Unthinking Limpet

The following was sent to me by an anonymous Ph.D.  See if you notice a trend in our healthcare system:

I’m a psychologist, although I no longer have a clinical practice. My 27-year-old son is no longer covered by our insurance. He’s between jobs, so he has MediCal, California’s version of Medicaid. He’s been living with us, waiting for the federal government’s hiring freeze to be over so that he can accept the job he’d been offered by the Department of Justice.

He had nausea and vomiting for 24 hours. No other flu-like symptoms. No abdominal tenderness and the like. My wife and I thought it was likely some food poisoning, but because of his medical history we wanted to make sure we were doing the right thing. We brought him to a local urgent care center. They informed us that since he was on MediCal, they couldn’t accept him. We offered to pay cash for the visit, but they said that since he was on MediCal, they couldn’t accept cash since MediCal means that he doesn’t have the income to pay—even though we, his parents, were paying. They said that we could bring him to an ER or we could call the hotline run by the insurance program.

Since this had not yet risen to the level of a true emergency, and bringing him there would result in a long wait and a large bill, we decided to go with the hotline. My son was feeling really miserable. We called the hotline. After he attested to the person answering the phone that he had given me permission to speak for him, I was transferred to what I presume was an R.N. who clearly had a series of algorithms on a computer screen in front of her. To save time (or so I thought), I quickly ran the case for her. Our conversation went something like this.

ME: “I’m the father of Philip R., who’s asked me to convey his symptoms and history to you. He’s a 27-year-old man with a 10-year history of Type 1 Diabetes that’s generally under control. He’s on an insulin pump and uses a continuous glucose monitor. His serum glucose levels are currently within normal limits. He’s had nausea and vomiting for the past 24 hours. He currently can’t keep any food or liquids down, even water. He has no other flu-like symptoms, no pains, no headache, and no abdominal tenderness. The one thing that he ate that my wife and I did not were some blackberries yesterday afternoon. He’s wondering if there’s anything else he should be doing other than replacing water and electrolytes.”

NURSE: “Does he have any chronic illnesses?”

ME: “YES. He has Type 1 diabetes. He’s had it for 10 years. It’s generally under control.”

NURSE: “So he has Type 2 diabetes….”

ME: “No, he has Type 1 diabetes. It’s a completely different disease.”

I began to feel like I was in the middle of the old Bob and Ray Komodo Dragon routine.

We went over the details of his symptoms. She was clearly checking off boxes on an algorithm without thinking about what I was saying.

NURSE: “Does he have any problems with his immune system?”

ME: “YES! HE HAS TYPE 1 DIABETES! It’s an autoimmune disorder. He’s had it for 10 years.”

The bottom line was that she recommended that we give him a teaspoon of water every few minutes to see if he could hold that down.

He was fine 24 hours later, so it likely was food poisoning of some sort. But I was really struck by the disconnect between what I was saying to the nurse offering the triage/advice and her desire to stick to the written algorithms like an unthinking limpet.

I also believe “Unthinking Limpet” would be a pretty good name for a band.


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