Today I happened upon an unnamed skill absolutely necessary in negotiating our health care system. I am not sure what to call it; it could fall under health literacy but it probably belongs to its own category, a category that I will call “bureaucratic literacy” until someone tells me the correct term. I will add that this would be a necessary skill whenever a “system” is providing services and not just the health care system. Let me tell you the situation
Today my cleaning lady asked if I could do her a favour. She is trying to have her prescription for eye drops renewed but her own family doctor and specialist seem to be away. The pharmacy needs a limited use code from the doctor’s office and has sent a fax but is waiting for the doctor’s office to respond with the code. If the pharmacy cannot obtain the code, my housekeeper may have to pay the full rate for her medication, which is not something she can afford.
She came to me because she did not know how to approach this problem. When she first described to me what was happening, I could get a sense of the problem but did not completely understand it. I spoke to the pharmacy – a rather complex situation was set out. Since the prescription was not new, it wasn’t clear to me why the limited use code was not on file. I was given to understand that this needs to be included each time. This is not typical in my practice, but I will certainly keep this in mind for future reference with my own patients.
It seems as though many pharmacies rely on fax backs from doctors’ offices and the pharmacist had not considered a phone call. I tried a phone call and was received by a message centre. I sort of explained the problem because I only sort of understood it. The message centre then explained that they were a message centre and gave me a phone number for the doctor’s own line and not the general clinic number.
There was a very nice message on the doctor’s line that told me I could leave “an administrative message”, which I did. I asked Mrs. K. do the same but she was much more tentative than me, which I do not think is surprising and which I also think might be less likely to get any action because it was tentative.
I then phoned the pharmacy back and asked how this problem might be approached and received a few more suggestions but the long and the short of it was that, without the limited use code from the prescribing physician, the patient would have to pay full price for the medication. I did find out that they could be reimbursed once the pharmacy receives the code…
I felt as though I were caught in a one of those twisted situations that Dickens described in Bleak House, except that 21st century technology makes the whole situation move faster but not progress faster. Intriguingly, my housekeeper felt as though progress had been made because at least she knew that everyone understood what was supposed to happen and that was certainly the case. She thanked me for what I had done.
Exactly what did I do? I had a sense of the kind of questions to ask and how to ask so that information and further assistance could be sought. Persistence is part of the skill set, as is a steady reasonable approach. Frustration never helps in these situations. One certainly needs to understand the complexities of bureaucracies and how stringent guidelines/regulations are and how powerless everyone is to overrule them. Navigating these situations require a set of skills that one can become accustomed to, as I have.
I know a number of you have read this and have also experienced exactly the situation I am describing. What do you call the set of skills that you use to assist in these situations? Will bureaucratic literacy work for you?