Calling patient number 5,465,763...

Ah, technology. This is my second attempt at writing, after a frozen-computer problem. Here goes! I was actually writing about another type of wonky technology: The automated phone call (maybe my computer knew and staged a protest). I got one of those calls today from my mail-order pharmacy - which already gets little love from me (see several previous posts about lost/late insulin orders). Today, I got a new sort of call from them. The computerized voice asked if I wanted to renew "your prescription." Well, which one, they didn't say. So I said yes to find out. The pleasantly banal voice said, "Would you like to renew your [computerized version of throat clearing] silhouette MMTx57359..."

Now, I have lots of experience with MMT numbers. I've used numerous infusion sets over the 10 years I've been pumping: the quick-set, the silhouette, the sof-set, the sure-T (briefly). Each one of these has both a short and a long catheter version (who uses the short ones, besides kids, anyway?), and each has a couple of different cannula lengths (you know, the part that stays in under the skin once the needle comes out). Each combination of these has its own MMT number.

The problem is, right now I have about four prescriptions on file for the different variations of these that I've been trying, in my attempt to get something to work because my abdomen has decided to re-enact the Alamo (actually sometimes I can get a needle to go in there, but then, of a sudden, my arm decides it's had enough and won't let a needle penetrate its armor). I'm currently alternating between the silhouette 13 mm (for my abdomen) and the quickset 6 mm for my arm. Both have the 43 cm catheter. But my pharmacy also has a 23 cm catheter prescription lurking in their records, from when a nurse at my doctor's office screwed up despite my clear instructions.

So I had no idea which prescription the computerized caller was talking about. I said no, I didn't want to renew right now. That started the barrage. "Are you still using this prescription?" (Translation: We're going to cut you off if you don't really, absolutely need this.) I said yes (I am still using it). "Do you have enough of the medication right now?" (Translation: If you do, then you're being prescribed too much, and we're going to cut you off.) I hung up the phone. Interestingly, the computer didn't automatically call back. I wonder what it would have done if I'd said "maybe," or "it depends."

I'm always amazed when people talk about applying business principles to medicine, or using checklists to "improve" medicine (which doctors talk about a lot these days; e.g., Atul Gawande's recent book, "The Checklist Manifesto"). It's not that I think they're wrong entirely. I do, for example, want a surgeon to double-check that he (or she) is about to operate on the correct leg. It's just that, in my experience, the way these ideas are applied in practice, it usually gets all screwed up. Or perhaps, it gets applied in places where it just shouldn't. You'd think, at first blush, that it would be a good idea to send reminders to people about renewing their medication. If someone's taking a med for high blood pressure, it's important not to miss any doses, but it might not be the first thing on that person's mind; he or she won't keel over after one day without the drug (as I would without insulin). Maybe that person is also taking a drug for high cholesterol, and would get two reminders. But it'd still be easy to distinguish between the two.

But in my case, I really could use a secretary just to keep track of all my prescriptions. Besides the myriad infusion sets, there are the reservoirs (a separate pump supply), test strips, lancets, and the insulin itself. Never mind anything else I take. (I also need to order IV prep soon - the pads with sticky antiseptic to wipe my skin before inserting the infusion set - I don't need it for my abdomen, but I do for my arm, and no regular pharmacy carries it). And I can't imagine an automated-renewal system being about to account for all of this. Most humans, apparently, can't conceive of a person needing all of these things on a regular basis. There is no simple checklist that works for all patients, in this case.

And yet, I know I'm not at all unusual in this regard - at least among type 1 diabetics (and many type 2s as well). So when is the medical system going to get with the program, and figure out how to deal with us? Of course, the medical system is geared to handle emergencies better than chronic illnesses, so it's meant a major overhaul in thinking. But it's been a good long while in coming, hasn't it? They used to think we wouldn't be around long enough to bother (I'm being cynical, but I don't think I'm off base here). Now, it's clear that a lot of us are going to be here for a good, long while, and it only comes back to bite them if they ignore us too much. For those of us who have insurance, it now covers more than it used to (when I first tried to get the pump, it wasn't covered). They've figured out it will cost less in the long run. But it's still a constant battle.

I almost just launched into a tirade about another type of phone call I've been getting - from some nurses hired my my insurance company to ensure I'm taking my medicine and getting regular doctors' check-ups (hey, I have type 1 diabetes; if I wasn't taking my medicine, I'd be dead! They get us confused with type 2 diabetics all the time...) But I'd rather reflect, at this point, on the lovely few days off I had last week, because our daycare providers was on vacation. We finally got to take H to our local zoo - something I've been wanting to do for more than a year; she's a big Curious George fan. We went to the playground a lot, too, and generally spent a lot of time outdoors. It was a great way to kick the winter blues without having to deal with airports (don't get me started on what I have to go through there; the pump always sets the scanner off, not to mention travel with a kid...). I just loved feeling - well, normal.