Bureaucracy and Unnecessary Stress – Updated with Ultrasound Results

On Tuesday morning I awoke from a bad dream in which this baby’s heart had stopped. It came out of the blue and shook me to my bones. I had been intending to cancel this Friday’s (today’s) upcoming ultrasound because it is so close to when I will see Dr. Braverman on Monday. The dream caused enough unrest for me not to follow through on the cancellation plan. I am going for ultrasound number three later today. The lump in my throat as I type those words is palpable.

On Wednesday morning I called my general practitioner’s office the second they opened to ask if I could pick up a copy of my ultrasound report from last Friday to send to Dr. Braverman (and to add to my binder of personal health records because that’s the kind of obsessive behaviour that turns my crank). After leaving a detailed message for my doctor’s amazing nurse/assistant and getting a clarifying phone call from a complete stranger who happens to be sitting at said nurse/assistant’s desk this week (hopefully because said nurse is on vacation), I spent the day waiting and waiting and waiting.

Mid-afternoon I left another message. Very late in the day I got an alarming call back. The stranger had spoken to my doctor who reportedly said:

* she didn’t think that weekly or biweekly ultrasounds were medically necessary (even though she never told me that when she requisitioned them for me on November 10, 2014);

* she remains concerned that our public health care provider may refuse to cover the costs of these ultrasounds and therefore they may not be insured services (presumably because they are not medically necessary in my doctor’s current opinion (?));

* she was not comfortable giving me any more of my personal health records without consulting the clinic’s medico-legal representatives; and

* I may have to complete some paperwork, wait and pay some money to obtain my records but my doctor and the stranger would not be able to tell me anything further until Thursday because the medico-legal people had left for the day.

To say I was upset and stressed out by this development is an understatement. To say the timing was terrible is trite. The tailspin and fury that followed ruined my evening and disrupted my sleep. Deep down, I felt abandoned by my doctor – the same doctor who has seen me through all but the very first of our eight pregnancy losses, the same doctor with whom I have shared both of my comprehensive immune diagnosis and monitoring reports from Dr. Braverman – and fearful that this is the kind of crap I will be facing throughout this pregnancy if we are fortunate enough to see it continue.

I raged against what I have come to behold as a hateful Canadian public health care system. The irony is not lost on me that the LP and I pay a disproportionately high amount for this abysmal system (clearly for others’ use of it since my own access to it has been thwarted at many turns and remains tenuous with respect to the current pregnancy apparently). Once again I found myself saying I would rather pay for private health insurance and have the option to truly choose my care providers and care than live here under this oppressive regime of sub-par care and doctors more concerned about getting paid for their services in a model that wants to refuse payment for anything that may not be “medically necessary” in their draconian view.

In case you fear l lost my mind and am now incarcerated because I brought an assault rifle to either my doctor’s or the public health provider’s office (because I contemplated it – do these people who mess with me at this point forget I am completely hormonal and jacked up on steroids?), there is – or may be, time will tell – a less unpleasant ending to this story than the above would suggest possible.

Yesterday the stranger from my doctor’s office called and said:

* I could pick up last Friday’s report;

* it was the last report my doctor would provide free of charge;

* my doctor had prepared a new requisition to replace the one she gave me on November 10, 2014 in which she instructed the sonography lab to fax a copy of all future reports to Dr. Braverman directly; and

* it is up to the labs whether they comply with this instruction. If they don’t I will have to call each time, pay a small fee for the reports and drive to pick up copies from my doctor’s office.

I don’t mind the small fee. I cannot erase from my memory and anxiety banks the comment that my doctor does not think these ultrasounds are medically necessary. I am still reeling from that and feeling very unsettled about the implications of this comment for my present and future care prospects here at home. I am left with a flurry of questions that – as evidenced by the time of this post – have woken and kept me up at night.

Has she put this in my chart? What else does she think is medically unnecessary? Did she even read the Braverman diagnostic and treatment reports? Does she even believe I have autoimmune conditions that have been responsible for much of our painful reproductive medical history? Will she be sharing her opinions with my ObGyn when she transfers my care to him if this pregnancy progresses?

Ugh.

Why can nothing – or seemingly little – on this journey for us be simple and free of unnecessary stress?

UPDATE: Today’s ultrasound went very well and offered some deeply appreciated reassurance. Baby was measuring ahead (8w4d) at 19.8 mm (I think – I was sneaking an unauthorized peek). That’s almost double from last Friday – the little one had a big growth spurt this past week! Her/his little heart was thumping along at 181 and 179 bpm. The little one also waved its itty bitty leg buds at me and showed off a big old cranium filled with a whole lot of invisible space at the moment.

