Good News!

It is so nice to be taken seriously.  This new gastroenterologist looked at my CT images and said, “We need to get this done soon.”  He rearranged his schedule to fit me in.

Next week I should be able to eat without pain.  I’ll be able to visit people over the Thanksgiving weekend without fear of landing in the hospital again.  My kids will be able to concentrate on their schoolwork instead of worrying about me.

Instead of just dictating when I had to show up, the nurse asked about my schedule and gave me options.  I told them to do it as soon as possible, and I’d make it work.  It turns out I have some juggling to do because my pre-op appointment with anesthesia conflicts with my children’s violin recital, and the actual procedure conflicts with another doctor’s appointment that I’ve had scheduled for a month.  BUT it will be done!  I’ll juggle the other things as best I can, and I’m happy to do it.

The nurse said they would have done it this past week, except they couldn’t schedule an operating room at the hospital without a guarantee that the machine would be here.  Apparently the EHL/ERCP combination is a special procedure that requires borrowing a machine.

It’s funny how different medical practices can take such different approaches to their potential patients.

Practice #1

Practice #2

 Phone call to schedule appt  3 weeks after receipt of referral  1 day after receipt of referral
 First appointment  5 weeks after receipt of referral  2 days after receipt of referral
 Procedure appointment  8 weeks after receipt of referral  2 weeks after receipt of referral
 Asked about my schedule  No  Yes

The second place will perform the procedure two days before the first place will even get me in for an initial appointment.  Is it solely a matter of how they do business, or is there a difference in how the referrals were written?

I owe my family physician huge thanks for getting me the new referral.  I wish there were something I could do to convey my gratitude to him.

________
Edit to change ESWL to EHL

Have You Stopped Beating Your Wife?

Some questions are loaded, and there’s no good way to answer them.  My high school debate coach was the first to introduce me to loaded questions.  We were taught that lawyers are infamous for this technique, but once you know about it, you recognize it other places, too.  Some of the medical questionnaires I’ve had to complete lately seem to have been designed by people who like loaded questions.

For example, have you stopped beating your wife?  sounds like a simple yes-or-no question.  It’s really a trap.  “No” means you haven’t stopped; you’re still beating her.  “Yes” means you have stopped, so you’ve beat her repeatedly in the past and recognized the need to stop.  When feeling pressured, few people think to say, “I have never beat my wife so there’s no need to stop.”

My family physician only asks for “average number of drinks per week.” I’ve never before seen such questions as these new doctors are asking.  Date you quit drinking?  is one of those questions that really have no good answer.  What if you haven’t quit?  What if you don’t know a date?  What if you do know a date?  Does that mean it was a significant event worth remembering?

Now that my pancreas has decided not to function properly, doctors are actually reading some of my paperwork and looking a little closer at how I answer their increasingly detailed questions.  One of my new doctors flipped through all the forms I’d filled out; apparently I interpreted the loaded question wrong, because he asked, “Have you ever been a heavy drinker?”

Should I ask for a definition of heavy?  I have a neighbor who is drunk before 3:00 every afternoon, but he insists he’s not a heavy drinker.  Does anybody ever respond “Yes”?  Is “No” ever believed?  Is there a way to broach this subject without sounding defensive?  If it won’t change anything, then there’s not really any point in asking.  Are there different treatment tracks based on the patient’s past ETOH use?

Maybe (unlikely) I’d forget all about it, except that I went directly from that doctor’s office to another who insisted that I can’t have chronic pancreatitis, because only long-term alcoholics get that.  Despite the fact that there’s plenty of evidence to the contrary, if that’s what practicing doctors believe, I foresee problems ahead.  I can anticipate being grilled about my drinking history for the rest of my life, and it won’t matter what I say.  If anything, telling the truth will make things worse because the doctor will be convinced that I’m untruthful.  That’s not particularly encouraging.

When doctors put “Date you quit drinking?” on their patient history forms, the line on which answers are written needs to be longer than 1/2″.  I want to write, “I was never a drinker, so there was no reason to quit.”

Referrals: It’s the Money

It is incredibly frustrating to need a doctor and have a referral, yet be unable to get an appointment.

It is maddening to know that if I’d consented to inpatient surgery, all of this would have been resolved in September.  September.  It is now November.  Never again will I attempt to keep expenses down and get out of the hospital as soon as possible.  It is not efficient to try to do things on an outpatient basis.

The gastroenterologist to whom I was referred determined that I need a highly specialized procedure that he doesn’t perform.  He sent a referral to the new GI (let’s call him GI#2) and told me that the new place would call me to schedule an appointment.

I’ve written about this before.  The short version is that after a week without hearing anything, I followed up.  Even though they had all my paperwork, they wouldn’t schedule an appointment.  I was told it would be another 1-3 days before that could happen.  It wasn’t.  A second week went by, then I followed up again.  Still no appointment.  I was told to be patient.  GI#1′s scheduler called me to schedule my follow-up with him since I should have seen doc#2 by now.  Finally I called my gastroenterologist’s (#1) office again and asked if they could please refer me to someone who will actually make an appointment to see me.

Another day, no word.  And another.  I started making phone calls.  There are  doctors much closer who do this procedure.

I phoned my family physician’s office and explained the situation.  “Would it be possible to get a referral to someone else?”  Yes.  “Can I make an appointment so that you can be paid for doing the work?”  No.

My family physician’s office asked which doctor I wanted to see.  I picked the one who had said they could try to work me in this week.  Referrals don’t happen instantaneously; I was told that it would take a day, so I waited two before phoning to make an appointment.  They couldn’t find my referral, but did find my name in their computer so made an appointment and said they’d track down the paperwork.  Good people.

Did I have to wait a week?  Two weeks?  Three?  No.  If it worked for my schedule, they could see me the next day.

A few hours later my phone rang.  It was GI#2′s office.  Once they have a referral, it takes them more than three weeks to bother contacting the patient to set up an appointment.  Caring nothing about my calendar and existing commitments, or the fact that my stomach hurts any time I try to eat, they issued a summons to appear in their office two weeks hence.

I politely accepted the appointment (hedge my bets – I’d hate to say no thanks  after all this time and then discover that there really is only one person in the state who does this procedure), but the following day I met GI#3.  They can  do the procedure and I don’t have to drive to BigCity.  They even gave me a choice between a few dates and will contact me once they can arrange anesthesia.

A few hours after I returned home from meeting GI#3, GI#1′s office phoned and said that the doctor had written a referral for me to see… the local guy?  another local guy?  No.  GI#4 is another doctor in BigCity.

I was starting to wonder if perhaps GI#1 lives in BigCity and commutes, the way he keeps wanting me to go there as if it’s right next door.  Instead, a recent post on KevinMD makes things quite clear:  Why Patients Get Unnecessary Referrals to Consultants.  GI#1 works for one hospital system.  GI#3 works for a competing system.  My rheumatologist has already told me that they’re not allowed to refer outside the system.

WHY is it about whose employer gets the money, instead of being about what’s best for the patient?

 ***

This post was published in November as part of NHBPM’s – 30 health posts in 30 days