Digest, 8/28/2021: Come Rub Upon My Belly with Your Guava Jelly
the eighteenth weekly digest post
As I have mentioned, I was benching a couple weeks ago and felt a pop in my left shoulder. It didn’t hurt a great deal but something definitely felt wrong. Since then, I have consistently had an issue where, when I raise that left arm up above a certain point, it seems to catch on something and doesn’t want to go further. When I push past that point, there is a notable (sometimes audible) clicking or popping. Trying to stretch it out on a bench press or shoulder rack with no weight brings soreness and a disquieting feeling of weakness. It will feel normal for awhile and then I will absently swing my arm over and it will pop again and it feels like something is structurally wrong. Having rested it and put it in a sling and tried to take it easy, t’s not getting any better and I know that I need to see a doctor.
Luckily I have insurance, so shouldn’t be a problem, right? I knew going in that I had to see a different doctor before seeing an orthopedist, thanks to the bizarre and wasteful HMO system my insurance is on. (I get my health insurance through the NY State of Health ACA marketplace system.) The last three times I have seen a primary care doctor, it’s gone like this. Me: “I have problem.” Doc: “Ooh, yeah, I don’t know anything about that. Here’s a referral to a dermatologist/endocrinologist/neurologist.” Like, literally no further investigation, just total surrender the moment my explanation has left my lips. So I looked for an appointment that, I assumed, would be much the same. Every online doctor lookup and appointment system I have ever used has been an absolute nightmare of outdated information, incompatible systems, and terrible UI, and this was no different. After hours of searching online and several phone calls, I was left unable to find an appointment to treat my injured shoulder sooner than September 28th, more than a month in the future. This would be bad enough, but of course I have to budget in the amount of time waiting for an appointment with an orthopedist once I got the referral that was almost certainly going to be the sole outcome of the primary care visit.
I went to urgent care. That’s what urgent care is for, when you can’t get an appointment with a doctor’s office, right? I checked and made sure they were in-network. They were on the list and my card says “Urgent Care $0.” When I showed up they told me that my insurance worked there. The doctor told me exactly what I thought he would - I don’t know what’s wrong with you, you need to see an orthopedist. (The growing inability of primary care doctors to solve anything seems like an issue but I don’t know.) He said we’ll get you a referral and call you back. They never called me back, so I called them. Turns out they can’t give me a referral; I need to get one from my PCP, although I have never met my listed PCP and have been shunted between doctors by their system time and again. So that appointment was useless. My girlfriend, who is a saint about this stuff, called my insurance to complain. The urgent care place was, in fact, in network, but despite that a referral from them was no good. Insurance additionally told her that we should have found a specific orthopedist and sought a referral for that doctor, though it would still require seeing a primary care doctor first, and the person from the insurance company declined to provide advice or recommendations for how to wade through the opaque system to determine which specialists we might approach about potentially getting an appointment with in a theoretical future where I have a referral, provided of course those specialists are taking new patients and have any appointments available in anything like a reasonable timeframe.
So I was right back where I was: I need to see a doctor, but in order to see a doctor who will actually help, I first need to see a doctor who can’t actually help, and getting to see that doctor will require waiting for a month with an injured shoulder, and then once I see him the only thing he’ll do is give me a permission slip so that I can hunt around again for an appointment with a second doctor, which will inevitably entail waiting weeks again, and then hopefully that second doctor can help, although s/he will likely tell me I need an MRI, which I will then have to get approval for from my insurance company, which will take more time, then I will have to get an MRI appointment and wait for it, then once I have gotten the MRI I will have to secure another appointment with that second doctor before s/he can help me, which will again likely take weeks. Should I need surgery, it’s likely that this will not be carried out by that second doctor, and I will need to pursue additional authorizations from my insurance company before seeking a third doctor who can perform the surgery, which will likely take additional weeks for scheduling, and then perhaps I will begin the process of being healed. This is the process for an insured and affluent person in the most technologically advanced and richest country in the history of the world.
I am insured, I am in the top 10% of American earners, I have an unusually flexible schedule, and I have the language skills and patience to navigate confusing and contradictory online and phone systems. I’m in a city that has among the highest level of doctors per capita in the entire world and which is internationally recognized as a leading center of cutting edge medicine. I’m also in pain. And yet for 10 days I simply could not secure a prompt meeting with someone who can help ease that pain. Thanks to the extreme patience of my girlfriend, we have done the paperwork to change my listed PCP and have made a more prompt appointment with that doctor, which will be contingent on approval from the insurance company. And she got me an appointment despite the receptionist saying they didn’t have any openings by appealing to her personally. I know that clogging the ERs with non-emergency needs is a big problem but, honestly, I get it.
My girlfriend lived for 15 years in the UK, and after navigating her own care here for a few months and helping me navigate mine, she says that the NHS - constantly maligned by conservatives and libertarians in the United States - is just vastly easier, simpler, more friendly, better. Of course, were I poor and uninsured, things would be vastly worse. I don’t know how people continue to justify our rotten system. I don’t.