My cervix is still long and closed (yay!) and I saw the very early stages of the placenta forming. The technician suspects it will be posterior (the Miracle Toddler had an anterior placenta) so that should be interesting if it comes to pass. I have no experience with this but I’ve read that one feels more and earlier movement and is less likely to suffer back labour with a posterior placenta. Sounds good to me!

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38 thoughts on “Bureaucracy and Unnecessary Stress – Updated with Ultrasound Results

  1. I can’t begin to imagine the depth of frustration you have over getting the records. The idea that your scans are not medically necessary is just plain ridiculous and I hope your provider will listen to reason when you can get a hold of them…hopefully without rifle in tow. 😉 I have tremendous faith that today will abate your fears and you’ll see your healthy growing baby. Thinking of you today.

    • Thank you. I hope today settles my jangled nerves too. I don’t have a lot of faith in the labs faxing my reports to Dr. B given the policy of the blood labs here not to fax internationally (which this requires) but we shall see. For today I will settle for a heartbeat and growth consistent with gestational age, no new issues please, and no guff from the lab doing the ultrasound. This is my simple wish. Too much to ask? It seems like everything is too much when it comes to the system here sometimes.

  2. Two things: first, based on your history, I can see why you had that dream. Remember dreams release fears sometimes to help you cope. I can’t imagine the anxiety you’re experiencing because of it though. I do wish we could control our dreams (or nightmares) though. I still have them. I’m so hopeful you’ll see that heartbeat, but I think the fears will never go away. Second, you are not just hormonal and that doctor made me upset for you!! What do you mean not medically necessary?!? Obviously she’s never had a miscarriage, am I correct?! That’s awful. It’s like she’s jealous you got help from another doctor or something! She seriously needs to suck it up and be happy for you. Your feelings of betrayal are justified. I’m sorry and glad they’ll send the reports (even for a small fee). Good luck today.

    • Thank you – on so many fronts. She has never been pregnant or had a miscarriage, you’re right. She has generally been supportive which is partly why that comment has thrown me for such a loop. If she really believed that, why give me the requisitions in the first place. It is very confusing and unnecessary – why even have the staff tell me that when I cannot speak directly to my doctor and demand an explanation? It is just so deeply inhumane and morally offensive, it blows my mind.

  3. Ugh. I’m sorry this happened to you. I too, am so friggin’ frustrated with the Canadian health care system. We pay almost half of what we earn to taxes, and for the fertility stuff, still end up paying out of pocket anyway. You’ve been forced to seek medical services in NYC, at your own cost, because there’s no one competent in Canada. I hate this “medically necessary” shit. “Medically necessary” is why we’ve both had so many losses before anything was done about it, and in both of our cases, we have had to seek it out ourselves. Unfortunately, doctors don’t get paid when you’re healthy and happy. But they do with each pointless visit which they deem to be “medically necessary”. God, I’m all pissed off for you right now, because after all your miscarriages, they are gonna nit pick about a couple of extra ultrasounds? PUH-LEEZ!

    • Yes. It is exasperating and inhumane. I feel the same way about the difficulties you’re facing and I’ve faced even when paying out of pocket. The Canadian fertility docs for the most part are not much better at accepting immunological causes of RPL and infertility or being creative in looking for reasons and solutions. It wears me out. And makes me want to scream.

  4. Well, the doctor appears to be “covering her ass” instead of worrying about *your ass* at this time. Frequent scans aren’t medically necessary at this point in an apparently normal pregnancy. But due to the fact that you’re high-risk for multiple reasons (RPL, AMA, autoimmune issues) I would think that more scans would be justified–in the US you would be referred to a MFM specialist (and receive closer monitoring). Why haven’t you been referred to a specialist? I assume they have MFM’s in Canada. Maybe Dr. Braverman can help?
    I was previously lamenting healthcare in the US, but after realizing that public healthcare is a nightmare for people with issues outside of “the norm” (in CA and the UK) I am actually grateful for our private healthcare. Sorry you’re tangled in “the red tape” 😦 XOXO

    • Thanks MLACS. It all seems so absurd and cruel, they could have done the red tape crap without adding that medically unnecessary comment that has derailed my confidence in my doctor to the point I dont even know why I would want to stay with her for any more prenatal care than absolutely necessary. She has totally broken my trust and that is the most damaging part of this whole gong show.

  5. I am so frustrated for you right now! Would it help if you have us someone’s contact info and we could all contact on your behalf? I am guessing no but want to find a way to help relieve your stress. Please keep us posted on your ultrasound. Sorry for all your hassles!

