I am going to do my best and try very hard to keep my comments brief, but they might become curt at times. Hence what follows is a greatly abridged account of the epic which I have written and rewritten in my my mind several times. The problem is that this matter is extremely complicated and has been going on for a while which makes my job difficult.

During the month of January, while I was in Switzerland, my back seized up, and I was severely incapacitated and in pain. Before coming home in February I called an orthopedic office here to make an appointment. (I will not mention names throughout this discourse.) My pain was severely exacerbated when I arrived at Logan and to make things worse I fell on an escalator while getting my car rental. Foolishly I drove home. That’s the abbreviated background for what follows.

Please recognize that the aim of this piece is not to complain about my back problem or even about the cost of medical help. I know that there are many out there in a lot worse shape than I am. My purpose here is to comment on, from what I’ve been told by many, is “the best medical system in the world.”

I returned home on Feb. 6. I am writing this on April 6, and as yet have been unable to see a doctor — by that I mean a medical doctor (MD).  I have only seen physician’s assistants (PA) and nurse practitioners (NP) — and Dr. Google. I have since learned that this is called “mid-level creep.” Many studies show a significant increase in errors by these “mid-level” practitioners compared to doctors, but they are preferred by hospitals and insurance companies because they are cheaper.

The “orthopedist” I saw several times is a PA. During that period I was given oral steroids, an anesthetic injection, told to get physical therapy (PT),  get an X-ray and later a CAT scan.  To get both images done, I had to go back and forth between the office and the hospital numerous times because of faulty communication between both sites. I was told I would have to wait over a month to get PT. When I went back to the PA I was told, “There’s nothing more we can do for you.” I never saw a doctor. I asked what I should do? I was told to go to a pain clinic.

When I contacted the clinic, they said they needed a referral from the orthopedic office. It took days for that to happen. Again I had to communicate with both parties multiple times to get it done. When I went to the clinic, I saw another PA. The recommendation was to get an injection but they needed my insurance OK. That took more than a week and several of my calls to set up a conference call between the clinic and Medicare after Medicare denied the procedure.

The clinic then told me they would change the injection so insurance approval wouldn’t be needed. They said, “It would work as well or even better.” The obvious question then is why didn’t they propose that first? My appointment date couldn’t be made before two weeks.
As mentioned above, I am writing this report on April. I am still waiting and have still not seen an MD. I have omitted mentioning scores of calls I made to get to this place. I have still not received my injection (which of course may or may not work,) nor have I been told what medication I will get after having  asked several times.

I should add two positive notes to be fair.

First, everyone I spoke with listened to me and was polite — even when I became exasperated by the system.

Second, I am able to see my primary care doctor, an MD, usually on the very same day I call when necessary. What’s more, my primary care doctor is wonderful and not involved in this story. The sticking point is that this doctor is a “concierge doctor” and one must pay extra to become a patient.

So is this the best medical system in the world, or am I an outlier? While you’re answering this question, you might also let me know how I can get rid of this back pain.

Jonathan Kahane lives in Westhampton.