This Week’s Posts
I published too much this week. Sorry.
Monday, August 23rd - Is the Conventional Wisdom on Educational Spending All Wrong?
I consider the evidence on the influence of school expenditures on quantitative educational outcomes, and whether recent studies showing a causal relationship between the two override the repeated observation that countries/states/districts that spend more don’t perform better. My answer: inconclusive!
Tuesday, August 24th - “Old School Lifting” is Not the One Noble Path of Exercise Weightlifting is great. If you are authentically motivated to do certain “old school” approaches, or if those approaches best satisfy your practical needs, great. But too many people today are benching, squatting, and deadlifting near their maximum weight because they’ve bought into a weird moralizing that doesn’t belong in the gym.
Wednesday, August 25th - Antifa is a Fatherless Child
I have been involved in radical left politics, and particularly in organizing and protests, for almost 25 years. Antifa and black bloc have been a fact of life for all of that time. In the past there was a communal understanding of the dangers inherent to antifa and how the rest of the movement have to rein them in, but now the far left is debated by educated elites who have no protest experience and no commitment to the actual health of the movement, and all the do is celebrate antifa violence from their Macbooks. This is not ideal.
Friday, August 27th - The Center Holds, for Good and Ill (subscriber only)
We live in a culture that perpetually declares the end of the world (Y2K!) or the beginning of a new one (driverless cars!) but it seems to me that we will live in this mundane and imperfect reality for a long time. (But I wouldn’t hate being wrong.)
Friday, August 27th - Quickie: For a Lot of Parents, the Point of Private School is to Keep Their Kids Away from Black Kids
Pretty self-explanatory. You can’t democratize institutions that are designed to be exclusive, you can’t created equality and maintain elitism.
And we got Chapter Seven of The Red, the Brown, the Green.
From the Archives
In a little short-lived online journal funded by Moleskin called the Towner, I argued for the necessity of types of condemnation that are not identity-fueled - that is, that some people are just assholes, rather than racists or sexists etc., and that this is not only fairer for those accused of bad behavior but actually makes it easier to prosecute accusations of actual bigotry.
Song of the Week
Substack of the Week
Free Black Thought is a larger project, largely but not exclusively driven by Black writers and academics, that challenges conventional assumptions about what Black people are “supposed” to think. When I first became aware of the project it was represented as conservative, which is merely an indication of our stupid binaristic political culture. The opinions represented in FBT tend to be committed to freedom of speech and an ideal of racial reconciliation rather than endless racial division, which are only coded as conservative within the context of our broken discourse. I don’t agree with everything I’ve heard under their umbrella (sometimes I’ve disagreed quite fervently), but there’s a dedication to inquiry here and a level of commitment to research that is rare. This post on the origins of critical race theory is a good example; there’s just a ton to be learned there. Check ’em out.
The Merciless, Danielle Vega, 2014
I picked this book up simply based on the cool cover you see here. I knew nothing about its contents. Which is not sound practice! I bought this CD based on this same principle and it was some of the worst music I had ever heard. But I lucked out here. This is a tight little thriller that has a rather predictable plot turn that doesn’t make its execution less fun. In the story, three teenage girls stage an “exorcism” of a classic bad girl type from their school, an exorcism which really amounts to an excuse for imprisonment and torture. Our protagonist has been dragged along and faces an ethical dilemma about what to do. Shit goes wrong, and suddenly they’re all trapped in an engagingly tense crisis. I will say this, without spoiling anything: there’s a sense in the book that later events justify some earlier behavior, and I really don’t agree. But I don’t have to agree with the implicit morality to enjoy the book.
Comment of the Week
Relevant Ginny Hogan joke:
“Thank god exercise makes you hotter. If all it did was improve your health, boost your mood, increase your longevity, prevent physical pain, and help your sleep, I’d never do it.” - H.G.Welp
That’s it for this week. Our next theme week next week!
Not a single compliment about my cat? 😑 The terrorists have already won.
Hi Freddie. Primary care doctor here. Sorry you're having so much trouble getting in to see someone. HMO systems can be really rough and finding a good primary care doctor to navigate these systems is essential. Once you have someone responsive who you like and trust, getting referrals can be easier by emailing your doc or via telehealth as BronxZooCobra suggests. The problem is finding someone good who is taking new patients and then getting an initial visit- which can sometimes take months. For now: change your PCP to whomever can get you in immediately (which it sounds like your girlfriend managed), get your referral to ortho AND to physical therapy. You may or may not need an MRI but ortho should decide this. Once you get your referral and your shoulder is taken care of, if you like your new doc- great. If not, do the work to find someone you do like now and change your provider so that if you need something in the future, you're not stuck in this bind. Maybe your psychiatrist can recommend someone in your network and help you get in for an appt? I'm closed to new patients precisely so that I can be responsive and see people when they need to be seen, but I make exceptions if another doctor reaches out to me and asks me to take a patient.