Saturday, July 9, 2011

Why They Call It a Stress Test*

Dear George,

Years ago the University’s contracted with the world’s largest fast food chain to install one of its burger restaurants in the student union, the first such franchise ever to be located on a college campus. Some of the health-conscious faculty protested against poisoning the student body, but I was impressed that our institution was such a progressive world leader. Soon I started buying a Double Super-Duper cheeseburger and large fries every day for lunch. After one year on my daily burger diet I left a faculty meeting and felt a momentary twinge in my chest. I thought it was due to my colleagues’ irrational behavior, but I checked with my family doctor just in case. He too didn’t think it was anything, but he proceeded cautiously and referred me to a cardiologist named Dr. Zink. Dr. Zink did an angiogram on me at a local hospital. Much to everyone’s surprise, one of my arteries was clogged with what I later interpreted to be quarts of cheeseburger grease. Dr. Zink did an angioplasty to clean it out, crushing down the fatty goop with a high-pressure inflated balloon.

I’ve gone to Dr. Zink’s office every few years since for a follow-up treadmill stress test. Since I’ve cut Super-Duper burgers by 90% or more, the results have always turned out fine. In fact, getting my stress test has become one of the more rewarding events in my life. It’s because the technician always tells me how amazingly I’ve done and what good shape I’m in, saying reassuring things like, “Many men your age can’t even walk on a treadmill.” I noticed on my calendar last year that I was overdue for another stress test. I made an appointment, but then I got a letter from the doctor’s office saying they’d changed their billing practices, that stress tests were now considered hospital outpatient tests, and that I should check with my insurance company about payment. My insurance company, of course, said that the charges would be applied to my deductible, and they wouldn’t be paying anything. The doctor’s office was a little imprecise, but it was clear that it would cost me something like three or four thousand dollars. Since I was feeling fine, I cancelled my stress test. The billing person got agitated, implying that I would probably die within weeks if I didn’t get their test, and offering to work out a plan for payment over time. I didn’t do it.

When Katja retired in June, we switched over to Medicare and a new gap insurance policy. Surely, I thought, Medicare would want me to live for a while and wouldn’t defraud its clients. I called Dr. Zink’s office, and a man who sounded like a temporary employee said yes, that Medicare covers nuclear stress tests. So I scheduled a new appointment for 9:30 on a recent Tuesday morning. When I arrived, the receptionist claimed she couldn’t find any record of my appointment. She retrieved my file, then said in a crabby voice that I hadn’t seen Dr. Zink for a long time. She asked who had authorized my test. “Dr. Zink,” I responded, “he told me to have another test in three years.” The receptionist got crabbier. “You’re supposed to see him every year for a checkup. You can’t just walk in here like this.” I probably looked a little dumbfounded. Since I’ve had no symptoms, I never think of going to the doctor. The receptionist got up and left for a few minutes. When she came back she said that Dr. Zink had, in fact, authorized my test. She repeated that my behavior was very irregular. Then she said that they hadn’t pre-certified my test with the insurance company, and, since it was likely that the insurance company would refuse to pay, I’d have to pay the entire bill out of pocket. “Please call them,” I begged. It turned out that the insurance company would cover a nuclear stress test, though I’d need to pay $500 toward the deductible. I gulped and said I’d like to go ahead.

The receptionist put me in a waiting room and gave me a glass of water to drink. She said first they’d take pictures of my chest, then put me on a treadmill, then take more pictures with my heart under stress. Then a tall, dark-haired woman with angular features named Roxie came in and took me to a lab room. She hooked me up with an IV and injected radioactive fluid into my veins. She was pretty untalkative and surly, explaining that everybody in the office was upset with me because I hadn’t followed the rules. I didn’t say anything, but I started thinking that my stress test was going very poorly so far. Roxie lay me down on a platform in a big rotating machine like a CatScan and took pictures of the interior of my chest for fifteen minutes or so. At the end she pushed the platform I was lying out out from under the machine and banged it against its end-frame. She apologized for the sharp jolt, though I suspected this was how Roxie gets back at patients who she’s irritated at.

My nuclear treadmill test came next. I’d been working out at the fitness center for a couple of weeks to boost my treadmill speed and endurance, hoping that I could set a new patient record at Dr. Zink’s. A technician named Meg administered the test. She didn’t smile at all. I told her I do treadmills all the time and I’d have no difficulty. Apparently having been already informed that I was a problem patient, Meg was unresponsive. She rapidly increased the speed and incline of the treadmill. After nine minutes I’d reached a heart rate goal of 130. I said I’d be glad to do more, still thinking to myself that I would like to try for the office record, but Meg slowed the treadmill down and shut it off. No praise, no rewards, no exclamations of joy -- just silence. Then Roxie came back, injected some more radioactive fluid in my veins, and put me back in the Catscan machine, taking pictures of my racing heart for a second time. Once again she banged my platform against its frame when she was done. I got up, and Roxie cursorily said they’d call me in a few days. No so-longs or best wishes. Roxie did call a few days later and left a sixteen-word voice mail message saying, “This is Roxie. He reviewed your test last night and it came out normal. Take care. (Click.)” She didn’t invite me to call back with questions, come in next year, etc. It didn’t seem like very much information for an ultra-expensive test, probably around $250 per word. However, I didn’t complain. Instead I went to the fitness center the next day and started working out on the treadmill so I could force them to give me some praise the next time around.



*Pseudonyms used in this story.

G-Mail Comments

-Phyllis SS (7-15): Dave, Well, I'm glad you are OK. Give people a little power and..... You told this so well - I laughed out loud because we've all encountered these people. Phyllis

-Vicki L (7-9): Hi Dvd, I'll congratulate you, and heartily! You've looked healthier than any of your siblings for at least 10 years, despite your 'elder' status…

Loved your blog. Vicki

-Donna D (7-9): oh david, that's so sad. why do you need praise from these people? its all about doing the best you can do and that's what you're doing. give yourself a lot of praise!

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