Civil Disobedience Revisited, or Float Like a Butterfly, Sting Like a Bee

In a previous posting, Who's Afraid of the Big Bad Administrator, I wrote about my refusal to tolerate rudeness from administrative personnel, as well as my refusal to sign a form that would potentially have me paying for a service that my insurance would cover.

Last week. Deja vu.

I had come to my hospital's lab to drop off my daughter's stool sample for a routine check. Because I had adopted her from China, the doctor wanted to rule out parasites. Pretty standard stuff. I had already gotten all the materials from the lab, which informed me that all I needed to do was drop off the sample, as I already had given the lab staff the doctor's order for the test to be conducted.

So imagine my surprise when I sat at the registration desk, and the woman there said that I needed a referral from the doctor -- not just an order -- in order for labwork to be processed. And this woman, one of the hospital's gatekeepers, was nasty. I don't know what kind of power trip she was on, but she could've easily called the doctor's office right downstairs and had a referral walked up, faxed in, and/or e-mailed, but instead, the registration clerk decided it would be more fun to give me a hard time.

She had no idea whom she was dealing with.

She told me that without a referral, I couldn't drop off the sample. Then she tried to publicly humiliate me with a barrage of condescending statements and questions, such as "You should know better, that a doctor's order isn't good enough; you need a referral," and "Why didn't you get a referral?," and the constant digs about my medical-system intelligence, which was the last time she dared say anything condescending to me.

When I told her that the lab said a doctor's order was all I needed, she said, "Don't you know that you need a referral for special procedures? Don't you know how the medical system works?"

That was when I started to make her really sorry and did like Mohammed Ali said: "Float like a butterfly, sting like a bee."

Except I stung like a wasp.

I immediately responded, "I had breast cancer, so I know full well how the medical system works! Don't you tell me how the medical system works. The lab told me that all I needed was a doctor's order and to drop off a sample, which I have with me today. When I was at the registration desk just a few days ago, no one told me to get a referral. If you want a referral, I suggest you get it yourself."

She did apologize for her tone, but she still was arrogant when she said she needed me to sign a form that acknowledged I had no doctor's referral.

That spelled trouble.

And sure enough, she handed me a form that looked familiar; it was the same form I discussed in Who's Afraid of the Big Bad Administrator, the form that says because there is no referral, I would agree to pay whatever insurance doesn't cover.

She probably thought I'd comply because all the verbiage on the form seemed intimidating. Maybe she thought I was stupid.

So I read the form through and then said, "I refuse to sign this. You can easily get a referral, so there's no way I'd ever pay for labwork that is covered by my insurance."

She said, "What?!," followed by some remark meant to bully me into compliance: "This form just says you acknowledge you don't have a referral."

I countered with, "But that's not what this form says. This form says that I will have to pay any costs if there is no referral. And I refuse to pay. In fact, rather than signing the form, I'm going to write on it an explanation of why this office has led me astray."

She looked on with horror, as I wrote my composition on the form under the signature line. (As a writer, I love to write, and the massive amount of text on the form showed that passion for my craft!)

I explained how a doctor's order was written for the labwork and that the lab said this order was all that was needed and the registration personnel never told me about a referral in the first place. I also wrote that if there was no referral, it was the fault of the lab staff for not telling me right away and that they have caused me a major inconvenience. I then signed that what I just wrote was true.

Oh, and I added the line, "I will not pay for services rendered because I had a doctor's order for the lab tests and followed the proper protocol."

The registration woman was shocked, stunned, horrified...

She started acting all nice to me and finally treated me with respect. She immediately called the doctor's office and asked for a referral. If she had done this in the first place instead of being lazy and looking to abuse someone, I wouldn't have felt the need to be so difficult.

When confronted with rude medical staff bent on making your visit miserable, there's only one good option.

Civil disobedience.

Beth L. Gainer is a professional writer and has published numerous academic and magazine articles, as well as an essay on her breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. She writes about a potpourri of topics, including motherhood and her Chinese adoption experience at http://currents-living-discovery.blogspot.com/, and her cat Hemi blogs at http://www.catterchatter.blogspot.com/. Beth teaches writing and literature at Robert Morris University in the Chicago area. She has a guest posting on The World's Strongest Librarian at http://worldsstrongestlibrarian.com/3597/sharing-a-loved-ones-pain-guest-post-by-beth-gainer/.

She can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

Who's Afraid of the Big Bad Medical Administrator?

Answer: Not the patient.

As covered in previous blogs, when navigating the medical system, bully/incompetent doctors are just one of the many hurdles you face. Other huge hurdles that we patients face include those administrators whose job, it seems, is to make life difficult for us.