    • Oops. Learn from my experiences and hopefully fare better than I have or at least be able to anticipate some of the obstacles and engage creativity to overcome as many as possible. It is just so exhausting when this has to be my lot just to survive a freaking pregnancy and the medical system where i live. I now understand why people file professional complaints and sue their doctors. I used to defend docs against their college complaints and litigation. I am having a hard time not wanting to go on the offensive now myself.

  6. Ugghhhhhhh! That is all so frustrating.

    First of all, I’d be surprised if you WEREN’T having dreams like that! I’m sure those fears are so ingrained in your subconscious at this point, and they have to come out somehow. I had a dream the other night that I was in a room full of women getting egg retrievals and everyone was moaning because it hurt so bad. I hadn’t even realized I was nervous about the retrieval at all until that point. And that’s just a small thing. What you’re facing is huge. That’s all to say that I think these dreams are normal and that Azulito is safe in there still. Do keep us updated on today’s ultrasound, though, please!

    And your doctor, WTF?! I would feel betrayed, too. Is there any way to access her directly so you can get clarification on why she’s being a d-wad? Can you call and demand that she call you? Or even set up an appointment face to face just to talk to her? Not that you want to go to another appointment, but it might help to hear her explanation.

    Hang in there and good luck today!

    • Thank you. I have a prenatal appt with her on Dec. 5th assuming all is still progressing by then. I may need until that time to calm down enough to have a well-reasoned conversation with her about her stupid bloody comment via the stranger receptionist. I definstely plan to tell her what i think of that as a form of practicing medicine and the kind of thing about which I have defended college complaints bu patients against their doctors.

  7. As you well know I am just so sorry your doctor was impossible and unsupportive! I suspect your problems are not done, as I’m pretty sure there is no way the sonographer will send your reports out of country. But, at least she is willing to let you pay for them, which hopefully means you won’t have too many issues. But of course my confidence in her is pretty shaken.
    Sorry you are having bad dreams. Hopefully it was a one time thing and tonight you will dream happy thoughts!

    • Thank you very much. You and I really have bad luck with local doctors don’t we? Actually you have mostly good but one really bad apple on your basket. I agree – very little chance they will fax Dr. B the reports. Thanks for the good wishes.

  8. Ugh, seriously? I can’t understand why, with all of the technological and medical advances we have, things continue to be so completely screwed up. I hate to break it to you that private insurance doesn’t actually get rid of any of this mess. Which means its a bigger flaw in a bigger system. Who isn’t getting screwed by this? At any rate, I hope things start to settle out for you soon!

  9. WTH is up with Canada? Why are you even seeing a GP at all? Our GPs don’t do anything close to this stuff, they send you straight to the OB.

    Also, why can’t YOU do whatever the heck you want with YOUR medical records? So confusing.

    Private insurance doesn’t fix all this for sure, but it does allow you to just pay for extra if you want it. I can’t imagine not even being allowed to get the scan even if you are willing to pay cash.

    • I know. It is absurd. My GP specializes in prenatal and pediatric care. My Ob is the head of high risk at the womens hospital so he won’t even see patients until second tri usually because he is super busy.

  10. I am so sorry for the red tape. Healthcare is a messed up system no matter where you are, it seems. Juggling doctors internationally certainly doesn’t make it any easier! I really hope you can get everything sorted out with them. You certainly don’t need the added stress right now. Looking forward to some happy results on today’s ultrasound!

  11. Thinking about you hon and praying so hard for today’s scan. I’m so sorry your GP’s office is treating you this way and adding to your stress right now. It really makes no sense that your doctor agreed to the extra ultrasounds, and is now rescinding on that. It really sounds like this nurse has taken it upon herself to decide what you need and don’t need. Is there any way you can schedule an appointment with your GP to discuss this? It’s hard to wrap my head around this because I can email my doctor with any concerns I have. I never realized how bad the system is there until I moved to the US. Yes, I pay a lot for my health insurance which really sucks, but for the most part, I’m confident I’m getting the best care for my money. You pay a lot too through your taxes and get sub par care. It’s not right.

    Praying all is perfect with baby today. Huge hug!

      • Yay! I’m so happy and relieved. Gook luck at your next appointment. Hope you can sort this all out with your GP. If not, Hopefully your new OB/Gyn will be more understanding.When do you transfer over to an OB?

  12. First of all, I’m so glad the ultrasound went well. ❤ I'm so sorry you're going through this mess and basically feeling betrayed by your doctor. I don't understand people. 😦 I am thinking of you and hoping that these crazy people change their minds! Hugs!

  13. Oh my dear friend! I picked up on so much anxiety and fear in this post. Deep breath! I can say from experience that most of my terrifying dreams NEVER come true. I am relieved to hear the little one is doing well, but I share your feelings about our healthcare system often failing those of us who need it to the most. BIG HUGS! Thinking of you and baby.

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