Speak Stiltedly and Wear a Yellow Shirt

It never fails to be a gorgeous, blindingly sunny day when I go to see my ophthamologist. For those of you who haven’t been seeing an ophthamologist for your entire lives, an appointment on a sunny day means one thing…dilated pupils.

My ophthamalogist, let’s call him Dr. Hot Stuff, is associated with the New England Eye Center. Lucky for me (I thought) one of their offices is down the street from my apartment, so whenever I’ve been blinded by the light of Dr. Hot Stuff’s fancy equipment, I can stumble home in the bright sunlight with only a chance of getting run over by a truck.

Dr. Hot Stuff was recommended to me by Dr. Really Nice, my previous ophthamologist in Another State. She was really, really nice, even when she was frying my retina with a laser beam because I have bad retinas that occasionally need to be put in their place. She had a great chairside manner. Dr. Hot Stuff is a well-known retinal specialist, but I still miss Dr. Really Nice. I saw Dr. Really Nice for the six years I lived in Another State. She was recommended to me by Dr. Really Old, my ophthamologist at home in Fall River, whom I’d been seeing since the age of three. There were others before him, but I don’t remember them.

The point of all that background is that I haven’t chosen my ophthamologists randomly. They were recommended to me. My eye issues are not restricted to the occasional need to shoot a laser at them, either, but the danger of retinal detachment is certainly the most serious problem. I find it comforting to have the New England Eye Center down the street, conveniently attached to a hospital where really serious things with freezing pens might have to happen in a retinal emergency.

I was a little surprised last year when my HMO, let’s call it Blue Something Blue Something Else, allowed me to see Dr. Hot Stuff for my semi-annual eye exam, even though I hadn’t chosen a primary care physician at the time. Judging by this year’s visit, that was an oversight on the part of Blue Something Blue Something Else. At the time, Dr. Hot Stuff said to come back in a year, so today I went back. I knew that Blue Something allowed me only one eye exam in two years, but that never stopped me with my previous HMO, AnotherStateCare. Somehow Dr. Really Nice managed to refer me to herself so I could see her whenever she wanted to see me.

So, silly me, I thought maybe Dr. Hot Stuff’s medical opinion that I ought to come back in a year in case my retinas were falling off again would be enough for Blue Something, since it had always been enough with Dr. Really Nice and AnotherStateCare. When I called Blue Something, they asked around the Blue Something office and eventually decided that seeing Dr. Hot Stuff again so soon would be a medical visit and I needed a referral from my primary care physician. That sounded simple enough.

My PCP is Dr. Conveniently Located. She’s a couple of blocks away from where I work. I picked her out of the big Blue Something provider directory based on proximity to my workplace and gender. If you’re getting the impression that I care more about my ophthamologists than my physicians, you’d be right. My previous PCP was Dr. Conveniently Located In Another State, the one who told me I’d just have to live with my bursitis/tendonitis/whatever because I was getting old. Before him was Dr. College Health Center, who also failed to diagnose or cure my bursitis/tendonitis/whatever - though since I was only nineteen at the time, he refrained from calling me old. Before that was whoever was on pediatric duty at the Navy base in Newport. You don’t want to hear about my mother’s obstetrician, to whom I owe my high tolerance for alcohol. You can imagine what confidence in the medical profession (outside of ophthamology) this sequence of physicians has inspired.

So last week I called Dr. Conveniently Located for a referral to see Dr. Hot Stuff. Dr. Conveniently Located is part of Harvard Vanguard, a medical cult located here in the metropolitan Boston area. People had made various negative noises when I’d mentioned that my PCP was part of Harvard Vanguard, but no one had explained the cult aspect to me. So when I left a message on the special referral answering machine at Dr. Conveniently Located’s office, I figured they’d get back to me or to Dr. Hot Stuff eventually.

Instead, when I got to Dr. Hot Stuff’s office, I still had no referral. Dr. Hot Stuff’s people called Dr. Conveniently Located’s people, who acted like this was a big surprise to them, although I’d left all the information on the referral answering machine, twice, and called enough times to establish that it was, in fact, just an answering machine. Dr. Conveniently Located’s people said that Harvard Vanguard has their own retinal specialists, so they don’t refer patients to other retinal specialists. They’re still considering my request for a referral, and if they don’t accept it, they said, I’ll have to pay for seeing Dr. Hot Stuff today. They told me all this before dilating my pupils, but it took me months to get the appointment to see Dr. Hot Stuff so I wasn’t about to leave and go see some cult ophthamologist I’d never heard of in another few months, by which time my company may have already gone under and I’d have to pay anyway.

I used to pay to see Dr. Really Nice before I signed up for AnotherStateCare, back when I only had insurance against Being Run Over By Trucks and not for eye exams. I figure it can’t cost more than four times what I paid then, with inflation and Boston prices and the fact that I’m no longer at the poverty-line end of the sliding fee scale. The thing is, it’s not like I’m going to an ophthamologist who’s not part of Blue Something - I’m just going to one who’s not part of the Harvard Vanguard cult. So even if my cult refuses to give me a referral, I think there’s a chance Blue Something will pay anyway, since nobody warned me that having Dr. Conveniently Located for a PCP would mean I couldn’t see Dr. Hot Stuff anymore - not even the Blue Something people I spoke to last week on the phone who told me to call the referral answering machine.

Maybe I can even switch to another PCP who will give me a retroactive referral to Dr. Hot Stuff. More likely, when I ask our Blue Something representative to give me a list of PCP’s who are willing to refer me to Dr. Hot Stuff (who wants to see me again in a year), she’ll cover today’s appointment rather than compile such a telltale list.

This entry was posted on Tuesday, March 18th, 2003 at 4:07 pm and is filed under Boston. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.