The Affordable Care Act

July 2009
Dr. <mailmerge>
I’m writing to you in search of a physician to oversee my health. I found your name through my insurance carrier Aetna and your office is either near my home in Pacific Beach or my office downtown.Referrals customarily provide sufficient guidance for finding a doctor. In my case, I’m not ill or injured often enough to have had more than an annual check up requirement. I’ve tried the Scripps Executive Health program a few times and a doctor recommended by a family member. However, neither seemed suited to the kind of care I wish to find as I enter the second 50 years of my life. In the former case, the Scripps program is not covered by insurance and the general physician made mistakes recording my interview last time. I’ve paid for a lot of insurance over the years and haven’t used it. In the latter case, 11 minutes of doctor-patient contact over two years of annual checkups isn’t enough, in my judgement.I work out 2-3 times a week, on average, using a system called Actitrax and the facilities of GOld’s Gym on Sports Arena and I spend one hour a week with a trainer. For risk factors, I work a desk job, ride a Harley every day and smoke cigars occasionally – usually on the golf course. The blood bank LDL cholesteral test has had me as high as 293 and as low as 261 since they started recording that info. My father (76) was recently diagnosed with diabetes and had a triple bypass last December. My mother (74) recovered from breast cancer 25 years ago. One brother is a bit overweight, but all three of my younger siblings are healthy. I stand 6’3″ and weigh 220 with goals of getting to 205 (busy spring this year so didn’t keep the workouts up). I’ve been married once and just might go there again.

It’s been two years since my last full physical and I should probably get a colonoscopy, so I’ve heard.

I know the days of leather case packing family doctor have been run over by the truck of modern healthcare, but I’m hoping to find somene that will be interested in preventative health care until I don’t need it anymore. If I fit with your practice, please drop me a note and let’s talk.

Thank you for your time,


No, not the one passed by Congress they didn’t read but passed anyway, like it was the Terms everyone accepts without reading when you install a new piece of software.

Instead, I’m talking about my search for a personal physician in 2009.

The Backstory

When Scripps Clinic first opened it’s Executive Health Center, I signed on.  For $750, I was sent materials ahead of time (some to collect bits of me for later analysis) and assigned an entire day – including lunch – to have every bit of me poked and prodded, analyzed and tested, examined.  I thought it was a great idea.  I went a couple of times, but the price got to be over $3,000 the last time I went, and the General Physician on staff upon hearing I smoked an occasional cigar on the golf course lackadaisically wrote that I smoked cigarrettes.  Given the state of healthcare records management and patient interfaces, of course, I don’t find this out until I apply for shareholders insurance for my company.

So, next option – a referral.  Someone referred a doctor at Alvarado Hospital.  (Names hereon will be obscured to prevent all sorts of things.)  I went for a couple of annual health checks and on the last one, I recorded 7 minutes with the doctor in a two hour visit.  Now, admittedly, lots of his staff wrote down many of the same things he asked me about and I spent a lot of time talking with them.  However, not wishing to have my overall health monitored by a graduate from Coleman College, I wrote a letter explaining why and fired that physician.

What to do

I got on the Aetna web site – the healthcare provider I’d signed up for my company – and did a search with a 6 mile radius around my house and the same around my office.   I weeded out the obstetricians and pediatricians which resulted in a list of 100 doctors.

The letter I sent them is in the sidebar of this post.

Of the 100 letters I sent from the list of active physicians on the Aetna web site, I received:

  • 6 letters returned as no longer at the address
    (at which Aetna was to send insurance money, one presumes)
  • 2 hand written notes from doctors
  • 1 copy of my letter with a handwritten note from a doctor
  • 1 prescription form with a hand written note from the doctor
  • 1 email from the staff of  doctor
  • 1 email from a doctor
  • 1 phone call from a staffer

So, armed with my 7% response rate (87%, after bounces, electing not to respond),  I began my interviews with first-in responders.

