October 27, 2006, 11:31 am
Hmmmm….
The adult looks rather tense.
The kid’s getting ready and it’s not even his turn yet!
He’s even comforting dad by holding is hand.
Is it just me, or does the doctor looks slightly like a mad scientist?
I swear I’ve seen that face in a “B” horror movie.
******************************
John decided not to fire his endocrinologist after all.
Remember the mess with the medications that had me so fired up?
John went to his next appointment with Dr. Endocrinologist.
Seems there was a bit of confusion.
Dr. “Endo” got the impression that we had moved to New York and were trying to have him renew perscriptions from our new location. According to him, the pharmacists were not clear in explaining the reason behind the “loss” of five months of renewals.
Okay….
That explains why he would not order renewals.
But…
Why didn’t Dr. “Endo” bother to pick up the phone and respond to either the professional-sounding phone call from John or the “you-got-some-’splanin’-to-do!” challenge from me?
One phone call. Two minutes.
That’s all that would have been needed to (1) resolve the confusion and (2) keep the goodwill in the physician/patient relationship.
Well, the goodwill is still there.
John didn’t fire him.
He likes Dr. “Endo”.
For some reason, I don’t trust that doctor.
And I can’t put my finger on exactly why.
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What exactly does contribute to trust in a physician/patient relationship?
- The subjective feeling that the doctor actually cares about the patient as a person as well as a constellation of diagnoses. To the doctor, you aren’t just a number or just another patient.
- Communication: knowing that the doctor is willing to answer questions as they come up. Knowing the physician will call you back when you have a question or a problem.
- The trusted doctor encourages patients to educate themselves on health issues and is not afraid to address an article or an internet reference.
- Knowing when it is time to call in a consultation or refer to a specialist. The doctor you can trust knows when they don’t know.
So the onus is all on the physician?
Not at all.
- The patient keeps appointments as scheduled or gives adequate notice if unable to do so. Doctors are busy and they run tight schedules. The appointment you don’t keep is an appointment someone else could have used.
- The patient exercises patience if the doctor is running late with their appointments, knowing that medicine is anything but orderly and urgent matters arise. The patient understands that the doctor does believe the patient’s time is valuable and tries to adhere as closely to schedule as possible.
- The patient is compliant with the medications and plan of care developed with the doctor. If they cannot be comply, they are honest with the physician in describing the issue(s) that interfere with compliance.
- If the patient disagrees with the way a doctor deals with a medical problem, the patient is honest about their feelings and discusses the issue with the doctor. The first inkling that there is a problem should not be the request for their records to be transferred to a new office.
If these factors are present, trust in the physician/patient relationship can flourish.
*****
So, the patient needs to agree with everything the doctor does.
Absolutely not!
Examples:
Our pediatrician of 27 years would never give anything to stop vomiting. Nada. No Phenergan suppositories no matter how many times I phrased the question.
- I could have easily obtained anything I wanted from any ER doctor I worked with, but I did not. Why? Because I knew I could trust my pediatrician and while I had a different opinion on the use of medications in vomiting, it didn’t mean he was wrong.
- The outcome? Three adults who survived every bout of pediatric gastroenteritis intact. And hydrated.
Same pediatrician: my son had his first febrile seizure at the age of about 2 years.
- A prolonged post-ictal phase ended with Son running up and down the ER saying hi to everyone about 8 hours later.
- Negative spinal tap. I was a wreck.
- The ER doctor could not get my pediatrician to admit my son for overnight observation.
- Dr. Pedi said it was not a necessary admit, that because I was an ICU nurse, I was able to provide adequate observation at home. The ER doc was ticked. I was ticked (and told Dr. Pedi at the follow-up visit).
- The outcome? An EEG later that week (this was pre CT era) and a totally uneventful course for the rest of the illness. And an unnecessary hospitalization prevented.
- Did I want my son admitted? Yes, so I would not have to deal with the fear that witnessing another seizure would surely ignite. Did I change pediatricians? No. The hospitalization would have been for my benefit, not my son’s. Dr. Pedi had his eye on his patient.
One final example.
My bout of chest tightness was diagnosed as esophageal reflux/spasm. Home from the ER I go armed with a prescription for Protonix.
I did not believe it was reflux for one minute.
I had heart problems. I knew it.
So I express this concern to my new internist and he runs an additional EKG, listens to my concerns about being written off because I’m a woman, and wants a run-down in detail of exactly how the chest pressure began and progressed.
Diagnosis confirmed. Reflux with esophageal spasm.
So do I drop my internist because I don’t agree with the diagnosis?
No. And why?
Because he listened to me. He cared that I felt brushed-off in the ER. He did his own evaluation.
And for the record: he was right.
