The Argument Clinic

There is an old Monty Python skit called the Argument Clinic, where a man goes into the Argument Clinic and proceeds to disagree and contradict with the man inside the office.  http://youtu.be/kQFKtI6gn9Y  My last appointment with my Primary Care Provider could have been straight from that skit.

I went to see him because of a cough that wouldn’t go away. I had seen him 10 days before, and the course of potent antibiotics hadn’t resolved anything, and I was still sick.  The office squeezed me in at the end of the day, and the doctor entered the exam room, exclaimed my name and said, “why it’s been three months since you were here!” 

Umm, no. “I was here 10 days ago.”

“No you weren’t, it’s been three months.” Wrong. I can’t believe that I’m arguing with the doctor about when I was here last, and that he refuses to listen to me. 

“Check the notes” I finally tell him. Hold on, tap, tap, tap.

“Huh. You were here on September 13.” he states, as if he was telling me something I didn’t already know. 

Time to pull up stakes and find another doctor, perhaps one who isn’t senile.

 

Mind Your Own Specialty

Six months ago, I had some outpatient surgery.  All went well until four days later, when my bladder stopped working due to the side effects of the anesthesia.  I didn’t know that’s what was going on at the time, all I knew was that I was in massive amounts of pain.  Two visits to the ER later (evidently the pretty docs at the ER had a hard time figuring it out too), the problem was taken care of.  I was ordered to follow up with my primary care doc.  Typical for him, he orders me to see a urologist for a follow-up, “just to be sure.”  And typical as well, the first appointment available for the urologist that he recommended is sometime after I’ll be eligible for Medicare.

So, it’s off to another urologist who does have an appointment available, a neighbor of a friend of mine.  I’ve seen this guy at social events and around town, but never had a conversation with him socially.  Frankly, I was surprised he knew that I was friends with his neighbor, he was quite chatty with me.  He did a thorough exam, said all was well, and it seemed to be a one-time incident chalked up to anesthesia medication.

And then he decided to not mind his own business.  “Hey, listen, you should get a personal trainer and work out a couple times a week. You’re fat and weak. ”

Duh.  I know.  I had seen my primary care doc and endocrinologist for the past six weeks trying to figure out what was going on and this guy seems to have a pat solution. Ahh, to be one of those stay-at-home wives with nothing to worry about than a bit too much cellulite and having time to spend all morning at the gym fretting over the size of my thighs.  It’s more complicated than that, frat-boy.

He takes another glance at the form I filled out in the waiting room. “Wait. Hemochromatosis?  Who has that?”  he asks.

Oh boy, and he’s Chief of Staff at the local hospital? No wonder I go out of town for medical care now.  He then told me a long boring story about when he was in medical school during the last century about he got the question right on a quiz, and the answer was “hemochromatosis.”  I think it was the first time he actually had met someone who had it. He told me at least twice it’s called “bronze diabetes,” as if I didn’t know that. Mind your own specialty, I was thinking, because clearly you don’t know a thing about hemochromatosis.

Or endocrinology. Or rheumatology. Or hepatology.  Had I taken his advice seriously and had the time, money and energy to work with a personal trainer twice a week, I would be crippled by now.  I’ll have to make a note to tell him that at the next social event.

On second thought, why would I even bother to talk to someone who has such a disdain for fat chicks, or smart ones?

It’s not me, it’s you.

I’ve said it before – seeing doctors is a lot like dating. Just sent a Dear John letter to the last doctor I saw, a guy I was sent to by Dr. Primary Care. I had emailed Dr. PC after my latest fall, informing him that this was fall #3 in less than 3 months, and this time off the top step of  a bus, right onto my knees and my left cheek. Ouch. Freaked me out to the point I was too scared to drive home after the incident.

To Dr. PC’s credit, he called me right away. “Have you seen a neurologist?” “Yes, many.” “Time for a second opinion.”
(Or 12th, whatever.)

So he sends me off to his second choice, because he knows his first choice of neurologists has a waiting list to rival the French Laundry.  So, I get sent to Dr. Second Best, who has an appointment available relatively soon, and a very empty waiting room when I arrive.  That should have been my first clue. He does the standard neurological work-up, and decides that based on my symptoms, a brain MRI is in order.

Not having a recent photo of the inside of my head, and the fact that I had smacked my face pretty hard, I was agreeable to an update of the noggin.

Dr. Second Best also asked me to email some other MRI results, which I did. Twice. Since he didn’t respond  by email with so much as a  “Thanks,”  I assumed he had given me the wrong email addy, so also sent these results by snail mail.   Still no response.

After my brain MRI, I called the office to get the results.  “Everything’s fine,” chirped the receptionist. “Great, can you please mail me a copy of the report?” ” No problem.”

I wait. Nothing. Nada. He doesn’t call, she doesn’t send copies, crickets.

