Moderatix note: This post will be United States Military centric, as that is the perspective I offer, and the broken system within which I currently exist and attempt to navigate. Other voices are welcome and experiences appreciated within the context of the conversation, since I can not pretend to know every thing about every military experience from every branch in every country.
One of the most frustrating aspects of dealing with a chronic pain condition while under military care, as an active duty service member or a dependent is an inconsistency of care. Something that I learned pretty early on is that my best bet for getting the best care is to have a regular doctor.
May I drop into a sports metaphor?
Your regular doc, or in my case, my PCM, should be the quarterback of your health care team. Sie should be the one on the field, aware of all the other team’s members (your symptoms, labs, tests, etc.), the plays your team have available (medications, treatments, therapies you are trying/have tried), the other team members (other docs and lab techs), as well as the special teams coaches available (specialists). The quarterback should be able to run the plays and call audibles as needed, because the quarterback presumably knows the team, is comfortable with the team and the plays, and has been doing this a while.
But if you are playing on a military team your quarterback gets traded. A lot. Often without you even knowing, in the dark of the night like Jon Gruden to the Buccaneers.
It isn’t unusual to call central appointments (because no matter how many times you have seen your PCM you can not just call hir up and schedule your own damned appointment directly, even if sie told you to) and ask for an appointment with CDR (Commander) Happygunns only to find out that sie has been sent out w/ the Reagan to whatever mission it is currently floating. To call this a hiccup in care is the understatement of the year. It can pretty much end the season before the playoffs.
This is a huge chunk of what amandaw calls the Second Shift for the Sick if you are trying to navigate your health care through the military. Now, you have to find the time to get over to the TRICARE office to request a new PCM (which usually has to happen in person). That takes time and spoons, and may involve some accessibility issues. If you have a chronic condition you have to make sure that you get a medical officer (who, to my understanding, is O-5, equivalent, or above) to make sure sie is qualified to handle chronic conditions, instead of a Chief or other upper enlisted Corpsman or an lower ranking officer, which is a majority of PCMs at most MTFs. Now, you have to call to set up a meet and greet with this new PCM, and that is going to take time because CAPT Nukeboom already has existing patients, or is new and has to fit you into the schedule. If the appointment you were trying to make with CDR Happygunns was for a prescription refill (like, oh, something super easy to get like Vicodin or another pain medication), this means that during all of this time your quality of life is being compromised. That prescription might mean spoons, which translates into showers or laundry or hugging family members or just being able to sit upright. Maybe it was an appointment for much needed lab results (wait for it…).
CAPT Nukeboom isn’t going to just jump in and hit the ground running. If we go back to the metaphor, sie is going to need time to get acquainted with the team. Sie might even throw out the playbook and start over from scratch. Odds dictate that CAPT Nukeboom wasn’t just going to write that Vicodin script or whatever you came for (yeah, I was kind of done w/ football too…let’s see if I can’t get a good hockey metaphor next time) anyway, you drug seeker, without really really making sure you really really need it.
Those lab result you were waiting for? If you hadn’t gotten the results from the doctor that ordered them, and that doctor happened to be CDR Happygunns then you are going to have to go get new tests (WHEEEEE!). Only the referring doctor can get the original results, but that’s OK, because CAPT Nukeboom wanted new labs and tests done anyway, and you haven’t been poked with something sharp in at least three months…
There is also a good chance that CAPT Nukeboom might disagree with whatever course of treatment CDR Happygunns was recommending at the time, regardless of how well it was working. More spoons will be spent trying to reason with said new doctor who may or may not be receptive to your input. If you are dealing with a best case scenario they are, and things speed along nicely, and you are only set back about three weeks in your care (only!). Hopefully you can hold on without your Lyrica or your pain medication or your anti-seizure meds or your anti-depressants or whatever else you are waiting on, because you are not going to get anything until CAPT Nukeboom is satisfied that sie has fully come to understand your file. If you are dealing with a less than best case scenario, you are going to fine yourself back in the TRICARE office begging them to let you request another new PCM. Second verse, same as the first.
There are obvious reasons why these things happen (um, Hi, Mr. President, thanks!), but there is absolutely no reason why it needs to continue this way for people living with chronic conditions. Modern technology means that our medical records are kept electronically as well as in hard copy back ups for all the doctors to access. Lab work and test results are available freely to any doctor with access as your health care provider. Notes and thoughts and memos from the countless doctors and providers…oh and all the specialists are all still there…a phone call or an email away.
A bump in your care can be enough to set you back months, and maybe even undo any progress you have made at all. For some people I know (myself included) it can be enough to make you try to just “tough it out” and draw inward, afraid to seek medical care.
While the military medical system has many wonderful facets, including the fact that it is “free” *ahem* there are some huge flies in the ointment that need to be addressed. With the high volume and tempo of deployments going on and the demand of medical personnel in the field so high, it might do well to actually use the military’s love of contracting civilians a little more in areas where it could be more useful.
I’m just sayin’.