September 30, 2007, 12:59 am

The Standard of Care in an HMO – Compare and Contrast


Joe doesn’t know it yet, but he is on a date with…

Anne Jamison, RN, of the Super Secret Assessment Squad!

Secretly and with deft precision, she feels for enlarged lymph nodes while dancing with her target.

Audaciously, she audits his auditory acumen by whispering in his ear.

Her diagnosis?

Coordination, impaired, manifested by an inability to dance secondary to klutzemia and exacerbated by ETOH intoxication.

Recommendation: no second date.



Ahhhhh….the statistics test has been uploaded. The literary narrative has been finalized and sent to my professor in Wisconsin.

I can breathe. Finally.

Actually, I was breathing pretty heavily earlier this week. With all due respect to my husband, here is a pic of yours truly with the cause of last Tuesday’s hyperventilation.

That’s Jeff Scott Soto on the right, just in case you were wondering who was who. You know, I’d look a hell of a lot better if I had Photoshop. My image correction software just doesn’t cut it.


I am appalled at a certain HMO whose slogan rhymes with “Drive”.

Let me put it this way.

In my ER, if you come in with pain in your calf with redness and heat, a doppler study is done to determine if a deep vein thrombosis (DVT) is present. If you complain that your other calf is also sore, we will do a doppler study of that leg to make sure you don’t have bilateral DVTs.

In my ER, if you present with bilateral calf pain, redness and heat and you happen to mention you had burning in your chest that morning and jaw pain the night before, you get all of the above and (a) an EKG, (b) a big ass IV in your left antecubital space for the contrast you will get when you go for the (c) CT scan of your chest to rule out pulmonary embolism.

In my ER, if you present with all this and you are a status/post trauma patient of four-and-a-half-months with bilateral fused ankles, a cast on one leg and a halo on the other leg with explicit instructions to keep your legs elevated since the accident until you began weight bearing two weeks ago, you would be admitted for observation.

At least.



Take the same patient with the same chief complaint and let’s see how one particular HMO facility decided to handle the case.

Well, they did a doppler study of one leg, despite the presence of pain in both. What do you know? There’s a DVT there!

Then, they gave an anticoagulant and sent the patient home.

No doppler on the second leg. No EKG. No CT of the chest despite the presence of transient chest burning and jaw pains earlier in the day.

You see, if you have a simple DVT, you can take oral anticoagulants and follow up as an outpatient with your doctor.

But…the patient didn’t have a simple DVT. The patient had bilateral DVTs.

That wasn’t all she had.


How did the patient finally get the correct diagnosis? She was taken by ambulance late last night to a decent facility; one that was not affiliated with the HMO.

She had chest burning, shortness of breath and bilateral leg pain.

She was throwing pulmonary embolisms.

This facility gave a damn. This facility did not brush off her complaints. This facility did the tests. This facility made the diagnosis. And this facility will treat her appropriately.

Just like they did last May.


You know that HMO, the one that has the slogan beginning with “Be Well….”? They should change it to “Go to Hell…” because that is how they treat their members.

Yeah, pardon the language, but I’m pissed.

This patient nearly died last May. What the hell was “Brand X ” HMO thinking when they saw this constellation of symptoms?

“Let’s finish the job?”

Health maintainence, my derriere.



  • Sean

    September 30, 2007 at 5:36 am

    ugh! Sorry to sound controversial, but thank GOD I live in Canada! Here, it wouldn’t matter who you were, you would have received the best treatment. No messing around with this crap…ugh.

  • Mae

    September 30, 2007 at 9:04 am

    Thank God for E.R.s. I happen to work in one as an RN. There are many issues concerning overcrowding in ER’s, but one of them is certainly the fact that patients cannot get in to their HMO doctors office(the wait is sometimes 3 weeeks and up) and even if they do, they have to wait for “approvals” for that CT scan. If you have bilat DVT’s and go to your HMO Doctors office, your screwed and very possibly dead. Get ready to wait even longer in the lobby, since we have to now house Drunks (no more drunk tanks, they come to the ER)all night long (I work night shift) and we have to house the homeless all night long. We are the social backbone of America. The ER is the frontline. So, get ready to wait longer and longer for that CT scan you can’t get at your doctors office for 3 months. You can wait 3 months or wait 8 hours.

  • AlisonH

    September 30, 2007 at 11:19 am

    Oh, Kim! I’m so sorry! Give her my best, and I’m so glad she made it to the better facility!

  • Nurse K

    September 30, 2007 at 5:01 pm

    With all due respect, Ms. Kim, the “HMO” didn’t treat the patient, a doctor and nurse did.

  • Mother Jones RN

    October 1, 2007 at 11:21 am

    I hate HMOs. I’m glad that your story has a happy ending.


  • Candy

    October 1, 2007 at 2:02 pm

    It’s very scary (and WRONG) that the nurse who obviously saw her in said HMO facility wasn’t a stronger advocate for her patient, but so fortunate for her that SMF (and you) were close enough to save her AGAIN.

    If this poor woman developed bilat DVTs only a few months apart, what kind of treatment plan must she be on? It seems her physician didn’t do his due diligence on her case…and will be fortunate that the woman (and her family) don’t sue their pants off.

  • beastarzmom

    October 1, 2007 at 7:12 pm

    And also with all due respect to Nurse K and many of the other very fine people I know who work at that same HMO, I have some horror stories to tell and will never work somewhere that only allows me that choice for health coverage. There must be something in the culture or policies that cuts too many corners. Not that tragic or near tragic mistakes don’t happen everywhere – It just happens too much there.
    Glad this patient was able to get to another provider.

  • Jen

    October 2, 2007 at 7:27 am

    Kim,I’m glad to hear the lady ended up being ok. My Dad wasn’t quite so lucky. He went into his doctor at the same HMO (slogan that rhymes with “Drive”) on a Wednesday. He presented with radiating chest pain, “heart burn”, and nausea. He was 56 yrs. old, a life long smoker, on meds for hypertension, and high cholesterol. What did the doc do? An EKG, a prescription for Zantac, and see you later. By Saturday morning 9 a.m. my Dad was dead. Do you think they could have done a little more workup on Wed?? I wish so much that my Mom or Dad had called me on Wednesday or the days after. I didn’t get a call until Saturday 7:30 a.m. when he was in the ER. By then it was too late. Too much heart damage had been done and he died. With all that said, I’m a firm believer in when God says it’s your time to go it’s your time to go. Still, I will never have that HMO, ever. I agree with you.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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