The Third Third

A Thank You Note to my Doctors -- AND to Blue Cross Blue Shield

*I sent the following notes of thanks to two physicians who treated me last week, and to Blue Cross Blue Shield for their services.  All parties probably receive more complaints than praise, so I trust my appreciation will be welcome.  Feeling compelled to write these letters and calling the care I've received extraordinary, however, underscores the inequality of access and affordability in the health care industry today, and the failure of most physicians, in our by-the-numbers system, to listen to and care for the whole patient. How does your health care measure up?*


Dear Dr. Phelan:


My thanks are slow in coming, but no less sincere:  I so appreciate your attention to my foot and ankle (in addition to the expertise and encouragement regarding the nerves and muscles in my lower left leg for which I initially saw you).  You are the first physician in six months who has been able and/or willing to focus on both the top (the swollen ankle) and the bottom (an ulcer, it turns out) of my foot and to provide access to treatment for both with your referral to Dr. Liu, who saw me, at your request (thank you, thank you!), that same afternoon.  Further xrays revealed a severe sprain, but nothing broken, and he prescribed a big boot that (1) immobilizes the ankle and (2) at the same time takes the pressure off the ulcer so that it can heal.  Healing is actually happening on both fronts, and I am most grateful for Dr. Liu’s and your (unfortunately, all-too-rare) thorough professionalism and comprehensive care.  


I hope I won’t need to see you again, but I am very happy to have you in the system!





Dear Dr. Liu:


Thank you for taking care of me on short notice last Thursday, when Dr. Phelan referred me to you.  I very much appreciated the thoroughness of your examination and your careful attention to both the top (the very swollen ankle) and the bottom (the ulcer that wouldn’t heal) of my foot and your treating, as Zorba the Greek would say, “the whole catastrophe!”  I’ve been hobbling along with the neuropathy and foot drop for about 9 months now, exacerbating the issue by spraining my ankle, and feeling -- in addition to increasing pain -- increasing frustration that no one in medicine (doctors, physical therapists, etc.)  was really addressing the Big Picture such that I might regain all available strength, balance and mobility and pursue my normal activities.  Obviously, my ankle is testament to the fact that pursuing my normal activities (like cross-country skiing) without the requisite strength and balance is not a good idea. I look forward to working with you to achieve these goals and again, I thank you for your professional expertise, detailed explanations, and patient care. 





Dear Blue Cross Blue Shield:


When we signed up to be “partners” in my health care, I’m fairly sure you did not imagine, any more than I did, that it would be so expensive a proposition.  At least not this year.  


Even if you had had the option to reject me (and I doubt that you did as I am fortunately covered by a group policy afforded partners and retired former partners of my husband’s law firm), you probably would not have, as my record is one of a very healthy woman with relatively few medical issues over the course of several decades.


However, my body betrayed me this winter, tossed me into the hospital for five days, and subjected me to myriad expensive tests.  In addition to feeling vulnerable and frightened, I felt guilty; in the context of this country’s ongoing healthcare debate, it seemed I was using up much more than my fair share of our healthcare resources.  My sister, a physician, assured me the resources are meant to be used, especially if they can help restore a 63 year-old’s health and vitality.  


The verdict is actually out on whether or not the tests accomplished all that much; the results are mostly inconclusive as to what caused the pulmonary embolism and concomitant (but not necessarily related) heart problems, but the ultimately negative results are somewhat reassuring that there are no underlying life-threatening conditions.


But you know this.  You have watched my record carefully, I am sure.  The real reason I am writing is to thank you for hanging in there with me these past four months, giving my doctors  -- the internist, the cardiologist, the hospital staff, the physical medicine specialist, the neurosurgeon, the orthopedic surgeons, and the physical therapists -- freedom to do their work and giving the institutions and practices that would bill for the services rendered the requisite assurances they would be paid.  There was no hassle.  I didn’t have to fight for my life and for my coverage.  And even when I arguably made matters worse by trying to cross-country ski on a very weakened left foot and severely sprained my ankle again, you did not question the need for more xrays and different braces.  I could get the help I needed without fear of mounting or insurmountable debt.  I am most grateful.


I was reminded recently, when I took my car in for servicing, that our working relationship is not necessarily the norm.  I asked after my service representative’s health, remembering she had been diagnosed with breast or lung cancer and had been very pleased a couple of years ago to report that the chemotherapy and radiation had worked.  She said she was doing well, but then launched into a relatively benign complaint (all things considered) that her insurance company had denied permission (or payment -- in this case, the same thing) for the CT Scan which might have cleared her for a full year, so she still had to be checked every six months.  I don’t know the particulars, and they don’t truly matter if you’re the patient in need of the evidence that the cancer you fear has not come back and you now have to wait six more months to get it.  Bottom line, her insurance probably wasn’t as good as mine and she didn’t have the strength or the financial resources to appeal their decision or the financial resources to pay for her physician’s recommendation on her own.  I felt guilty again; the access to and allocation of resources is terribly unfair.  But I also felt grateful, again, to you, Blue Cross Blue Shield, for taking care of me as you contracted to do for our $1200 a month.


So, thank you.  And please keep up the good work.  I am back to taking care of myself so others don’t have to, but I am deeply appreciative of being so well-insured.







Ann S. Sentilles

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