLING HIM!!! Just say you’ll pay for this man’s care and let me fix him up. Ma’am, I’m afraid I can’t do that, the kid says. I need to know the size of the hemorrhoids before I can approve payment for the surgery. Okay, okay, okay, says the surgeon—on the faculty at the medical school, incidentally—the guy’s hemorrhoids are roughly the size of Nebraska. The lad making medical decisions for his HMO over the phone thinks for a few seconds, fills in the blank on his screen, then approves the procedure.”
The laughter this time was heartfelt, but also a bit edgy. Having medicine practiced over the telephone by HMO MDs or, even worse, non-MDs was a constant sore point for most of the Hippocrates Society members.
“That’s it until next month,” Will said. “Back to you, Tom.”
Lemm returned to the podium and silenced those who were still buzzing over Will’s cases.
“One last piece of business,” he said. “As many of you know, Jeremy Purcell, who was to champion our cause at next week’s forum, has had emergency bypass surgery. He’s reasonably stable at White Memorial but has been absolutely forbidden to participate in the debate. We can’t back out of the deal, so we need to select someone who can face up to Boyd Halliday. Jeremy has promised to make his notes and slides available and to spend time coaching whomever we choose. As
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