It wasn’t cardiac at all.
*****
So John feels he can trust his endocrinologist.
He’s comfortable with the man’s style and was satisfied by the explanation of communication break down.
I can live with that.
He loves his new family practitioner, also. Even if she did use the dreaded “c” word.
You know the one.
Colonoscopy.
In the end, he has two doctors he feels he can trust and whose opinions he values.
Who says you can’t have it all?
September 14, 2006, 1:47 pm
How cute is this?
Of course it doesn’t specify which “cheek” they are talking about, but we get the general idea!
I’ve gotten hugs from my patients but never a kiss.
My husband doesn’t count. Well, that’s not true.
He counts, but he isn’t my patient!
The only patients that seem to like my “cheek” are little old ladies!
******************************
Hubby never had any problem taking control of his diabetes once he came to grips with the diagnosis.
He takes his blood sugar more frequently than he has to with Type 2 diabetes and has seen the cause-and-effect of dietary mis-steps, adjusting his intake and choices accordingly.
He exercises and has now lost 20 pounds and wears a 32 inch waist.
He hasn’t been this thin since we married 27 years ago!
I didn’t realize he didn’t know anything about his medications.
******************************
Up until John’s visit to New York last month, I had been filling his weekly pill containers.
One for the morning and one for the evening.
He knew the nature of the medications he took. A pill for lowering his blood sugar, one for his triglycerides, aspirin and a med for his cholesterol.
I’d discuss the meds with him, often using the generic and the brand names interchangably.
*****
What John didn’t know was which name went with what med.
Although he took his medication bottles with him, when he needed a refill on two of them, he was lost on how to go about getting them 3000 miles from home.
When we did arrange for them to be filled, John was taken aback by the fact that the medications given to him there didn’t look like the same medications from home.
What was Gemfibrozil?
I had referred to it as Lopid even though we bought the generic version.
But the shape is different!
Different company.
He was anxious that he would mess up his med schedule and perhaps take too much metformin.
I was surprised at how unsure of himself he was after three months on the same medication.
*****
Then it hit me.
I had been handling the bottles. I had been filling the weekly medicine cassettes. I had been talking to the pharmacy about refills.
John had been taking his medications passively.
Up until the age of 51, he had never even been on medication. It made sense that while he could grasp the mechanics of blood sugar readings and tweaking his diet to make those readings fit parameters, the weak link in the chain would be his understanding of medications.
I wasn’t helping matters by handing them to him in cassettes marked only with the day of the week.
*****
To learn, John needed to actively immerse himself in the administration of his medications.
It wasn’t enough to have the medication names written on the bottom of the cassettes.
He needed to hold the bottles and read the labels every day. Become familiar with the generic and brand names. See the dosages so that they became etched in his memory and take control of getting his medications refilled.
Just as he needed to learn how to navigate the health care system when he had never even seen a doctor, he needed to learn his way around the world of pharmaceuticals.
*****
And so my part in this diabetic partnership has become one of support.
I shop, so I make sure portion controlled, healthy snacks are always available. Our house has had more fruits and veges in the last four months than in the previous two decades.
And honestly, that is really my only “responsibility” when it comes to helping John with his diabetes these days.
He’s conquered the diet, exercise, glucose testing and now the medication aspect of his illness.
Today he received the results of his first A1C since his diagnosis. He dropped from 8.7 to 5.7.
5.7 is in the reference range for non-diabetics.
I’d say he’s done a pretty good job.
September 8, 2006, 11:46 am
Dang!
Doncha wish you lived in the ’50s when this breakfast was considered good for you?
My grandmother used to make this sort of breakfast for my grandfather every day at 0400 before he went off to work.
My grandfather is now 90.
My grandmother lived to be 78.
Maybe cooking it is bad for your health, not eating it.
Of course, today we have other options.
Egg Beaters, turkey sausage.
But nothin’ beats real bacon. Crispy, mouth-watering bacon.
Accept no substitute!
******************************
Thanks to all who commented that a Family Practitioner might be a good choice for my husband.
He has his first appointment with his new doctor in two weeks. Young doc, in his late 30s who is in a Family Practice with his wife! It’s a family practice in more ways than one.
Very happy to take on new patients and was recommended by the marketing manager of the hospital he is affiliated with.
I’m sticking with my internist, who I absolutely love, but should he retire, I’ll join my husband at the new place.
He will not be seeing the endocrinologist who has taken care of his diabetes for the last four months.
******************************
I had a bad feeling when my husband was told at his last appointment that his endocrinologist, Dr. H, only wanted to deal with his diabetes.
Now how does one just deal with diabetes without dealing with lipids, cholesterol, blood pressure - basically the whole patient?
