However, as my little tour through the world of outpatient medicine reminds me, it’s unlikely I’m going to find anyone to really going to step up and do intensive case manaegment unless the entire reimbursement system is stood on its head.

Right now, I’ve seen:
* My PCP, who, with a Holter, has documented that yes, my heart is going a wee bit too fast at times

* My psychiatrist, who knows me well enough to know when I’m having panic attacks. He and I believe that’s not what’s going on here.

* An allergist who says I have a tight chest and shortness of breath due to moderate asthma

* An OB/GYN who’s concluded that no, menopause isn’t causing the tachycardia, but can’t help otherwise.

* A pulmonlogist who concluded, after sleep lab testing, that though I have sleep apnea, it’s too mild to be causing the HBP, tachycardia and exhaustion.

* A cardiologist who tells me that the Holter and lab work I have aren’t “worrisome” but proceeds to schedule me for an event monitor and an echo (presumably because I *don’t* have a problem? you tell me!)

Now, the nice people at the PCP practice are trying to do the right thing. They’ve made some phone calls and collected some test results. But I think given the handful of (otherwise minor) ailments I have, and how they’re tangoing all over me, I need a real case manager.

As the managed care system stands, however, I think I’m going to have to pay for one out of pocket. Got any better ideas? I’d love to hear them.

Signed one tired, frustrated lady…