Help - need medical test for job

Factual Questions
1

Let me start off by saying I am in no way seeking diagnosis or medical treatment advice.

Here’s the situation: I applied for a job with the Federal government. I passed their basic physical but because of a history of asthma they want me to take an FEV1 test. Please, do not start about how an employer should pay for required pre-employment testing, etc. - I’ve heard it all before but we’re talking about the Feds. Maybe it’s not in the contract for the physicians they’re using. Whatever.

Anyhow - the Feds were very clear they want JUST the FEV1. Just that. Nothing else. Please do not spend my money on anything more elaborate than that.

I can NOT get this test scheduled!

I have talked to numerous doctor’s offices. Most have insisted that I have a COMPLETE physical before they will even discuss this test. I have already HAD a physical. They talk about interpreting the test - the Fed doctors will interpret the results. They talk about “asthma education” and “follow-up” - I’ve had fucking asthma for 40+ years and, having managed to stay out of the hospital entirely and going MONTHS, sometimes YEARS, without exacerbations I think I’m managing pretty well, thank you. So far the “winner” has been the office that said I’d have to become an official patient, get a physical, etc. and I said, OK, let’s say I do that, how soon can you get me in and the reply was “I’m sorry, the doctor is not accepting new patients at this time…” :rolleyes:

My lack of medical insurance has not helped. I had one office hang up on me. I have been scolded for being “irresponsible” for not having insurance. I had an office refuse to schedule me since “if you don’t have insurance you obviously can’t pay for services”. Um… I am TRYING to get a JOB with BENEFITS so I WILL HAVE insurance…!

I have been accused of doctor shopping. Well, perhaps I am, but it is at the request of a potential employer who apparently wants me as they have called/e-mailed me several times over the past month encouraging me to get this done.

I have the ability to pay in cash several hundred dollars up front, if necessary (yes, I have friends and family).

OK - am I missing a Magic Phrase? A Secret Handshake? What the fuck do I have to do to get this test? Docs, help me out - I have less than 60 days to get this done or I lose this job opportunity. How do I get an FEV1 test?

(No, I do not have a “regular doctor”. I don’t have health insurance. People without health insurance do not have “regular doctors”, they don’t see doctors until there is a pressing need for one. I did contact the doc I saw in January 2007 because of a norovirus infection but he was not helpful.)

I live in Northwest Indiana, but I am more than willing to travel to South Bend or Chicago to get this test DONE so I can get my foot in the door with this agency, get out of poverty, get health benefits, and basically back to somewhat of a normal existence. I would like focused, helpful advice please, on how to achieve this (I thought) modest goal.

2

Is the test difficult to get done (on the doctor’s end)? There are some tests that have to be submitted on ice or dry ice, shipped to a single lab, etc. If so, contacting a University with a medical school might work better.

3

Eh, missed the edit window. I think from what I see on line that it is not a test using blood/serum/etc, but rather a measurement of pulmonary tidal volume or (FEV = forced expiratory volume).

4

I don’t know that this is possible without an M.D.'s referral, but have you tried contacting the pulmonary function testing department of a local hospital and explaining that you just need this very simple test for a job? Maybe at the least, they can refer you to a doc who won’t make you jump through hoops.

I’m not a pulmonologist, but it seems to me that this test should take a very short time to do and be simple to interpret.

5

Yes.

They absolutely will not do this without a doctor’s order.

So far, every hospital has absolutely refused to recommend a doctor.

Yes.

However, EVERY pulmonologist I have spoken with - let’s be honest, I haven’t spoken to the docs, just he gatekeeper/receptionist - has been adamant I MUST have a complete physical AND a “consultation” and THEN, MAYBE the doc will order the test I need for the job. Price estimate being $300-400 even before I get the FEV1 and no guarantee I will get it - it depends on whether or not the doctor will order it, after all that.

Regular MD’s can order this test, but so far every one I have spoken with has refused to do this because of some variation on “We don’t know you - you really need to get medical insurance and establish a relationship with a doctor before getting this test.” HELLO? I am trying to get a job here so I can GET insurance!

