Mr, Cupcake at Craters of the Moon

Mr, Cupcake at Craters of the Moon
Mr. Cupcake at Craters of the Moon

Friday, November 6, 2015

my first encounter with the health care system in the United States

Some of you may recall it was February 4th, 2013 that I entered the United States. While it seems like it was only a blink of an eye ago, we are actually coming up on three years. Can you believe it? I am less than four months away from being eligible to apply for US Citizenship.*

One of the things that scared us about moving to the United States is health care. It's a very confusing system from the Canadian perspective, so navigating insurance and then what to do once you have insurance and need care was really daunting. It was only in the last couple of months that I bought health insurance for myself, despite the Affordable Care Act, because it just seemed like too much of an expenditure for something I may not even use.

I'm pretty healthy, see. I exercise, I eat really well, manage my mental health, etc and don't have any outstanding health issues that require care. However, I work in health care and I acknowledge I am aging. It's also been four and a half years since I had a physical so I had no idea what my numbers were. Getting my student health insurance sorted out and making an appointment at a clinic was just on my to do list.

And then I had a health scare a couple of weeks ago. It wasn't a big one, but I know just enough about anatomy and disease to be worried when I had pain in my chest and shortness of breath. Pain in my chest where my heart is. My grandfather died of a heart attack at 67, though he was morbidly obese. Anyway, this freak out was the kick in the pants I needed to see a care provider, that very day.

Wouldn't you know it, there is a student health clinic just half a mile from where I work and they are all hooked up with my student health insurance. I was able to get in that afternoon to see my new primary care provider, who is a Nurse Practitioner rather than a physician. That's something I have no experience with (though I think we do have NPs in Canada, they just aren't as common) but I do have a friend who is a nurse and wants to become an NP. She explained to me that NPs are the ones you want to go to for preventive and maintenance care. Doctors do the diagnosing. Ok, got it.

The visit to the clinic was mostly like any other clinic visit. The New Patient Intake form asked a bunch of questions I had never encountered before ("How many sexual partners have you had?") so that was interesting. Giving urine samples has gotten to be really sophisticated. The blood pressure machine had me at 132/86 which of course worried me.

I spent an hour with the nurse practitioner, gave her my full medical history and all the family medical history I know. The physical itself was just like every other one and thank goodness she said I'm not due for another one for five years (in Canada it would be every two years). She did strongly encourage me to get a mammogram, which I am extremely opposed to (I don't have a family history and I'm not convinced they actually help with early detection).

I wasn't expecting it but we talked about my acne, how I had done the 5-month course of isotretinoin in 2007 but my acne has returned. She can't prescribe that drug (only a dermatologist can) but she did give me a script for a tretinoin cream which I'm hoping will help. (I'm leaving in a week for my industry's biggest academic conference and I intend to launch my job search there, so I really hope it's gone by then!) They checked my blood pressure again at the end of the visit and it was down to 113/73.

The best part about this whole experience (aside from the assurance that I probably just pulled a chest muscle because my heart is just fine, and the potential for clear skin) was that this visit was free. I couldn't find information anywhere on the health insurance website that said how much this visit was going to cost and when you are worried there is something seriously wrong, you care less about cost and more about getting well. And it was free! My first visit is free, any subsequent visit is only a $10-co-pay. I mean, my insurance cost me $190 per semester, but still, that's way better than I was expecting.

For my American readers, I'm sure this is all no big deal but I confess I was really worried about accessing care because I thought it would be so complicated. It was for the same reason I delayed getting dental care but that ended up having a happy ending too - I thought because it had been several years since I'd had a cleaning that I would have a number of cavities but no! All clear, thanks to my nightly dedication to flossing.

*so I have more or less been planning to apply for citizenship, but I think it would mean renouncing my Canadian citizenship. That hasn't been a really big deal to me, since I had no intention of ever moving back. Mostly because we can't afford to live in the places where we want to be that also have work in the fields we want to be in. There is just so much more opportunity for me in the United States in my career (by the factor of 100x or more) so why would I go back north? Well, given the recent political developments in both countries, I am now not ruling out a return to Canada (oh gosh I'm saying this publicly). I say that because of the crazies currently running in the Republican primaries but also because of the amazing thing that happened in Canadian federal politics recently. Someone from my generation with my values is now the Prime Minister of Canada. The other day when Justin Trudeau was sworn in, afterwards he took questions from reporters. I was listening to the live webcast. A reporter asked why it was so important for him to have half of his cabinet be women, and his response "Because it's 2015" - I swear to you I nearly cried in my office. He took a solid and public position not only for women in Canada but around the world, and I've seen the reverberations in the aftermath. I believe he will make Canada great again and do more than repair the damage Harper did. I have never been much of a nationalist but in that moment I have never been more proud of my country of origin. 

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