I Don’t Understand

Dear Dr:

This problem with my GI tract has been going on for two months, and the more I learn, the more frustrated I get with how you have handled my case.

Why did your partner do an EGD instead of an ERCP?  From comments I’ve heard, I’m not the only one asking that question.  I really don’t understand.  The scope was already in place – he could have kept going until he found the problem.  That would have eliminated the need for the subsequent MRCP and the second CT.

Once you decided that I needed a lithotripsy, I don’t understand why you would only refer me to big-city when there’s somebody right there in mid-sized-city who does the procedure.  Referring to a competitor when you can’t provide the needed procedure looks like you want what’s best for the patient.  Conversely, making the patient wait months for treatment because you won’t refer to a competitor looks like you don’t really care if patients are suffering.

I don’t understand why you only told the big-city GI department about CT#1 and not CT#2.  Shouldn’t they know about both of them?  I don’t understand why the referral you wrote flagged me as routine so that they thought they could contact me in their own sweet time instead of treating me promptly.

When you wrote that referral, I’d already been suffering four weeks.  I don’t understand why, when it took three more weeks for big-city to call and set up an appointment even further in the future, and I begged your office to expedite the process or find me a different doctor who could do it sooner, you waited another week to respond.  I don’t understand why your response was to send my paperwork to big-city’s medical school, where it could gather dust for a few more weeks before they called me to set up a routine appointment.

You seem to view the fact that my entire abdomen aches and I can’t eat as routine, not serious, and not worthy of your attention.  Why is that?

Maybe you’re not familiar with any of the doctors in the competing healthcare system, but there is a doctor in mid-sized city who does lithotripsies.  He looked at my CT images and said that I needed to be seen promptly.  He even re-arranged his schedule to fit me in and get the procedure done as soon as possible.  He performed the ERCP/EHL last week.  My pancreatic duct was 80% blocked.  Eighty percent!  Maybe you think that’s routine, but I certainly don’t.

When I saw you in the middle of September, I had no idea this problem would drag on so long that it could affect my family’s plans for Thanksgiving.  What’s so incredibly frustrating is that it didn’t have to be this way.  You could have – should have – handled this very differently.

If you had referred me to your competitor, the procedure would have been done promptly, I’d have returned to you for follow-up, and all this would be in the past.  Instead this is ongoing and I’m not particularly inclined to return to you for follow-up.  Since you wouldn’t act in my best interests in this situation, why would I trust you in the future?

When I go to my family physician for help, I know he’ll listen to me and do what’s needed to get me well. When I go to my rheumatologist, I know she’ll listen to me and do whatever it takes to get me the treatment I need.   When I go to you… well, it’s so sad that the same thing can’t be said for you.

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.”