Sunday, November 22, 2009
Metro columnist Dan Casey: System tough even for ex-nurse
Dan Casey is The Roanoke Times' metro columnist.
dan.casey
@roanoke.com
981-3423
Dan Casey
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Read Dan's blog
Billye White is a die-hard Salemite who's 80 years young and still working 30 or so hours per week.
She's a former operating room nurse at Carilion Roanoke Memorial Hospital, where in later years she launched the hospital's marketing department. She retired from the hospital in 1995.
She's also one of those blunttalking people who's going to tell you what she thinks, whether you like it or not.
White called recently to chew me out for a poke I had taken at her beloved and well-run Salem Civic Center. But that wasn't the only thing on her mind.
Soon the conversation turned to vertigo and White's experience this past summer getting treated for a bout of it at Carilion Clinic.
It started early in July. "The balance was so bad, I was afraid of doing anything,'' she told me. "It was like I was staggering drunk."
An ER visit at Roanoke Memorial landed White an appointment with a Carilion neurologist -- one month later.
In the meantime, she fell and broke her nose and was treated for that at Lewis-Gale Medical Center's emergency room.
In all, the vertigo led her to eight visits with six different Carilion doctors: an ER physician, a family practice doctor, a neurologist, a cardiologist, in internist and an ear-nose-throat specialist.
And two MRIs, a CAT scan, a sonogram of her carotid arteries and a cardiac test.
Finally, White got what she needed.
That was a referral to the University of Virginia, where in September another doctor restored White's balance by grasping her head and shaking it -- literally.
That remedy, called the "Epley maneuver," is a well-recognized treatment for vertigo, a not uncommon malady in senior citizens.
It was so simple and it worked so well that it left White wondering what took so long -- especially in the "clinic" environment that Carilion has created.
Ideally, such a model is supposed to make medical treatment quicker, more efficient and less costly overall.
Federal privacy laws prevented Eric Earnhart, a Carilion spokesman, from talking to this newspaper about the specifics of White's case.
Speaking generally, he noted that doctors frequently require multiple tests to rule out serious causes for generalized ailments such as the kind of dizziness White experienced.
After talking with one of the Carilion doctors she saw, "I am very comfortable stating that the care she received and the cautious investigation of her condition by the physicians involved was appropriate," Earnhart wrote in an e-mail.
The purpose of bringing up White's story is not to slam Carilion or its many fine physicians. White told me she reveres her ENT surgeon. He was the one who referred her to UVa.
This clinic model is still evolving, after all.
Carilion is adding doctors, and policies, and initiatives, and health plans. And a medical school. The nonprofit company recently began marketing a Medicare HMO for seniors.
But listening to White recount these travails left me with one big question.
In my own family, and in my neighborhood, and out there in this community, there are large numbers of elderly retirees who spend huge chunks of their time shuffling from one medical office to another.
Their primary occupation has become traveling from one doctor's appointment to the next.
Their daily conversations consist of stories set in hospitals or medical offices.
So here's the question:
When somebody like a smart and blunt-talking former operating-room nurse has trouble navigating that kind of the system, where does that leave the rest of us?