As if dealing with illness and life-threatening conditions weren't enough.

I am beginning this posting with a caveat: most of the medical staff I've encountered have been helpful and kind. Most of the time, my doctor visits have been made more pleasant and relaxing -- all because of the administrative staff -- such as receptionists, medical assistants, records people -- who do have a difficult job and often have to deal with rude patients.

However, it's more fun for readers if I trash the administrators who have overstepped their bounds.

And more than anything, I'm hoping that this posting can help you stand up to rude administrators who seem bent on placing hurdles in your way or being rude and inappropriate during your visit to the office. I speak from experience and will discuss two memorable altercations I had with administrative bullies.

Ironically, I'm grateful for these experiences because they taught me the incredible power patients have.


Show Me the Money

When dealing with a potential or existing medical problem, the last thing you need to hear is a medical staff member discussing money matters with you. This type of insensitivity to your needs is unacceptable.

In my case, I was in my surgeon's waiting room only a few days after being told that an MRI revealed something suspicious, and I was scared -- like crap in your pants scared -- that it was a recurrence. Fresh in my memory was my great friend dying of breast cancer only a few months before, and I was deep in thought, wondering if I would share the same fate. My surgeon was going to examine me and schedule a biopsy.

The receptionist interrupted my panic-stricken what-if scenarios by calling me up to her desk. Imagine my disbelief when she looked in my tear-reddened eyes and informed me that I owed some money and would I like to pay it now or later. She started talking in a not-so-low voice about the amount I owed. In shock, I stammered something about being billed later. I couldn't psychologically deal with one more stressor.

I sat back down, crushed. I was embarrassed, wondering if others in the waiting room overheard this conversation. The tears of humiliation stung my sleep-deprived eyes.

Then my fighting spirit took over. I wanted my dignity and self-respect back. I walked back to the receptionist and told her in a not-so-low voice, "You know, I am grappling with a possible breast cancer recurrence, and I can't believe you have the audacity to discuss my bill at a time like this!" Before she could stop stammering, I added, "You and anyone in your office are never, ever to discuss anything bill-related with me in this office."

Now it was she who was crushed. I turned around abruptly and got back to thinking my fate. She and the rest of the administrative staff treated me like gold that day. One would think I was a celebutant. And I felt empowered, even though I was bracing for terrible news.


The Dreaded Record Keeper

In my posting A Train Car Named Quagmire, I discuss how I fought to get records transferred from one physician's office to another. Records departments simply amaze me. They are able to provide services and obtain records lickety-split when a doctor requests them, but not when a patient does.


In my case, the enemy was the center where I had follow-up mammograms and any pre-surgery labwork. Interestingly, whichever individual happened to be at the front desk was always rude and cold to me. I found it intimidating and passively tolerated their mistreatment and utter disrespect. Luckily, the technicians were nice, but the technicians unfortunately had nothing to do with ensuring records were delivered when they were supposed to be delivered.

My mammogram films and report were supposed to be ready for me to pick up before I saw my doctor who always wanted to see them during my visit (I did call the records department ahead of time and followed all the protocols). Yet, about 50% of the time they weren't ready, and I had to go to the doctor sans mammogram, which arrived a few days later.

And for someone who has been through a cancer experience, waiting a few days is like waiting an eternity.

I called the center to complain about the mishandling of these mammograms and, after speaking to several impolite personnel, I finally got a friendly staff member. I told her that since I already had breast cancer and very dense breast tissue, my mammograms needed careful inspection by my surgeon on time and that such mishaps could one day cost me my life.

She said, "Aw, honey, you're not likely to get breast cancer again." I volleyed back: "How do you know that? You can't tell a patient that! It is vital that your office ensures prompt and accurate delivery of my mammogram films and results." (Turns out that years later after my preventive mastectomy and reconstruction, the labwork indicated I had oodles of precancerous cells and would've had a recurrence in a few years.)

I asserted myself to my surgeon -- I politely insisted that, with my history of breast cancer, it wasn't prudent for me to to get follow-up mammograms at an unreliable place and from now on, I wanted my mammograms done at the hospital's far superior breast center. The stakes were too high, I explained, to allow this center to determine my medical fate.

He agreed, and I never had such problems again. Victory!

Fast-forward a few years later. I needed to go to this center for pre-surgery bloodwork. I was getting my preventive double mastectomy with reconstruction, so it was a stressful time for me. My doctor sent the center an electronic referral so I wouldn't need a hard copy. So I showed up a week before surgery, as directed, without a hard copy referral.