6

I think your best bet would be talking to a doctor directly – you might have to become a ‘patient’ but that should not require a physical. You schedule an appointment with a pulmonary specialist for a ‘consultation’ – before the appointment call the doctor’s office and leave the doctor a message as directly as possible asking if it’s possible to arrange for an FEV1 test same day because you need it for employment. The doctor or their nurse should call you back with a simple “Yes” or “No” afterward.

Edit: The idea here is that you should get around the gatekeepers and ignore them.

7

Have you tried a doc specializing in occupational medicine? I once needed a “physical” to get a driveaway car and was sent to some guy who took my $20 bucks and stamped some kind of ICC form.

Do you have an “free clinics” in your area? How about county-operated, sliding scale clinics?

b

8

I just called my immunologist’s office (they’re asthma specialists) to see if they’d just perform the test, and they didn’t see any reason why not. Try one of those if there’s one nearby?

9

The occupational guys won’t talk to me because, I have been told, they only deal with companies and employees, not individuals :rolleyes:

Yeah, great idea - I have not been able to do this

Given that some of these places, because I don’t have insurance, want a non-refundable deposit before even making an appointment I’m none too comfortable with trying that sort of end-run. One office even cautioned me against attempting that, so apparently you aren’t’ the first to think of it. Short of getting the docs’ home phone numbers I just don’t see a way to speak to the doc prior to the appointment.

I understand docs don’t like being ordered around by patients. Normally, I wouldn’t do that. If there were any way I could get this done without “bothering” an MD I would do it. I don’t understand why this is such a puzzle to the MD’s, or such a hassle. I am beyond furious over this. This is the BEST opportunity I’ve had in nine months of looking for solid work and I’m being screwed by the medical “professionals”.

I am so sick of this second-class (or worse) treatment because I don’t have health insurance. I am TRYING to better myself here! I am NOT a deadbeat! I am college-educated, I have worked in the medical field, and I am being patronized, talk-down to, scolded, ignored, and everything short of spat on.

I am trying the allergists and the clinics, but it’s been slow going because, ya know, I am also trying to work so I can keep a roof over my head. And, yeah, a lot of the allergist give me the same line “You have to be my patient you have to have a physical maybe we can discuss this job you want and maybe I’ll scheduled this test if I feel you need it.” I hate being poor, it sucks, people treat you like shit, and there are a multitude of obstacles in your way for climbing out of the hole.

10

Having worked in a medical clinic, I support this advice. The gatekeepers are trained on the rules, and are often not allowed to deviate from the standard operating procedures under any circumstances. The doctor very certainly should be able to order the test under the circumstances you describe, you just have to get face-to-face or get the right person on the phone to ask.

groman’s plan of scheduling a consultation then requesting the test be run the same day is a good one.

On preview: as for the office that “cautioned you against attempting that”–fuck that noise.

11

Damn, hit submit too soon -

I KNOW one of the concerns of the docs is that I’ve been neglecting my health for years and years but I had coverage until last November. When I say THAT I get a lecture for not taking COBRA. Well, if I HAD taken COBRA the cost for the monthly premium would have been MORE than my rent, food, and gas COMBINED. Unemployed I could not do that, I would have been out of money in less than two months, and evicted three months later for being unable to pay my rent! I can’t eat health insurance, or sleep in it, and it won’t keep me warm in the winter. I have not been poor white trash my entire life, but at this rate I will be for the remainder of my life.

WHY can’t these docs understand that ALL I NEED IS THIS ONE TEST? THEY are not making a decision based on this test, the Federal agency is. I will pay CASH UP FRONT for this, provided it doesn’t exceed a couple hundred dollars. Yes, yes, I know my condition needs to be “managed”, I should see a doctor regularly, yes I know this - THAT IS WHY I AM TRYING TO GET THIS JOB, so doing so will be FEASIBLE!