That was a red flag to me.
And then there was the prescription refill issue.
I will describe it. You tell me if I’m crazy.
- John travels for ten days to New York. We packed his daily med containers. He brings extra pills in their original bottles.
- Eight days into the trip, John realizes he won’t have enough Lopid or Metformin to last until he gets home.
- No problem, our Safeway calls the Rite Aid in New York. The prescriptions are transferred. When we need the next refill, they will get the scrips transfered back.
- Problem. Rite Aid only accept one refill, even though John had 3 additional refills on both meds. The prescriptions were removed from their system. Neither pharmacy can refill the prescriptions.
- Safeway calls Dr. H. He declines the refill request. He has strict refill policies, regarding when you can get refills and when you can call, etc. However in this case, John was stranded through no fault of his own.
- John is frantic he won’t get his medication. He calls Dr. H. and leaves a message, explaining the problem and noting that Dr. H probably did not understand the background. John is a lawyer, his call is calm and succinct.
- I am pissed. Not knowing that John has already called Dr. H., I call too, and leave a very, shall we say, adamant message that
- (1) not allowing my diabetic husband access to his medication is tantamount to holding him hostage to inflexible refill rules and
- (2) as far as I am concerned, is damn close to patient abandonment.
Being a nurse, I have very little tolerance for what I perceive as physician arrogance.
Dr. H never calls either one of us back.
When I am at Safeway pharmacy for my meds two days later, the pharm tech notes that Dr. H called in just enough pills to get John to his next appointment. Not one more, not one less.
Think there is a control issue here?
Dr. H, in the words of the inimitable Donald Trump, on September 14, 2006 you will be fired by your patient.
An endocrinologist who is not willing to care for the whole patient is not an endocrinologist he needs to see. Having to fight for metformin is inexcusable. All those pamphlets you threw at us during the first visit, while extremely informative do not pass for medical care.
John will see, instead, a Family Practice physician who can take care of all his medical needs in one office and see him as a whole person, not just as his latest A1C.
Should an endocrinologist be needed in the future, we will obtain a referral from his new doctor.
And by the way, your reputation is well known, and while you may be a very good doctor, your inflexibility is inexcusable.
We won’t be adding any sparkling anecdotes to your legacy.
September 1, 2006, 9:19 pm
I know just what her stomach feels lke!
Except I’m the one with the complaints!
Not about me!
I’m doing fine and am 32 pounds down in 36 weeks, physical therapy pretty much cured my back pain….until I undid four weeks of therapy at the Journey/Def Leppard concert.
Since when does three hours of foot stompin’ rock-and-roll mess with one’s back?
And don’t tell me I’m older…
If Mick Jagger can strut around a stage at the age of 64, I can certainly dance in place without fear of anatomical damage!
Can’t I?
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No, my complaints are about “Inferior Medical Center”.
Get a load of this story.
See if you can spot the no-nos…..
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The year: 1990
I’m five months post-partum with my youngest daughter, who is entertaining herself with Big Bird on a blanket on the floor.
I’m chatting with my sister on the telephone when I am consumed by a sudden, sharp lower abdominal pain that doubles me over.
Literally.
I hang up the phone because with the ungodly pelvic floor pressure I was then experiencing, I figure one of two things is going to happen next:
- I’m going to need a bathroom very quickly or
- I’m going to give birth to a cantelope
Since cantelopes don’t run in my family, I decide to prepare for the first option.
But I couldn’t bear down.
And I couldn’t stand up straight.
I was bloating like a balloon. And it didn’t feel like helium.
I couldn’t pick up the baby. I couldn’t even sit down.
Something was horribly wrong.
I called my husband and he came home to rescue the baby from the floor and to take me to the hospital.
******************************
This was all occuring at noon and I knew my OB/GYN was at lunch until 1400, so even though I didn’t think I needed an ER, it was what was available.
The triage nurse informed me (as I sat there at a 45 degree angle and wondering if the cantelope would resemble my spouse) that it would be at least a two-hour wait.
I unfolded myself to a 60 degree angle and said that if that was the case I’d just wait and go to see my own doctor because she would be back by then. I wasn’t angry or anything, I was just being practical.
I’m not sure what made her change her mind. Maybe I resembled the Hunchback of Notre Dame. Within 90 seconds I was in a room.
******************************
While the discomfort was constant, the pain varied in intensity. While I was waiting to be seen, a nurse walked by and saw me grabbing the sides of the (pelvic) gurney and panting.
Did I need pain medicine?
Uh…yes, please.
Two Vicodin. PO.
BA = before assessment.
Don’t get me wrong, I appreciated it. But in light of what was happening…..
******************************
It wasn’t even a gurney. It was a table.
