True health care reform? Sorry. We'll need a referral

October 31, 1999|By Arthur Hirsch

IT'S NICE THAT the U.S. House of Representatives backed me up with the HMOs, supporting my quest to sue people, choose from more doctors, go to the emergency room and have "experimental" treatments, whatever that means. The question is, do I still need a referral?

The House passed a controversial right-to-sue health insurance plan earlier this month that was part of a wide-reaching patient protection bill. But as lawmakers from the House and the Senate prepare to work out their differences in a conference committee, I'm left to ponder a mystery of modern medical science. It's the mystery you face when a clinic receptionist says: "Do you have a referral?"

Because in contemporary medicine nothing happens without a referral. Nobody exactly knows why, and surely you are not supposed to ask. The gods say so, that's all, and so the whole system is invested with a certain magical quality. Who needs a medicine man chanting behind a straw mask when you have a receptionist behind Plexiglas saying: "Do you have a referral?"

The House was still deep in the political wrangling weeks ago when my primary care physician confronted the limits of his knowledge and passed my case along to a specialist. Let's spare the gritty detail and say the medical trouble involved my frobis (rhymes with "no bliss"), an area in which the primary care guy had only rudimentary knowledge. Oh, sure, he could find your frobis, perhaps even describe it in vivid detail. At some point in medical school, however, he realized he didn't have enough interest in the frobis to devote his entire professional life to it.

Naturally, the next step is a frobis X-ray and function test and a referral to a licensed frobologist who will interpret the results.

And naturally, the results are inconclusive, according to Dr. Frobis, who asks me to return in a couple weeks for more tests. And naturally, when the appointed day arrives the technician about to administer an advanced frobogram looks at me and says: "Do you have a referral?"

That is, have the forthcoming tests been approved by the primary care guy, a perfectly fine gentleman who has acknowledged by virtue of his first referral that he barely knows a frobis from a fricassee.

"Uh, no," I say. Dr. Frobis asked me to come back.

"We need the referral," says the technician.

"Does this mean we can't do the test?" I ask.

"We're calling over there now."

It's deja vu all over again, recalling a previous experience involving another HMO and an aching left foot.

The primary care physician in that case was not a physician at all but a physician's assistant, whose knowledge of feet was at least as extensive as the pleasant guy at Hanover Shoes who knows enough to close a sale by saying, "Would you be needing any socks today?"

What a stroke of luck it was that the trouble that time involved a foot and not a vital organ such as a frobis. The physician's assistant -- who in a display of skillful lighting and costume design does a convincing portrayal of a physician -- refers me to a podiatrist. The podiatrist diagnoses a dropped left metatarsal (you could look it up), gives me a shot of cortisone and asks me to return in a couple weeks.

Silly me. On the appointed day the receptionist (why do I always expect that guy with the bushy handlebar mustache from "The Wizard of Oz" to stick his head out and say "GO AWAYYYYY!!"?) offers the customary warm greeting.

"Do you have a referral?"

The mind reels: A referral? From who, the physician's assistant? A guy in a white jacket who before they invented HMOs was probably working in a Lenscrafters store? Huh? This guy is supposed to pass judgment on the judgment of a boney fide Foot Doctah?"

Uh, no. Dr. Feet asked me to come back.

"We need a referral."

That's when out of sheer rage and frustration I make a proposal that's not merely outrageous but shocking.

"Tell you what," I say. "I'll pay for this myself."

Such a face she makes. You might think I pulled out an Uzi. Apparently nothing shakes them up like the mention of actual money. They're not set up to handle it. All right, she says, all right. We'll take care of it.

I make no such offer to the minions of Dr. Frobis. We wait. Testing is momentarily suspended. Tension mounts. All hands wait for the fax machine. At any moment, if the gods allow, a technician says, this most amazing medical device since the tongue depressor will spit out a referral.

From the doctor? I ask.

Silly man. Not necessarily, says the technician. Perhaps somebody in the office. Maybe a nurse. A receptionist. Somebody in the waiting room slumped over a 2-year-old copy of McCall's. Whatever.

As long as someone's looking over the shoulder of these madcap specialists. As long as there's a referral. As long as Congress is involved. Most important, as long as there's someone to sue.

Arthur Hirsch is a feature writer for The Sun.

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