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Whose boobs are they are whose money is it, anyway?

May 30, 2008

My question was directed to a representative of the legal department at a local hospital’s mammography clinic. I was not permitted to schedule a mammogram because I would not name a doctor to receive the report. I wanted to receive the report first and then decide, should it be necessary, where to go for follow-up.

But my diligence in reporting for annual slammogram duty was thwarted by my insistence on self-determination. So here I am, a cardholder of the best insurance coverage in America, being denied access to basic health care.

Sometimes I think these things happen because I am white.

First, I tried to schedule the mammogram. When I refused to provide a physician’s name, I was told I could not be scheduled. Non-plussed but still polite, I said I was certain that I could come in self-referred. The scheduler agreed: Yes, I could most certainly come for a mammogram without first seeing a doctor. But I must provide the name of a doctor to whom the radiology report would be sent. It would be sent first to the doctor, and then to me.

That’s the way it’s always been: first to the doctor and then to me. A perfect score, no worries, just be sure to come back next year. 

A relentless presumption of illness drives the health care industry.

This year I rebelled. I would not go to my regular doctor or to my endocrinologist for cancer follow-up, so what was the point? I can read the radiology report. I know when I need help. And there’s another reason I want to be the first person to see my report.

My PCP is a pretty reasonable guy. If he were my country doctor, working independently, we could make decisions together: decisions like staying on HRT in spite of cancer findings, at least until some reasonable provision could be made. But my PCP is tethered to corporate protocols. I am terrified he would pull my HRT prescription in a heartbeat if any evidence of cancer were to be detected. I am terrified that the corporate protocols would replace my own decisions of how to deal cancer versus untreated menopause. I know many women feel the same way.

The scheduler went on to tell me that “legally” they could not release my report to me until it was first reviewed by a doctor. Fine, show it to a doctor who has no control over my HRT and then give it to me. But “legally” became the meme that prevented me from scheduling without naming a doctor.

“You keep saying, ‘legally,’ can you provide me with the citation for the law you’re relying on?” I asked. She could not, but very kindly provided me with the number for the legal department.

I contacted the legal department. The receptionist called me back in a few minutes with some information. She said there is no state law or statute, but that the clinic follows the guidelines of the FDA Quality Assurance Act on Mammography. I pointed out that guidelines and an Act were two different things; an Act is a law; guidelines are not. She agreed but that was all she had.

I looked up the Act. It contains provisions for self-referred patients. The clinic must provide referrals for follow-up care if the patient does not name a doctor (Sec. 900.12):

(2) Communication of mammography results to the patients. Each facility shall send each patient a summary of the mammography report written in lay terms within 30 days of the mammographic examination. If assessments are “Suspicious” or “Highly suggestive of malignancy,” the facility shall make reasonable attempts to ensure that the results are communicated to the patient as soon as possible.

(i) Patients who do not name a health care provider to receive the mammography report shall be sent the report described in paragraph (c)(1) of this section within 30 days, in addition to the written notification of results in lay terms.

(ii) Each facility that accepts patients who do not have a health care provider shall maintain a system for referring such patients to a health care provider when clinically indicated.

So, clearly self-referred patients who do not name a doctor are contemplated; however the Act also suggests that a facility is not required to accept such patients in its language, “Each facility that accepts patients who do not have a health care provider….” The question is, does this violate the strong public policy against denial of access to health care?

In any case, the Multicare system clinic is clearly out of line telling prospective patients that it cannot “legally” provide mammograms unless the patient names a doctor to receive the report.

Where I live, Multicare rules. “Patient privacy” means everyone in the Multicare system except the patient has access to information concerning the patient. Corporate medicine has smothered patients’ privacy and self-determination.

Multicare patients all have designated PCPs. If you don’t choose one, you’re issued a default PCP for these purposes. And he’ll receive your mammogram report automatically, and maybe he’ll pull your HRT if he doesn’t like it.

Unfortunately, the clinic’s policy might have a tendency to discourage women from getting mammograms, because of the fear of losing their HRT.

Conclusion for now: Health care consumers–and their doctors–are hostages of the policies that corporations and their subsidiary governments devise. 

  1. Jane permalink
    May 30, 2008 1:07 pm

    What a perfect example of the medical-beaurocratic sludge health care has become! Doctors hate people like you, my husband and myself because we do the unthinkable: we think. And we also do the unspeakable–take the care of our own bodies into our own hands.

  2. Cathy Butler permalink
    June 28, 2009 1:29 am

    How is it possible there can be SO many of us with all the same story?
    Read mine at We must have had the same medical facilities:}:} Feel free to post everyone. I have Florida exposed and they are frantic. The Legistlative Body of Reps even got the top gun attorney involved. I apparently hit the targets too fast and too real.
    By the way, in Florida it is the law that after ten days, even if you do not have a doctor, the med reports are yours anyway. You may wish to check your state laws again.

  3. November 18, 2009 7:37 am

    Great entry! Check out Living Beyond Breast Cancer’s official statement on the new guidelines:

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