Heather, and that is her real name, was the Physican’s Assistant on duty that day. She took one look at me, listened to my history, did an exam and pronounced her diagnosis.
“Ovarian Torsion”.
Damn, she’s good!
Let’s get an ultrasound!
Okay!
***
Two hours and two liters of water BY MOUTH later…..I’m in ultrasound and three people come around to look at the screen.
(Yes, they let a woman with acute abdominal pain drink enough to fill her bladder.)
The sonogram tech began his interrogation.
When did you last see your doctor?
Five weeks ago.
Everything was FINE?
Uh…yeah…why?
I can’t discuss the results with you.
Uh oh….
***
The bloody urine specimen I gave them on arrival was sent to the lab to rule out a urinary tract infection.
Or a kidney stone the size of a cantelope.
I told them it was contaminated and would be of no use.
When I got back from ultrasound, they told me my urine was contaminated with blood and of no use.
Hellloooooo straight cath! Let’s add burning uretheral spasms to the mix!
I also discovered that pelvics are not transferrable. One person cannot verbally tell another person what they felt.
Oh great…
I had to have a second pelvic from the off-going ER doc. Apparently it was very productive because I then got one from the ONCOMING ER doc! Hell, let’s just sell tickets and let everybody have a look, eh guys?
The concensus? A ruptured, and hemorrhaging, ovarian cyst that measured 7.5 centimeters causing intermittent ovarian torsion.
I told you that PA was good!
I would have to be seen by the on-call OB/GYN.
It was now 1600 hours.
I would need surgery.
***
Four hours later Dr. OB Wan shows up.
I’ve been in the ER for eight hours now.
Hemorrhaging, supposedly, but still with no IV access.
Still in pain, but somewhat muted by the earlier Vicodin.
And guess what?
Another freakin’ pelvic.
I told him to go ask the other guys.
***
Now I get my IV because I am going to surgery.
But I get something else, too!
An NG tube because they let me drink so much water before my ultrasound, that I was not considered to be NPO!
I refused.
He insisted. I knew the risks of aspiration, he said.
***
The nurse brought the NG into the room packed in ice.
Ice? I’m getting an iced tube in my nose?
Profuse epistaxis from right nares?
Check.
Go left, old nurse.
Profuse epistaxis from left nares?
Check.
Get away from me NOW.
The OR wouldn’t be ready until 2300. I went in at 2345, almost twelve hours to the minute that I had arrived, now bleeding from both ends.
***
The anesthesiologist gave me Neo-synephrine to snort bilaterally and then after I was out placed an NG without difficulty. I had 400 ccs of fluid in my stomach.
Per the OR nurse, who gave me a full report later:
They did multiple attempts at a laparoscopic removal but because of scar tissue due to three C-sections, Dr. OB Wan couldn’t see.
And as he was palpating all over my abdomen to get the offending organ into view, he pushed a little too hard and the entire cyst burst.
Good thing no one faints at the sight of blood in the OR because when they opened me up it was everywhere. She said they had a hell of a time cleaning it all out.
It pays to have surgery where you work (I worked Psych there at the time) if you want the real scoop.
I survived and Dr. OB Wan saved the ovary.
***
Recovery was uneventful except for two things:
- The insurance company considered my surgery day my first post-op day even though I didn’t even get into surgery until 2345 and wasn’t finished for hours into the next day! So I was discharged home less than 36 hours later, with a five-month old to care for and after my second abdominal surgery in five months.I was charged for a hospital room at the same time I was in the ER.
- At my six week recheck, Dr.OB Wan said that if I wanted any more kids I had better have them within two years and then have my tubes tied! Why? Because if I took the birth control pill after the age of 35, I would die! And he had the graphs to prove it!
I hightailed it out of that office so fast you would have thought I was an Olympic sprinter.
Dr. OB Wan still practices. Ran into him a few times at another hospital when I was working ER. He didn’t know me and I didn’t tell him he was one scary guy.
***
You see, that is the thing with Inferior Medical Center. The actual experience there is exasperating, frustrating and sometimes just plain unpleasant.
But everything always turns out alright in the end.
I mean, Dr. OB Wan did know how to save an ovary.
He just didn’t know what the hell he was doing when it came to reproductive advice or the latest statistics on birth control pills.
And isn’t that what you want from an OB/GYN?
Never been to a male OB/GYN since. I get my care at a Women’s Clinic staffed by female doctors and Nurse Practitioners who know what they are doing when it comes to caring for women.
Guys, you can be really good at what you do as OB/GYN doctors and nurses, and I would have accepted a male nurse in L&D without a flinch.
But it takes a woman to know what you are going through. And I hate to admit that.
But it really does.