I shoot off an email to Dr. Primary Care, who thankfully does check his message box and responds.  He hasn’t contacted you?  Why I sent him a bunch of copies of reports (seemingly the same ones I did). No, he hasn’t followed up with me, either.

So Dr. Second Best, you’re done with me. Either you don’t have a clue what’s going on and your little ego can’t handle telling me that, or you’re really that disorganized or disinterested in your work to care.  Either way, I deserve better than what you have to offer, which is nothing.  I’m sure you won’t shed a tear that I won’t be going back to see you, but I will make sure that your colleague doesn’t send any more patients to you.   Also, make sure to respond to my requests for the medical records and notes right away, because if you don’t, I will have no problem in filing a formal complaint.

If you think I was too much trouble to bother with, wait till the State Medical Board knocks on your door.

Wha? Doctors that seem to know what they’re doing? Twice in one day? Get out!

So it seems my iron levels are up again. I’ve finally rebounded from my little stint with anemia and my iron levels have gone back into the stratosphere. What I find interesting is that in the last six weeks or so, I’ve had a plethora of blood work done. First, because I went to the primary care doc and complained of rapid weight gain and feeling cold all the time. That was his cue to check thyroid, after I suggested to him it might be my thyroid. I was right, the thyroid numbers were off. Which got me handed off to an endocrinologist. He couldn’t figure it out and did do much. The primary care doc wanted me to get a physical and ordered a bunch more tests. I reminded him to order an iron panel. Good thing I did. Way high again. Time to go back to a hematologist again. Thyroid levels were even more way off. Send a message to endocrinologist, who responds back – follow up in 12 months. Really, are you kidding me? I think that’s code for “go get a second opinion and maybe somebody else can figure out what’s going on, because I sure can’t be bothered.”

I really didn’t like, no, make that despised, the hematologist that I saw last time. He was dismissive, arrogant, smug and overbled me. Worst of all, he contradicted whatever my hepatologist (who I think is a rock star) said. I had been avoiding this d-bag for months, and now that my iron levels were in the stratosphere again, I had to find somebody who would give me the “Mother May I” to dump some blood. Ah-hah, a review on Yelp from someone who has Hemochromatosis who raved about a doctor. Small world, she’s in the same office as Dr. Smug.

Side note to any doctors who might be reading this. You might hate Yelp, but until you come up with a better system to find a decent doctor, shut up.

You surely know me well enough by now that I have no problem breaking up with a doctor and dating his roommate, which is just what I did. It didn’t seem to surprise the office staff that I was cheating on the first doctor.

Best move I made in a long time. She actually had 21-st century training in hemochromatosis and I got the feeling that I wasn’t her first rodeo. She even pronounced it correctly. Matter of fact, reviewed what went wrong last time and how to tweak the treatment. Talked to me like I wasn’t crazy. There is hope!

To top it all off, as I’m parking the car in front of the Medical Center, I get a call from Rock Star Hepatologist office: “Dr. F saw your lab tests. He wants to see you right away.” Uh, oh. You mean to tell me that after all of these other docs who looked and my abnormal test results and blew me off, Doc RockStar paid attention? I haven’t seen this guy in a year, and he’s watching my lab tests? Dang! There’s a reason I think he’s a rock star, he’s that damn good. This guy is probably has a patient load three times what the other guys do, sees patients in a 300-mile range throughout the state, and yet will call you at home on a Sunday to answer an email, not to mention will testify in court on your behalf.

Of course, the downside is that finding a time slot to see him is tricky, I have to wait eight weeks, or hope for a cancellation. Hopefully my iron levels will be back to normal by the time that rolls arounnd and he’ll have nothing but positive things to say about my health. Glad at least to see that there’s some doctors out there who don’t blow off the hard cases, and have my back.

Don’t make me lie to you.

So I ended up in ER today. I didn’t want to be there. I wanted to be at my primary care doctor’s office, or even  the urgent care office. I was perfectly capable of getting myself to those places, except those places weren’t open. It was Martin Luther King Day, and apparently it’s not allowed to require medical help on a holiday.  Except at the Emergency Room. So that’s where I ended up.

A few days earlier, I had taken a nasty fall and really banged myself up. I was alright, or so I thought, until 24 hours after I went tumbling down the steps of a bus onto hard pavement my spine decided to file a complaint. It went on strike and refused to work. My back decided to take the day off.

After getting a lecture from an Endocrinologist about osteoporosis last week, I had two goals in seeking medical advice: Pain management and checking for fractures and breaks.

After almost two hours of hanging out in the waiting room, I finally see the doctor. The first words out of his mouth were “When was the last time you had a tetanus shot?”

Really?   I didn’t step on a nail, and wasn’t there because I had cut myself. I had hurt my back. Where does a tetanus shot come into the picture?