Visit (sort of) Number One

My first visit, to a Dr. R on La Jolla Blvd, who had hand written a note on a prescription form and sent it the same day she got my letter.  I called the office and explained my purpose and made an appointment.  Upon arriving, the courteous staffer behind the window handed me a clipboard.  I explained I was just there to talk with doctor about possibly handling my healthcare and was not yet ready to become a patient.  She disappeared into the back and returned to explain the doctor didn’t do interviews.  Scratch one.

Next appointment, a Dr. G in Ocean Beach who sent one of the two emails I received.  I was eagerly anticipating this conversation because I had hoped to find a doctor who would be willing to interact with me on email.  Upon arriving at his office, however, I was met with a large poster of Michael Moore on the wall who had just released the movie Sicko in which he trashed the insurance and pharmaceutical companies, saddling them with everything that was wrong with American healthcare.  A position I rejected then and now.  However, the doctor himself was congenial and waved to a comfortable alcove where we could talk.  It was a pleasant conversation and he was pleasantly forthcoming.  However, he did tell me two disturbing things: that he didn’t believe in telling men with prostate cancer that they had it or counsel regular testing for it – since it couldn’t be fixed why bother, was his explanation; and, two, that he didn’t believe in using any name brand drugs, the generics were just fine.  Now, it’s possible he’s right about both, I don’t really know enough to say.  However, in any case I would want to know if I had cancer and to adopt an anti-establishment position on drugs seemed unmedical.

Number 3

I made the appointment with a Dr. G in Hillcrest on 5th, the one phone call from a staffer I received.  I arrived five minutes ahead of the appointed time, checked in and took a seat in the waiting room.  After twenty minutes, I checked with the front desk, and saying she would check, a staffer disappeared into the back not to return.  After another twenty minutes, I walked up to the woman sitting at the front desk, asked to be excused for my interrupting her work and said “My appointment was for 40 minutes ago. Do you know: is the doctor available or tied up with an emergency.”  She looked up, said “I don’t know” and looked back down to continue writing.  I waited a beat and then told her that I had to leave.  She could take my name off of the waiting list.

Two weeks later, I received a bill for $45 from the doctor’s office….it was coded “New Patient Regular”

I copied the invoice and wrote a letter to the doctor explaining what had happened and that I was not going to pay the bill or use her services as I knew that I would likely be interacting with her staff more than with her.  To the doctor’s credit, she called me back, leaving a voicemail explaining there’d been a computer problem.  She voided the bill.

Moving on…and up!

Now, beginning to feel a little Don Quixotish, I moved to the other email I had received, albeit from a staffer.  I called as requested in the email and made an appointment.  Upon arriving in Dr. Chamber’s office at the Shelter Island Medical Center on Rosecrans in Point Loma (yeah, a little foreshadowing there) , I was asked to wait a few minutes and the doctor would be right with me.  I sat down and listened to the staff behind the counter tell each other a couple of short funny stories while they were all bustling about a fairly small and packed office area.  Good sign, I thought.

A few minutes went by and a staffer called out my name and ushered me into Dr. Chambers office.  We sat down and bantered a little, I could tell he was taking a measure about how much time to allocate but after a minute or two, relaxed and we chatted about my letter, the state of healthcare in America, about his father – one of the first cardiac surgeons in San Diego – and generally about how each of us would approach my health.  I was thrilled at the discovery and have been pleased with his office and his services ever since. (as of October 2014)

I wrote thank you notes to the last three doctors who responded (two of whom were with Scripps) but had found what I was looking for.  It took a lot of effort, it seems to me, to take control of my own healthcare and it’s rewarding to know there are physicians out there willing to support me in doing so with their education, expertise and experience.  I believe if more people took responsibility for themselves, the litany of woes draping over the healthcare system like funeral sack cloth would be much diminished.  I don’t mean people should become their own physicians.  What I do mean is that from eating properly to exercising to employing the healthcare system as a backup to living, more resources would be available to people who have little choice in how their lives unfold due either to genetics or bad fortune.

I still wonder where the money went intended for those doctors listed as active in the Aetna network who’s letters bounced with bad addresses.

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