Sunday, January 23, 2011

Broken safety net

NewFNP has no problem with HMO's. This is quite likely because newFNP is generally healthy, is in the know, and -- in true newFNP fashion -- has her primary care provider through one of the best medical groups in the nation.

When newFNP went to her PCP and told her that she has been having diffuse esophageal spasms for two years and finally thought it was high time to get that mother-effing upper GI and quite possibly some esophageal Botox, she received her referral before leaving the office and had a specialty appointment twenty minutes later. The system is connected and coordinated.

If, however, you are newFNP's patient and you have a state-insurance funded HMO and you need specialty care, you are jacked.

Take, for instance, newFNP's 31st patient of the day last Thursday. Three months ago, she was told at another clinic that she was HIV-positive. She was told to get HIV care. Where to get that care? Apparently that was not a part of the discussion. Thus, this 32-year old woman showed up at newFNP's clinic stating that she heard we did HIV care.

We do not. Yet.

So newFNP picked up her cell phone, dialed a nearby clinic and handed her phone to the patient who proceeded to make the appointment. Only that clinic doesn't take her HMO.

Son of a bitch.

Yes, newFNP could have gone through the regular old system of giving the referral to the referral coordinator who would get to it as soon as she could given the extraordinary amount of work that she has. Then she would mail the referral to the patient. But the patient wasn't "trying to get no mail from an AIDS doctor" so that option was out. And frankly, this woman had been wandering around for three months out of care and that is just not acceptable to newFNP.

The patient got all of the details regarding the insurance switch she would need to make and then spent some time talking to newFNP about how she doesn't want the HIV meds to make her crave drugs again, about how she can't get state financial aid because she committed a felony while crack addicted and then cried for her diagnosis, for her situation, for her frustrations. NewFNP listened, acknowledged, supported.

She left the room forty minutes later -- five minutes before the clinic was scheduled to close -- and was told by a member of the support staff and HIV planning team, "I thought you were taking care of this!" To which newFNP replied, "What the fuck do you think I'm doing??!" As though taking the time and providing the care to this woman was unacceptable.

NewFNP was livid. And then she went and saw patient number 32.

Monday, January 17, 2011


Some things never change with newFNP. For instance, she will never stop looking for the perfect shoes to wear to clinic that are both stylish and comfy.

She found a near bulls-eye on a recent trip to Dolce Vita with her BFF but remarked that she would not want to wear her perfect suede wedge boots if her had to do an IUD insertion. One drop of betadine and that luscious beige suede would be ruined!! She swore that she would remove her new boots rather than take the chance at their being destroyed. After all, there are no surgical booties to cover newFNP's fashionable booties in her clinic.

So of course she headed to clinic last week with her super cute booties and was greeted with the news that the room was all set up for an IUD insert.


At first, newFNP felt a little awkward at the thought of removing her shoes for a procedure and, of course, she shouldn't take off her shoes at work. It's gross, for one, and her shoes offer her some protection from sharps and fluids and god knows what, for two. But fuck that! These boots are brand new and beige suede.

At first, newFNP followed that path of correctness and safety and kept them on, but tucked them under a drape. But she was nervous and couldn't go through with it.

When her patient was in the lithotomy position, newFNP quietly removed her booties and scooted them out of harm's way. The IUD insertion went smoothly and newFNP replaced her boots once the betadine was out of sight.

Thank goodness newFNP was wearing cute argyle socks that day! She would have hated for her medical assistant to have seen some of her B-list socks!!