By now I was prepared for the staff's lack of respect, and I was determined to not tolerate abuse.

Sure enough, the receptionist rudely insisted I needed a hard copy referral -- even though she had printed out the electronic version! She rudely directed me to an intake person at another desk, who coldly said the center couldn't do labwork without a hard copy referral.

I told her that I was having major surgery in a week and needed the labwork ASAP. She responded that the center would do the labwork, but only if I signed a form agreeing to pay for the procedure should my insurance not cover it because the referral was electronic.

(No, it doesn't make sense to me either.)

She shoved the form toward me, and that's where my civil disobedience kicked in. I told her, "You know, every time I come to this office, I am treated rudely and with disrespect. I demand respect. I am having major surgery next week, and I followed the correct protocol. So I refuse to sign it."

Her eyes widened in shock, and then she scribbled something on the form. I asked her what she was writing, and she said "Patient refuses to sign form." Pleased with my self-advocacy, I said, "Good!"

I got my bloodwork that day and didn't pay a cent.

When I relayed this interaction to my friends, they said they never knew they could refuse to sign such a form.

Well, now they -- and you -- know. While we want to be civil and treat medical staff with respect, when we find ourselves bullied by them, we don't have to passively comply.

Your voice needs to be heard, and you simply cannot tolerate disrespect from administrators.

Beth L. Gainer is a professional writer and has published an essay on her breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. She teaches writing and literature at Robert Morris University Illinois in the Chicago area. She can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.

Say 'No' to Thugs

We are able to say “no” to our children, teenagers, relatives, friends, and significant others. So why is it so difficult to say "no" to doctors?

Society is groomed to say “yes” to authority figures – particularly doctors. Maybe it's because we are inundated with TV shows and all kinds of medi-dramas that place doctors smack in the middle of a medical pedestal. From TV's Marcus Welby to Emergency to Trapper John MD to ER to Grey's Anatomy, it's all the same rhetoric: a doctor's word is good as gold.

I've built a team of excellent doctors, all of whom I trust with my life. But I couldn't get to this point without making hard decisions about which doctors to hire and fire. (In a future blog, I will discuss how to hire and fire doctors.)

Not questioning doctors can result in all sorts of problems for the patient. At its very worst, though, not questioning doctors can land you a spot at the county coroner's -- and not an adventuresome one like that depicted in Quincy.

And if you find yourself facing a combative doctor who is trying to bully you into compliance, use a very effective technique: civil disobedience.

In short, say "no" to thugs.

Here are just some of the doctor thugs I said "no" to:

• At the time of my diagnosis, I sought a second oncologist's opinion. He chose a treatment protocol that I later learned would likely have caused long-term damage to my heart. I also asked him about harvesting my eggs because, despite my dire terror, I was hoping to have a baby after cancer. He said, "You might want to think about how fair it is to bring a child into this world, only leave it an orphan." I left that appointment sobbing. I said "no" to him and "yes" to the first oncologist I had seen. And each day I am grateful for that decision.
• When I was planning my preventive double mastectomy, a surgeon also recommended other organs get removed as a prevention. Based on the judgment of my excellent gateway doctor and excellent oncologist, I said "no." He proceeded to bully me by interrogating me on the phone as to why I was not removing these organs, and I infuriated him (not purposefully) when I said that I was following the advice of my other doctors instead of his advice.
• Dr. Remove-All-Your-Organs finally got over his anger with me and, in an act of good will, offered my mastectomy surgeon his assistance in the removal of my breast tissue. She called me to ask what I'd prefer: her alone or the two of them working together. I told her that I didn't want that man to ever touch me and didn't want him anywhere near me on that day. In fact, he'd better not even be in the operating room! (I would've liked to say, he'd better not even be in the same hospital as me on that day, but that would be pushing my luck.)
• Another doctor I consulted who wanted to remove some organs during the mastectomy (yes, there was another organ-fixated doctor) started interrogating me after the surgery as to why I didn't follow his advice. I was stifled at that point, but once I got my bearings, I fired him.

This is not to say that we should barrel into a doctor's office, treat them with disrespect, or be deliberately contrary. Doctors are often right about our medical needs.

However, we should never forfeit our rights to be key players in our own health care. And if you encounter arrogant bully-doctors, just employ civil disobedience: Say "no" to thugs.

Beth L. Gainer is a professional writer and has published an essay on her breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. She teaches writing and literature at Robert Morris College in the Chicago area. She can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com. She also blogs on the adventures of her cats, Hemi and Cosette, at http://www.catterchatter.blogspot.com/.