I am going to go slam my head against the wall for awhile because I know it will feel better when I stop…

12

I’m sure you tried this already, but could this be done in a walk-in clinic - perhaps even the type they have in Wal-Marts? It is an incredibly simple, non-invasive test. You just blow into a tube a couple of times, and the results are charted on a graph. Could it be done by a nurse practitioner, or is an M.D. needed for some reason?

I think there are enough people out there chasing health care dollars. I suggest you look beyond the traditional “doctors” until you find someone who wants your money badly enough.

13

It’s not a particularly labor-intensive test. All it effectively requires is a tube and a barometer, and most PCPs should have the equipment on hand. Have you tried a walk-in clinic?

ETA: What Dinsdale said. If not, try an immunologist as mentioned above.

14

Would the Federal doc who gave you the basic physical (which you passed) refer you to someone who would do the damn test?

Do you have any nearby friends/family who would be able to get you in to see their own docs?

How long has it been since you had a “regular” primary doc? I know that in my situation, once several years had passed between visits to my primary doc (I had an HMO in the middle there), but they still considered me an existing patient and didn’t make me jump through all the hoops that a new patient would have to jump through.

15

Sure it COULD be - IF they have the machine! Apparently, most places around here don’t. I keep being told “Oh, we refer those to the local hospital…”

Yes. You are correct. It is incredibly simple. Why, then, is no one willing to schedule this?

As I said - everyone around here says “You have to go to the hospital lab for that test”. Hospital labs will only do this with an MD (or DO) order. That’s part of the stupidity, I guess - the doctor won’t even be administering the test, he/she just needs to order it!

I’ve been trying - but apparently none of the clinics/walk-ins have the magic machine. At least around here. Hence, my willingness to travel, though I assume I would be greeted with some suspicious if I, say, walked into a clinic in Indianapolis and requested a test I “should” be able to get closer to home.

16

No, most PCP’s around here do NOT have the equipment.

I am going to look into the walk-ins some more, but frankly, I’m not doing well with them. And there’s also the time constraint - I HAVE TO work in order to provide rent and food and I get NO sick days, no paid time off right now. A full day at a walk-in is a full day wage’s lost.

17

No. I asked. They did say that “Oh, yeah, for some reason people in your part of the country have problems scheduling these” and gave me some suggestions, which I am following up on, but with no success so far.

Half my extended family is ALSO out of work and have no insurance at this point. Those that do… well, I could travel 300 miles to my parents’ place. Or my sister is an MD… but that’s a 1000 trip. I suppose I could, if I have to, but there my be issues with conflict of interest there.

Hmm… maybe I should call my sister the doctor…

I tried to contact a doc I used to see in Chicago, but he’s gone for month visiting family in Australia. The other doc I’ve seen recently I already contacted - he doesn’t have the equipment, doesn’t do the testing, referred me to three other docs who all refused to see me due to lack of insurance issues or gave me the line about coming in for physical and consultation and stuff before even considering helping me out with this.

But keep throwing ideas at me, folks, sooner or later something will “pop”. And ignore my whining - I’m just very angry and upset and that’s going to come through because, ya know, I’m a human being in a bad situation who’s trying to get out of it and finding a Catch-22 situation everywhere.

18

Well, I’m going to let this run for a bit and check in later - I’ve got some things I need to do this morning. Keep on suggesting and I’m sure I’ll figure something out. I’ve got some time to get this done, I just do not want to wait until the last minute. I really want/need this job!

19

I am no medical biller but I think the problem you are running into is basically there is no money in the test for the doc, they will refer it out to a testing center.

Have you tried asking the potential employer for a referral to their occupational health place.

20

I still think you need to pierce the administrative wall in any way possible before you get anywhere. Schedule an appointment, any appointment. Once you have that, you actually get to communicate with actual nurses and doctors that are not on autopilot. It might be by leaving messages but at least you shouldn’t get as much of a runaround.

Or of course you can wait for some doper to post an elaborate scheme involving an asbestos litigation lawyer and three Jewish chiropractors :smiley: