Whenever I hear these words, I think: simple or complicated? Simple would be telling a client to bring in copies of last month’s pay stubs. But complicated can best be illustrated by Mr. C. Mr. C arrived in the United States, over 30 years ago, as an adult. Though he speaks fairly good English, his English reading and writing skills could be described as minimal.
One day, last month, Mr. C. calls the office about a medical problem. When he described his symptoms, we told him to go to convenient care, as it is cheaper than the emergency room. Convenient care then sent him to the hospital for tests and he was admitted. He called us the next day worried about the bill as he had no insurance and is currently unemployed. We suggested that he just concentrate on getting better; we’ll address the bill when he is home.
After a week he calls again, he is home and he wanted to tell us that he had the bill sent to him in care of the agency. He also said he had a doctor’s appointment the next day at the hospital but he wasn’t sure who with or where to go. I asked him “did they give you any instructions when you were released?” From these I got him to try and spell the doctor’s name. He spelled two different possibilities. One was a doctor and the other was a procedure. I said I would call the hospital and try and track down where he was to go.
I called the hospital and spoke with three different individuals before someone could explain what was going on. It seems Mr. C’s “doctor appointment” was really an out patient surgical procedure. Yes, Mr. C. was given written instructions (but his English reading level is minimal). No Mr. C. should not eat or drink after 9 p.m. and should be at registration by 6 a.m. As he travels by bus (he has a bus pass) I explain it would be impossible for him to be there at 6 a.m.
Hospital personnel spoke with the doctor and he agrees to push back the procedure to 8. But there is another problem. Mr. C can’t go home by bus or taxi after the procedure. If someone can’t pick him up he won’t have the test. After trying to find a ride for him, I agree to pick him up, BUT I don’t want a call until he is actually in the wheelchair, papers signed, and ready to go (I know how hospitals are).
My next call came from Mr. C. on the day of the procedure. I asked are you ready to go? Mr. C. said someone had called him and told him if he wasn’t coughing he didn’t need to go to the appointment. Who called him I have no idea and neither did the hospital, who called shortly after him, all upset because he didn’t show up. This is what I call more complicated case management and we still must deal with his follow up appointments. We plan on having staff attend so we know what is going on or what is required.