Pat Salber writes The Doctor Weighs In. She is a doc, an ex-med director at California blue shield, and a Kaiser Permanente member. And she loves them. This is why, and it’s quite an advertorial for Kaiser and an indictment of how everyone else does it. So if this becomes the standard, and people find out about it (and with $80m of advertising budget a year behind it, they will find out) can the rest of the US system compete?
Health care, the way it should be or (How to stop worrying and learn to love the bomb)
I have to tell you again about what great health care I get from Kaiser Permanente Northern Cal. (Yeah, I know, they screwed up on the transplant service). But, they are doing a lot of the things we, the wonks, have been hollering about for years. Read this.
Sunday night I noticed new “floaters” in the right visual field of my right eye. They were different from the run of the mill floaters – those little dark circles — most of us have. These were like long lines and they only moved on the right side of the visual field. The next day, I started having sparkling lights, again in the right visual field. Now, even an emergency physician knows this could indicate a retinal detachment (serious indeed). So mid-afternoon, when I had convinced myself it would be stupid to miss my own diagnosis, I called KP. The woman on the phone in the opthalmology department clearly had been trained. When I talked about the sparkles, she put me on hold and got a nurse.
The nurse tried her best to get me in the same day. She had an appointment available, but being rush hour, there was no way I could make it. She carefully went over the symptoms of retinal detachment and compared them to what I was experiencing. Together we decided it was OK to wait until the next am for an appointment. She carefully explained that if certain symptoms occurred (e.g., a sensation of a curtain coming down over the eye), that I needed to go to the emergency department right away as that could indicate a retinal detachment.
The next day (today) I showed up at the opthalmology department. The receipt I was given for my $15 co-pay listed the dates I had had all of my age/gender specific preventive services and the dates the next ones were due.
There was no wait to see the doctor. I was put in an eye exam room and saw a nurse right away. She explained everything she was going to do. She anesthetized my corneas, she tested my vision (with glasses and with pinholes), she used the slit lamp to look at the corneal surface, and then she put in drops to dilate my eyes.
After about 15 minutes (waiting for the eyes to dilate), Dr. Prusiner, chief of the department came in to see me (he is the brother of Stan Prusiner, the Nobel Prize winner who discovered prions). He did a very thorough exam of both retinas using a variety of techniques. He explained that I had a vitreous detachment (annoying, but otherwise, no big deal). He showed me a color picture of an eye with a vitreous detachment. He answered all of my questions. He did not seem rushed (because the nurse had done a lot of the early work for him).
We were finished, he gave me a 4 x 6 piece of paper with his name, his photo and the URL of his home page. Here’s the link so you can see how nice it is. This is, I think, the new KP Connect. It also showed all of the stuff (by major categories) that he had on his home page. He wrote down the diagnosis “vitreous detachment” on the paper and drew an arrow from it to name of the link where I would find the information he had chosen for his patients to read about this condition. He urged me to read it. I went on the site, found the condition, and, lo and behold, everything he told me was what was on the site.
He then told me, in detail, what symptoms would require me to call or go to the ER right away. But he assured me that the symptoms represented complications highly unlikely to occur.
By the way, he said as I was leaving. Be sure to make an appointment with the optometrist. I think we can improve the correction of your left eye.
I challenge you to find one single thing you would want that I didn’t get. This is the way health care should be.