Austin, TEXAS, January 5, 2006 — I go along with my dad to a doctor's appointment today. We were referred to this specialist (an endocrinologist) when one of my dad's blood tests came up a bit screwy for thyroid function.

After many blood tests and head scratching they concluded that the problem went away. Maybe in the summer, when it showed up, they had 'induced' the problem with all the pills and dyes and stuff they give to do all kinds of ultrasounds and MRIs and such. Somehow this doctor (who happens to do bone density exams in this office) decided to do one on my dad. OK, I guess since he had

the fractured disk, makes sense. Naturally she put him on Fosamax. And calcium. I watched this test back in June. The blob of cement in his disk looked pretty cool. But I digress.

This doctor is running a money-making machine to rival Microsoft. She has a waiting room crowded with dollar signs. Most of these people are diabetic or have thyroid problems she can fix. She can give drugs and test and retest blood. (My dad has a goiter that is the size of a small animal and that isn't causing symptoms and would be very difficult to remove.)

The first thing that upsets me about this doctor is that they want some paperwork. They show me a copy of his insurance cards.

"Are these still correct?"

"Yes."

"Fill this out with that information and sign it."

Well, they have the information but they want me to write it down. Why? So I can accidentally introduce an error?

I fill it out. They ask for his SSN. Then they ask for his primary insurance. Which is Medicare. Then they ask for the policy holder (him) and his SSN. Ditto secondary. I check self and leave out writing the SSN four times. (Medicare still uses it in the policy number.)

Then I notice that there is some stuff at the bottom that he is agreeing to. That he would pay $50 for a missed appointment not cancelled at least 24 hours ahead of time, that we would pay something like $25 for copies of records plus fifty cents a page over so many pages. And, I think, $25 for a returned check. Cheeky.

I take the clipboard back to the window. The girl behind the glass ignored me for a while and then finally takes it. She gives me a look like she doesn't understand why I didn't just leave it on the counter. Oh, yes, that would be good. With his SSN on it multiple times.

All this hoopla I didn't expect was completed well before his appointment time. But they were still late seeing us. Then we go to a room with a nurse after they weigh Dad. She takes his blood pressure and pulse. She asks what his pharmacy is and what his phone number is. (Um, exactly the same as the paper I just filled out which, however, doesn't seem to be in his chart. And exactly the same as what is in the chart.) She asks if his drugs have changed. Nope.

Now last time we saw this doctor, we didn't ever see her. Just some PA. This time, though, she comes in. She explains that the blood tests are fine. (Yes, the lab told us.) She asks if he is tolerating the Fosamax. Yes. She says that his goiter could be cancerous. Um, OK, but isn't the very definition of cancer that it grows? Why isn't this one growing?

"It's hard to biopsy because it goes way down." She says.

"He had a needle biopsy."

"Yes, and that showed it was benign but it still could be cancerous. It's big."

"He's scheduled to have a CT Scan in February."

"Can you copy me on that?" (I'm thinking, um, I guess so but you seem so useless when we have the surgeon and he has been looking at the scans for many times now and not seeing growth.)

"We could do an ultrasound!" She shouts. Maybe it's me but I see dollar signs.

She rushes out and comes back shortly.

"We have an opening!" Now I see an expensive machine (recently installed?). We had the last ultrasound at Austin Radiological. Her machine is idle. Oh. no. No dollars.

"Follow me." She says and rushes down the hall with my dad chasing her, caneless. I pick up the cane and follow.

She mumbles something at this point about "his wife" to an assistant. No, lady, I'm not his wife. Sure, my dad looks young for 89 but she has his birthday in front of her. (Not that she's looked carefully either at my dad or his chart in her rush to keep the parts moving down the assembly line.) And surely I don't look a day over, um, well, you know. I've carefully identified myself on forms as 'daughter' several times including a moment ago in the lobby although I don't know where that paper went.

So they do an ultrasound. She says it looked about the same as the last one. Now, this isn't really a surprise to us. The CT scans have looked almost identical since it was first discovered a couple of years ago also. She patiently explains that it "isn't going to get better by itself." Uh. No. OK. We have been tracking it just hoping he can live with it. Because the surgery to remove it would be devastating and require a sterum split like open heart surgery.

So, OK after she has penciled in enough codes to bill his insurance for this and that she admits she doesn't really need to see him again "except for a bone density test in June." Her disappointment that he can't be a more regular patient is palpable. We make the appointment for the done density scan. But we tell each other that maybe we will, maybe we won't do it in June. Maybe we will be on vacation. But, of course, we will call at least 24 hours ahead so they don't bill us $50.

No useful information was gained from this visit. The doctor ignored the patient, barely attended to the chart. But this doctor's money machine is on overdrive. There are two cashiers ringing people out. But they will get Dad's money from Medicare and his supplemental insurance carrier so we don't have to actually pay anything. Dad and I go eat a nice lunch, shaking our heads over the whole performance.

I need to have a checkup myself. Just the "I feel fine but give me a look over" doctor's visit. But I've spent so much time over the last year going to doctors with Dad that I feel like I don't have the energy to get a checkup myself. Of course, I've no complaints. Except about doctors. And the way they miss what's really wrong while distracted by tests you "ought" to have. I feel I've consumed enough doctoring the last few years...while going to few myself.

The good news is that I'm having a maintanance check for my car tomorrow. Service dealers have their own money machine but at least they put your car's vital statistics in the computer and keep your phone number and don't make you fill out new forms every time. Nor do they promise a $50 fine if you miss an appointment. And they give you a record of the work. No fee for copying. Indeed, I've been carting the dog to the vet multiple times over the past few weeks and Chalow's vet has a bed side manner that this woman could do well to emulate. Oh, there are good people doctors all right. But vets and car dealers have to do better than most doctors. Because we just wouldn't put up with it otherwise.