NO RINGING ENDORSEMENT FOR KAISER'S PHONE SYSTEM

Saturday, November 22, 2003

Kaiser Permanente does a great job of providing excellent health care in a cost-effective manner. Why do they have so much trouble with telephone messages?

I've been in three Kaiser plans since 1992, Northern and Southern California and now Colorado. I believe their model for health-care delivery is superior. Kaiser is principally a provider of comprehensive, integrated care with a focus on preventive medicine, a health maintenance organization decades before the term was invented. It can offer health insurance to employers because it is big enough to self-insure, and it manages the care it provides.

An enduring mystery of public policy is why anybody should have imagined that applying labels like "HMO" and "managed care" to entities that provided nothing but insurance would magically yield performance comparable to Kaiser's.

I've had wonderful doctors at Kaiser (I've had a lot of doctors). They can give good care because they're all working off a single medical record, and the primary-care doctors have authority to order tests or to send you to a specialist without calling someone for approval. They nag, but nicely, about the things you can do to improve your own health.

But the message system drives me to distraction. You can almost never call the person you want directly, not even to leave voice mail; those numbers are closely held. Instead, somebody copies down the message and (you hope) passes it along more or less correctly.

And the messages you receive in this game of telephone may be incomplete, garbled or flat-out wrong. Like these.

I had two routine appointments scheduled in early November, the first on a Monday, Nov. 3, with Dr. Amy Ghaibeh, in the Department of Internal Medicine in the Skyline Building in downtown Denver, and the second Nov. 5 with Dr. Lynette Vialet, in OB/GYN in the Franklin Building on the same block.

Real names, because I don't think this story reflects badly on them. I would unhesitatingly recommend either of them to a friend. But you may wonder why I tell you where their offices are. It's for the same reason the playwright has a rifle over the mantel in Act I; it will play a role in the narrative.

Ghaibeh asked me to stop by the lab to have blood drawn after my appointment with her. I did, and the following day someone from her office called to say I should have the lab work redone.

The caller didn't say why (it was low potassium levels) but, more to the point, she neglected to tell me that the doctor had ordered a prescription to fix them.

I found that out from Vialet the following morning. But because I felt so odd -- pulse racing, shaky, light-headed -- Vialet sent me downstairs to have an EKG.

The next day someone named Susan at a Skyline number left me two voice-mail messages, but unfortunately she left them on my cell phone, which I seldom use and therefore don't check. I didn't get them until the weekend.

When I called Susan back Monday morning she wasn't in, so I talked to someone else at the Skyline office. She didn't know what Susan's message was, but she looked at my chart and told me I needed to have my lab work redone, drink a lot more water, and come in for my pre-operative physical before surgery.

Surgery? Nobody had mentioned surgery to me.

A little later, I got a voice-mail message from Paula, also at Skyline, but when I returned the call she was at lunch. The person who took the call didn't know what Paula's message was, but she told me the same things the first person did, including the puzzling instruction about surgery. And later that day, when I finally connected with Paula herself, she did the same.

I am not being disrespectful to these women by using their first names, by the way; their first names are all they told me.

But I'd been thinking about where the idea of surgery might have entered the record, so I asked Paula, "Do you suppose it could be because in the Franklin Building they do EKGs in the pre-op physical department?" She didn't know, but she said that in Skyline the department did its own EKGs.

Tuesday afternoon Susan returned my call, and she explained that no, it wasn't really surgery after all, just a "procedure." And she had additional information to impart; my EKG was "abnormal," and I needed to see Ghaibeh as soon as possible.

But when I did, all was well (and the rifle was returned to its spot above the mantel without event). There was no mysterious surgery, and the location of the EKG was the only reason anyone ever thought there was. Moreover, the EKG was abnormal for someone who was going to have surgery -- the racing pulse, remember? -- but nothing to worry about otherwise. And we tweaked my prescriptions so even that shouldn't happen again.

All better? Me, yes. Kaiser's handling of medical messages, no.