Friday, June 16, 2006

Be careful with the codes of medical tests

This week I had to make some routine diagnostic tests. They were covered by health insurance, so my doctor gave me corresponding redirection documents (I cannot offer a better translation of the awful Bulgarian "napravlenia", as buraucrats have called these valuable sheets of paper.) I took them without looking at them and the told me I had to make blood test, urine test and blood group test.
When I last made such tests 3 years ago, the redirection documents contained some cues what they were for, e.g. "Urine". Arriving at the medical center, I looked at them to see which were for the blood and urine testing. To my unpleasant surprise, there were no cues, just some numerical codes unknown to me.
I decided to use my brain and not ask anybody. There were 2 redirection sheets. One of them contained 2 codes, 001 and 003. The other contained just 1 code, 012. I figured out that the first sheet was for the blood and urine tests and the second one was for the blood group test, which had to be done at another institution.
There was a label, "2 leva fee for taking blood, 1 lev for taking urine". Medical centers have the right to charge patients for sampling biological material and of course use it. I gave my sheet with 001 and 003 codes, the clerk asked for 2 leva and sent me to a lab where my blood would be taken.
Nobody mentioned any urine and I began to think that, after all, the second sheet was for the urine test. There was a line of patients waiting for blood tests and I, well, really wanted to give my urine sample (I am an old woman and cannot walk all day with a full bladder). So I returned to the clerk, handed her the second sheet and asked, "Is this for urine testing?"
She looked at the code and replied, "This is for sterile urine. Go downstairs."
I wondered because the doctor had mentioned no sterile urine, but she was expected to know the codes, wasn't she? That was her job! So I went downstairs. The clerk there took the redirection sheet, asked 2 leva fee for sampling sterile urine and accepted my sample without comment. I returned upstairs to wait for the blood test.
When my turn came, the nurse took a sample of my blood, then gave me a cup and told me, "Go to the toilet and produce an urine sample."
I was amazed and said, "But the clerk has just sent me to produce sterile urine." She wondered, "Why sterile urine? Possibly for microbiological testing? Anyway, try to produce some more urine and if you can't, don't worry, come another day."
I tried my best but produced little - it isn't easy to give two consecutive urine samples within minutes. Besides, the toilet was not the place I wished to return to. It was very dirty and after using it you had nowhere to wash your hands. (When I complained to my husband, he joked that women have a construction defect and therefore cannot produce an urine sample without contaminating their hands as well.)
2 days later, my blood and urine tests were ready. The nurses had managed to analyze successfully my micro-sample. But I had no result from the sterile urine and the redirection sheet was returned to me (in poor condition) with an annotation that it doesn't carry the right code for the sterile urine. After all my logic was right, it was for blood group testing. I don't intend to go again to this medical center (3rd City Hospital in Sofia). The nurses there are polite and competent, but the clerks are awful.
So, if you are health-insured in Bulgaria and undergo tests, be careful and ask your doctor which code for which test is, because the clerks whose job is to deal with these codes will not know and will not check!
It is good that most people doing these diagnostic tests are perfectly healthy. The ordeal would deteriorate the condition of anybody who is already ill.
The blood group testing will be subject of another post.

1 comment:

programmer craig said...

An old woamn? Surely not, unless I'm a REALLY old man :)

Don't even get me started on the way it is with HMO insurance here in the US! I think it's been about 10 years since the last time I had a relatively pleasant trip to the doctor's office. We still have pretty good medical care, but the "hurry up and wait" all the time drives me crazy. Plus the fact that with most HMO plans, doctors have to do tests and then more tests before they can authorize the expensive test that you actually needed done right from the start. Constant justification of expenses. I have a feeling it ends up costing more in the long run, anyway.