Thursday, November 5, 2009

Getting In Line For the Swine Flu Shot: A Physician's Story

The Disease Management Care Blog has a primary care physician buddy that has offered up his insights from time to time, and he's done it again. When he and another physician were unable to secure any of the H1N1 swine flu vaccine for themselves or their clinics, they decided to personally access the local public health system. For those of us with decent health insurance and an established relationship with a physician, the scenario below is surreal - and eye opening.

The photo is from the clinic and even with the alterations to anonymize things, the expressions speak volumes.

Draw your own lessons: this can either be an anecdote describing just how broken the system is or what happens when the government has full control. Either way, we can all agree this is something that should happen to as few people as possible.

When we arrived 10 minutes early, the first thing that struck us was how we had to enter the clinic building through a side door. The door was guarded by a burly security guard who told us that the waiting room was packed and that we would be given numbers as soon as people started exiting. As we waited in line, there were numerous sarcastic comments about nationalized health care. After almost an hour, the line we were in stretched about half a city block. The guard wondered aloud whether we’d ‘storm the castle.’

Finally, we were in the first group of twenty that were allowed in and I was given my prized laminated numbered card. Once inside, I was led up a flight of steps into the clinic waiting room that was teeming with lines leading to many doors and a longer line stretching along the near wall of a large room. We asked a clinic worker with a name tag and walkie-talkie where we should go. We were directed to the ‘reception hall’ and asked to wait until the line for registration got shorter. We waded through the lines and went to the hall with about 3 others out of the 20. The remaining 17 got in the registration line. Sometime later, a clinic worker told us to get in the registration line.

The woman in front of us was admonished for not being in a high risk group until she told the receptionist that she was here to register her child. We were luckier: our medical licenses served to verify our high risk status. We were then asked to fill out a form, which had all of the appropriate questions on them. We were then told to pick an immunization line. There were 6 rooms with frosted glass windowed doors that had long lines in front of them. We picked one and slowly made our way through the door. Two paramedics were there to greet me. One very patiently and slowly drew up the shot into a 3cc syringe with a large headspace. This is important because 1cc syringe with low headspaces are known to maximize vaccine yield, especially in times of shortage. The second paramedic patiently put on a new pair of nitrile gloves and administered the vaccine, and the first paramedic then proffered a band aid. While they reviewed my paperwork, no one verbally confirmed whether we had any allergies.

We then left.

At no time were we asked to verify our identities or addresses, nor were we asked for any insurance information. I am still wondering what the laminated number 23 was for, and had no idea where to return it to. If anyone is in need of one, please notify the DMCB blog and shipment for first class postage will be arranged.

The total experience lasted about 70 minutes from arrival to departure. It was certainly run differently than physician-based clinics. We agreed that it was nice to not have to show photo ID, insurance cards, or make a payment. The illusion of free care and no insurance hassle was kind of nice, but this was hardly the promise of Washington DC’s health care reform. We also agreed that our clinics were faster, had less staff, had more redundant system checks for allergies, conserved more vaccine and were more organized.

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