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Health Care, Health Insurance and Health History

This was originally posted on Jul 8, 2010, it is from the blog I accidentally killed. I have been thinking about this topic lately because of an experience I had volunteering at a free clinic.  Enjoy!

Last week I received my enrollment information from Emory, the school that is going to train me to be a baby catcher.  Nursing and medical schools are a bit different than other schools because in addition to classroom lectures, we work with people.  People in healthcare settings.  People depending on us for health care.  This means, we need to not only provide all the information to successfully enroll in classes, we need to provide all the information to be able to work in a health care setting.  Hospitals are required by law to have this information on file, and the school must ensure we have it before we are allowed to work/learn there.

So tomorrow I will be getting my token physical and my drug test.  Yes I said drug test…like I said, I have to follow the hospital employment requirements.  To make it even more interesting as a student you work at several hospitals and must have the mandatory paperwork for each hospital in place before the semester begins. Remember a few posts ago when I became painfully aware that many things contribute to the decision of where to give birth? (hmmm, I guess I need to add this post for you too?  How about tomorrow). This week I became painfully aware that many things contribute to the decision of who to attend a birth.

After a week of trying to become a patient in a family practice so I could get these forms filled out and submitted before August 1st, I really don’t care anymore who I see. I like this visit to be the first in a  partnership with a physician or nurse practitioner for the few years we will be here, but since my state sponsored program from New York (which runs out soon anyway) won’t cover non-emergent health care in Atlanta; and because my school mandated health insurance does not begin until August/September; and because I cannot become a patient at the student health center until I am “in school,” but will be expected to use their services as primary care once I am (because I will have the school insurance program)’; and because my last physical with my doctor was now over a year ago; and because the paperwork is due August 1st, I am stopping by the cheapest walk in clinic I can find to have the paperwork completed and signed.  After a week of trying to get what I expected and wanted, I give up.  The deadline is too close.  I simply ran out of time and options.

As I said, tomorrow I will have my token physical.  Token because I don’t have a doctor here in Atlanta yet so whomever I see will have meet me about seven minutes before they fill out the form.  Most of the information will be based on my answers to questions because they have no access to my health history except that I provide. Yes, I still care that I will have to meet this doctor for the first time while essentially naked; that I will probably never see him/her again; that this visit is really only the illusion of  health care; that true health problems are not likely to be discovered because of this appointment.  I am still me, I still wish I could have the highest quality care with a practitioner who partners with me.  But I am stuck in a system that makes it almost impossible to make this visit any more than a shadow of what health care should be.

And herein lies the dilemma for many expectant moms.  Not enough time to explore options before the appointment must be set.

Let’s assume a mom knew she was pregnant pretty early, maybe she tested as soon as she was “late.”  She is now about two weeks gestation, which is four weeks pregnant.  Her first visit with her chosen health care provider will be when she is ten weeks pregnant.  That leaves six weeks to:

Get an appointment to verify the pregnancy (if necessary for her insurance);

Review the list of care providers covered by her insurance;

Get recommendations, check locations and if she is lucky what hospitals different providers will go to;

Set an appointment for that tenth week…wait, that means she doesn’t really have six weeks to do all this.  Because she has to have the appointment set for the tenth week – she probably needs to have her decision made so she can schedule an appointment by the eighth week.

Four weeks – she has four weeks to pick her doctor/midwife to be on the right “schedule” according to the standards of care. And for many women these are not the best four weeks of pregnancy.  She has to stay motivated to do her research and make a decision while tired and sick to her stomach.

I gave up after 10 days, in perfect health and without the common symptoms of pregnancy.  While I might suggest the birth of her baby should induce her to put a little more care into her choice, shouldn’t the care of my family induce a little more care in mine?  I set out to find a family practice whose philosophy of  health aligns with mine.  I was supposed to choose the family practice who would partner with us for the next four years.  I settled for a one-appointment-stand with a doctor whose name I don’t even know yet.  Frustration and feeling pressed for time will do that to you.

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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