I told him it was irrelevant, that I had a vaccine reaction (check my chart under allergies – it’s right there), and that I settled my case with the Department of Health and Human Services. He shut right up and changed the subject.

I’ll never really know, nor would this doctor ever admit it, whether he changed the subject because he thought he was seeing the “crazy-lady-in-a-tinfoil-hat” patient, but his tone changed right after that. He did his job, but I could tell he wanted me to move right along.

Mentally, I was slapping my forehead and saying “stupid, stupid.” Why didn’t I just lie to him? When was my last tetanus shot? Why, a couple of years ago, I think.  Why does this doctor deserve the truth if he’s trying foist something on me that I don’t need? Would the doctor have thought of me differently if I had given him that answer, rather than giving him reason to believe that I had a mind of my own? I suppose I’ll never know. I have to figure the only reason that I wasn’t offered a flu vaccine is that they were fresh out of flu shots.

As far as the conversation with the endocrinologist went, he was gung-ho for me to go on osteoporosis-preventing drugs.  Now, I agree with him, my tests have indicated that I am pretty well on my way to having bones as strong as pretzel sticks at a very young age (relatively), but we differ on treatment and prevention.

This doctor is relatively new to my story, but I’m sure he doesn’t realize how profoundly my health, finances and life were affected by bad reactions to pharmaceuticals that were supposed to make my life better. Skeptical doesn’t even begin to describe how I approach a new medication.

Just because the Flying Nun raves about how cool and stylish her bones are thanks to modern medicine, doesn’t mean I’m about jump on that bandwagon. I told the doctor that I would research it and we would discuss it. He reluctantly agreed.

In my research of Fosamax and his friends, I found that a common side effect is bone and joint pain. Wait. I already have bone and joint pain. I’m not signing up for an extra helping of that.  So, diligently doing my homework, I discover that a version of Strontium is approved in Europe for osteoporosis and is 10 times more effective than the Fosamax gang. It’s available by prescription only in Europe, why isn’t it commonly prescribed here in the US?

Yes, you guessed it. Money. It seems that Strontium is a mineral, like calcium is.  No pharmaceutical company has bankrolled the clinical trial necessary to get this on the menu.  Big pHARMa can’t make any money selling  a mineral, which they can’t patent.  So there you go. Mr. Merck and friends would rather have you take something far more expensive and dangerous.

So, what will I tell the doctor about my decision on osteoporosis treatment? Sure, give me the prescription. I’ll never get it filled, and take the generic strontium (which is easily available) instead. I’ll let you believe that I complied with you and the pHARMa agenda.  When it comes time to recheck my bone density levels, let’s see what the results say.

After that, will I lie to the doctor?  Probably. They don’t like it when patients think for themselves.

Are your ears broken?

One of the things I love about my job is I get to go to some interesting places and meet some interesting people. Last week, I worked at a medical conference. Doesn’t matter what type of medicine, once these guys (and gals) are out of their familiar environment, they become completely helpless. Sad, really.

I’ve often felt, and you may have felt too, that doctors don’t listen. On more than one occasion, something I’ve told them has gone in one ear and out the other, or ended up in my medical records completely twisted around.

My little stint at the medical conference last week proved that doctors aren’t listening to a thing you or I say. Indeed, their ears are really broken. It seems that at the registration desk of this conference, certain people were entitled to a sweatshirt. Or as they were referred to, a “fleece.” Seems someone messed up on the fleece-ordering task, and the more popular sizes ran out quite quickly. By mid-morning, only Extra Large Fleeces were available.

So, as I was checking in these learned men (and women), I’d say something to the effect of “Sorry, we are limited on sizes. We only have Extra-Large. Would you like one?”

Invariably, every single one of them said. “Oh. Do you have a Medium?”

What the heck did I just tell you? “Sorry, only Extra-Large.”

“Then I’ll take a Large, then.”

WTF is wrong with your ears? Do you hear yourself? Apparently not.

If you can’t be bothered to listen to someone giving you one of those coveted fleeces, you must not bother to listen any of your patients. Which is something I knew long ago. This day just proved it. None of them listen. They don’t have to. They’re “doctors.” Now hand over that fleece.

It’s a genetic defect, not a character flaw.

Hey Dr. Specialist, don’t you dare call me fat, lazy and weak until you have completely reviewed my medical background. If I’m in your office for a problem with my bladder, treat THAT, and don’t tell me that I need a personal trainer twice a week and I should lose weight.

The fact that you even noticed hemochromatosis on my chart and the comments that you made, told me that you’ve never seen a patient who actually had it, and that the only thing you know about it is outdated information that you learned decades ago in med school. If you had, you would know that the primary complaint is weakness, then fatigue. It’s a GENETIC DEFECT not a character flaw.