Referral

I like people.

Usually. The ones I don’t get along with tend to be people who are either stupid, or lack common sense.

There can be exceptions, and unfortunately I found one. I was referred to a doctor who needs to be seen on an ongoing basis, and it hasn’t been a good experience. Since people can’t be stupid and make it through medical training, this is unusual for me. I’ve only ever had one other person providing medical care who I didn’t like.

This guy has pretty good credentials, and my PCP (whom I respect) recommended him, so I’ve tried to make the best of it. I’ve learned about this disease. I’ve talked to other people to learn what their doctors are like. I go to my appointments prepared – but I dread going.

Then one of my favorite medblogs had Rules for Doctors/Rules for Patients posts (great read), and I realized that when it just isn’t working, it’s okay to find a different doctor.

Previously I’ve written about finding a new specialist. There were lots of different things to consider, so it took a while. I finally finished my research, but still needed to talk to my PCP about it – something that I was reluctant to do. I like my PCP and don’t want him to think I’m complaining. “You know that doctor you referred me to? I don’t trust him,” just doesn’t seem like the right thing to say. And I wasn’t really sure how to bring it up.

Problem solved. Yesterday I had an appointment with my PCP, and he brought it up – asked if I’d been back to the rheumatologist yet. “No. I’ve been thinking about finding someone different.”  Immediately he had the name of another rheumy and gave me a referral.  I’ve been worrying about this for months, and it turned out to be no big deal.

But he asked why. I’d hoped to avoid that question.

So, why don’t I like the RD?

I don’t trust him. I told him that I was allergic to a particular painkiller.  Apparently having my throat turn red and my throat swell so that it’s hard to breath means I’m a drug seeker.  Never mind that my PCP knows I’d rather go without any drugs.  This guy could see that my neck was visibly swollen – that and accompanying rash are noted in my chart – his handwriting! Do so many people lie to get drugs that I’m never going to be believed about this? I didn’t want a painkiller, but he insisted on one anyway (and I get labeled noncompliant if I won’t take it – no way to win here). I took the new painkiller (minimum dose). The room started spinning; I crawled to the bathroom and spent the evening kneeling before the porcelain throne.  After a couple hours I was able to crawl back to the medicine bottle and there, in tiny print on the package insert, I learned that this medication is contraindicated in people with my particular allergy!  When I finally got a response (see below), it was: if I couldn’t take the new med, then he’d give me a prescription for the generic version of my allergy.  This man is trying to kill me!

Lack of responsiveness. Immediately the morning following the painkiller incident, I phoned to let him know what had happened with his prescription. Somehow I must not have conveyed the extent of the problem.  He didn’t return my call. The third day, I phoned again and left another message. Never had to do that before.  Still no return call.  The fourth day I tried again, and eventually his nurse returned my call to say that if the puking and spinning room were unacceptable, then they’d give me the med that inhibits breathing.  Maybe I was better off without the return call.

Blame. I talked to my PCP about the problem with the prescription.  He thought it sounded more like an overdose than an allergic reaction. That doesn’t really inspire confidence in the RD’s prescribing abilities. At my follow-up appointment with the rheumy I’d planned to ask about the meds, but he started the appointment by walking in the door and announcing, “It looks like you’re medication sensitive.” No greeting, no eye contact – blamed me for his error even before he was seated.  Subject closed.  I’d sorta thought that an apology was in order.  For the med, for not calling me back… Even if it was an overdose instead of an allergy, the company that makes the med says it shouldn’t be given to me. I understand that it’s my fault that I took the stuff. Believe me, I learned my lesson and will never again take any medication without learning about it.  However, he never should have prescribed it in the first place.

No Calls. A lot of RDs welcome phone calls. Or at least tolerate them. Some even have guidelines: call me if any of these things happen. After learning that, at my last appointment I asked, “What circumstances would indicate that I should phone you before my next appointment?” NONE. He told me that there would never be any reason for me to call him before my next appointment.

While I would like to never call, I don’t think it’s realistic. In the past it’s been normal for my only phone calls to my doctor’s office to be for scheduling routine well-child checkups for the kids, but there have been a few other calls:

• My son got kicked by a cow. It broke his hand. I felt this warranted both a phone call and a trip to the doctor.
• I cut off the end of my finger with a bread knife. It was an accident. I phoned to ask if the doctor could see me, or if I needed to go to Emergency. He took care of it and didn’t even lecture me to watch what I’m doing.
• My 5-year-old snuck up on the other kids while they were playing baseball and got hit in the head with a bat. I called to ask if the doctor needed to see him, or if I should just keep an eye on him. I didn’t have to make a trip to town, was told exactly what to watch for, and given instructions to call an ambulance if needed (wasn’t needed).
• My weirdest call: We’re studying anatomy and I wondered if the doctor’s office had a skeleton we could view. They don’t have a skeleton, so I bought one. It’s too tall to store in the coat closet, so we keep it in our bathroom. Interesting conversation piece when company visits.

I don’t think that I’m one of those people who bug the doctor’s office with every little thing that comes along. One of my kids’ files was archived because she never got sick and I somehow missed scheduling two well-child checkups. Really, I don’t make a habit of bugging doctors.

But I was told to never call the RD, so I won’t. Sure wonder why they’ve had my abnormal test results for a month and haven’t gotten back to me, but it’s not life-or-death. I understand what the word never means.

 

I couldn’t think of any short way to convey this to my PCP, and I’m not sure that it would even be appropriate. There might be a good way to complain about person A to person B, but I don’t know what it is. I took a deep breath, thought about it, but couldn’t do it. If I had a problem with the care provided by my PCP (which I don’t), I would address it with him, not with someone else. If I wanted to fix this, I would address it with the rheumy. That doesn’t mean that I’m going to complain about him to someone else (at least not in a format where he’ll be recognized). I just said, “He’s an arrogant jerk and I can’t stand him and I don’t trust him so I feel like I have to research every med he prescribes before I can fill the script. I don’t think it’s a good fit.”  Which my doctor accepted.

He didn’t have to think about it – knew right away who to recommend. This new rheumy is on my insurance list, is closer to my house than the old one, is board certified, is a member of the ACR, does research, takes email questions, has privileges at my preferred hospital, has a practice partner who’s a professor of rheumatology at the medical school… Is everything that I think I’m looking for in a rheumatologist (even female, which I wasn’t going to hold out for).

I dropped by the new office to make an appointment and pick up paperwork.  Okay, I’ll confess, I wanted to interview people in the waiting room.  The receptionist is nice, organized, efficient… and the doctor was visible – sitting in the back office, typing stuff into her computer.  This is a good sign.  I’m actually looking forward to seeing the rheumatologist, instead of dreading it.