For easier reading, I've written this using ordinary terminology, but I bristle at some of the common terms and phrases, so here's a brief debunking:

My doctor — "A doctor" would be much more accurate. 'My doctor' implies that the patient chooses or employs the doctor, has easy access to the doctor, etc. That's not true in any meaningful sense.

Urgent care That's corporate-speak for what's actually a profit center. The very big business of medical care is not willing to employ enough doctors that patients could be seen in a timely manner. It's more profitable to have a separate staff of 'urgent care' providers, more readily accessible, but only for a surcharge.

Health care providers Another term invented by the insurance and medical industry, because it sounds sorta vaguely warm and fuzzy. If you're seeing a 'health care provider' it means there's a giant corporation — the actual 'health care provider' — standing between you and the doctor or nurse you need to see.


Several years ago, with no warning and for no reason I could guess, my ankles and feet started to hurt a little, and within a few days they hurt a lot. A doctor's appointment takes at least weeks of waiting, but by the best of luck, I already had an appointment to see my doctor for an annual check-up, in only a few days. 

The pain was so severe, though, that I could hardly walk, so the next day I paid a premium price to limp into an urgent care facility. A woman in a white coat listened impatiently to my complaint, said "Hmmm," and prescribed an ineffective painkiller. 

The next day the pain was so bad, I borrowed my wife's spare wheelchair and went to work in it, and not as a joke. 

The day after that I saw my doctor, who immediately said, "It sounds like gout," and prescribed allopurinol pills, which quickly eliminated the pain. 

I've been taking allopurinol ever since, and I'll be taking it for the rest of my life. It's a perpetual prescription, to prevent flare-ups of gout.

At urgent care, the woman in a white coat — a physician's assistant, not a doctor, I later learned — had missed what my doc said was "the obvious diagnosis." Being me, I wrote a brilliantly polite letter asking for a refund for that useless visit to urgent care, which of course got me nada, but that's a different story.

The missed diagnosis is ordinary, though. Much the same thing had happened to my wife, when an emergency room physician missed her obvious diagnosis of gallstones. Brilliant doctors are everywhere on TV, but not so common here on Earth.

Back to this story, the takeaway so far is that without allopurinol for my gout, I can barely walk. 

Since losing my job, I've been unemployed and loving it, but in America that means no health insurance.

I've moved to Seattle, but my doctor in Wisconsin has refilled my prescription every 90 days, and the pharmacy back there mailed it to me. Luckily, allopurinol isn't very expensive so it hasn't been a financial hardship.

A few weeks ago, I requested another refill on the allopurinol, and also on some anti-cholesterol drug my doc prescribed. As always, I paid for the drugs and for the postage, and they sent a tracking number so I could see that my meds were on the way.

When the package came, I stupidly didn't open it right away because I still had a week's worth of the old pills. When I did open it, it was only the anti-cholesterol meds. I'm sure they're important pills, but they're only hypothetically important; the allopurinol is more critical. Without it I am crippled.

And then began the runaround, which would be boring to tell or read, and we've all been there, so I'll give you only the totals: Eleven phone calls from me to Wisconsin, ten callbacks or textbacks promised, two callbacks received. 

My doctor had approved the anti-cholesterol pills, but rejected the anti-gout pills. No-one told me this, though, until my third call, and only in my seventh call was I told that the doctor would not renew my allopurinol prescription unless I made an appointment for an annual physical.

Maybe it's medical confidentiality — they couldn't tell these things to me, the patient, until I'd asked several times.

Living 2,000 miles away now, making an appointment to see my old doctor seems impractical, but I've made an appointment to see a doctor here in Seattle. Price quote for that, for someone without insurance: $195, which is less than I'd expected. Gotta have those pills, though, and you can't get the pills without a doctor's say-so, so I'll pay. It's all part of the scam.

Eventually, my old doc approved a prescription, for only enough pills to last until my appointment with the new doc. I didn't say thank you.

It was a worrisome and painful week, but not debilitating, because I still had a few pills, and took one every third day while I was in prescription runaround.

Like Gloria Gaynor, I will survive, but this system can screw itself with a rusty phillips-head. It's the second time I've been through a refill crisis like this, and my wife (who had multiple chronic conditions and several perpetual prescriptions) went through it at least a dozen times.

Many millions of people have prescriptions like ours, prescriptions which never change, for chronic conditions that won't get better.

The requirement to see a doctor, again and again, and that doctors approve any refills, again and again, for the same perpetual prescriptions, is obnoxious. It's also counterproductive to good health. It serves no purpose beyond guaranteed income for health care providers.

I'd prefer to walk into a drug store, find the medication I've been perpetually prescribed, buy it and take the pills, same as aspirin.

If it's a drug with some dangerous side effects, toxicity, or interactions, say so on the label. We are adults here. At least give people an option to skip this interference from health care providers who can and do block access to needed meds on a whim.


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