Wherein Our Hapless Writer Gets An Earful Of Health Care In The '90s. By Vicki Hart IS IT JUST me, or does your health maintenance organization also seem to fall apart when it comes to treating a relatively routine medical problem? It's not an insignificant question, given the fact that 53 million Americans are currently signed up with HMOs. It's three weeks, seven doctors and five medications later, and I still have an ear infection, I'm still in pain, and I can't hear out of my left ear. And if my ear weren't so painful, I'd be dazed in awe at the ineptness of my HMO--let's just call it Intershaft. Here's my little tale of woe (the names have been abbreviated to avoid a frivolous, though nonetheless expensive, lawsuit): Saturday, June 1. I recognize the beginning of ear trouble, but like an idiot, I decide to put off the possible hours of waiting time at the urgent Care Center. Monday, June 3. At 8 a.m. I call the office of my primary care physician, Dr. V. I'm told he's is not in today. His office calls back an hour later to tell me I can see a Dr. R at 4 p.m. Dr. R examines me, confirms my suspicions of an ear infection, and writes a prescription for an antibiotic, Cefaclor. He orders an ear wash, explaining there seems to be foreign matter in my ear. A nurse takes me to a room and inserts what looks to be the world's largest syringe into my head and blasts water into it. The pain is excruciating. I tell her this, and she says, "Sit still, the Doctor ordered this." And she proceeds to do it again. I leave the office in pain and feeling like my ear is stuffed up. I'm unable to hear out of it. Wednesday, June 5. The pain is worse. I call Dr. V's office and am told he's still not available. They refer my case to Dr. U. I wait for two hours, but she doesn't call. I call again, and the nurse says Dr. U has been terribly busy and hasn't even looked at her referrals. Finally, Dr. U gets on the phone to say she's referring me to Urgent Care. Dr. P is the Urgent Care physician who sees me in the afternoon. He says I need another ear wash before he can examine me again. Another nurse gets the syringe out and...excruciating pain once again! Dr. P says the Cefaclor was not the appropriate medicine; he prescribes an ear wick and advises me to apply topical Neomycin for two days and then return to Urgent Care to have the wick removed. Friday, June 7. The pain has grown worse. At Urgent Care I'm treated by Dr. R. She removes the wick, and says Neomycin is the incorrect medication and she thinks it's given me a fungal infection. She orders an ear wash. After one wash I tell the nurse I can't do this anymore, the pain is too severe. The nurse advises Dr. R and suggests I be sent to the ear, nose and throat specialist. Dr. R says this is unnecessary and administers analgesic ear drops. She prescribes acetic acid drops and more analgesic for the pain and says there's no need to continue the Neomycin because it was incorrectly prescribed. After filling the prescription, I insert the drops into my ear as prescribed. The pain is beyond my power to describe. I call my husband and ask him to come home. My husband calls Dr. V, who returns the call an hour later. He advises quitting the new medicines and going back to the Neomycin. When I tell him it would be extremely painful to do so, he says I haven't tried it long enough and adds he's used it for 16 years with no ill effects. He says he'll refer me to the ear, nose and throat specialist, who won't be in until Monday. Monday, June 10. After a nightmarish weekend--every time I administered the Neomycin, the pain was overwhelming--I'm able to get an appointment with ENT specialist Dr. S. I tell him the history of my problem, adding I think I have a hole in my eardrum caused by the nurse at my first appointment using the syringe with such force. I report how painful the ear drops were, and I also point out that my equilibrium is off, I'm having trouble sleeping and I feel queasy all the time. He ascertains that, in fact, I do have a hole in my ear; and he says it was inappropriate to use the drops--he adds it was like putting vinegar in a wound. He also says the ear washes were inappropriate and advises me to never let them do that again. He verifies that having an ear infection on just one side causes an equilibrium problem. Dr. S advises I use over-the-counter Lotrimin lotion for my ear. Knowing I'm going on vacation Monday, June 17, he suggests I have my ear checked June 14. But when I go to make that appointment, I'm told Dr. S will be in surgery that day and I'll be seeing Dr. A. Wednesday, June 12. Fluid begins draining from my ears; the pain continues. At 8:45 a.m. I call my HMO's ENT unit. No one returns my call until 2 p.m. I talk to a nurse who claims she has Dr. A standing beside her. She says no one can see me in ENT, but she directs me to stop the Cefaclor and adds Dr. A says to use the Neomycin drops again. I tell her that's extremely painful and that Dr. S has told me not to use them. She tells me Dr. A says he even uses them in children who have tubes in their ears and that it's not painful. I tell her I can't do this again. She tells me they can't help me any more. Dr. A never comes to the phone. Friday, June 14. I see Dr. A and tell him my ears are draining, though still painful, I can't hear out of my left ear and it's bothering me terribly. He looks in my ear and says, "Oh, it's just a tiny hole. I see no drainage, of course I believe you that it was draining." He advises me to use the Neomycin and to avoid swimming underwater during my vacation. I give up. Three weeks later: The symptoms, while not as severe, are still with me. I've spent hours calling my HMO, waiting for their calls, waiting in the doctors' offices, waiting at the pharmacy. I've spent money on prescriptions I can't use. I feel I have no recourse. My HMO doesn't care, doesn't follow up. Not only is it apparently unable to cure my ear infection, it seems to have made my condition worse. At this point I don't know which doctor to believe, or which medicine is the proper one. And I certainly don't want to spend more time hassling with these people, who act as if it's a great inconvenience to treat me. BUT MAYBE I'M lucky, because there's Judy, whose lump went undetected so long in her breast that her only choice was a mastectomy. There's Tim, who broke his arm on Wednesday and was unable to get it set until the following Tuesday. And Bryan, who nursed his wife at home through a bleeding cesarean wound because they wouldn't readmit her to the hospital. In fact, Bryan may have said it best: "It doesn't matter whether you have Fatal Health Plan, Intershaft, Partners in Crime, or Blue Shaft--they're all big corporations trying to make a profit, who just don't care. HMO's don't work for the patients."

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