Last month’s cross-posting was quite an experience.  A couple months back, after reading Dr. Kevin Pho’s CNN article, Will the doctor answer your e-mail?, I blogged a response to his suggestion that patients should be Making Demands.  The Queen of Optimism kindly suggested that I submit that response as an op ed, and to my surprise and delight, Dr. Pho cross-posted that piece on KevinMD (here).  The comments over there got significantly off track, but the email responses were favorable.

Earlier this week, on Monday, an edited version of my third post in the speaking up series was cross-posted at KevinMD.  The responses were not nearly as positive (to put it mildly), leaving me wondering:

  • am I completely off-base on this?
  • do commentors always make such erroneous assumptions?
  • has my writing become that unclear?
  • was the whole point of my post edited out?

Reading some of the comments left me fuming:  not at the commentors who don’t know the whole story – well, maybe a little.  Mostly at the medical provider who could have killed me with his bad prescription.

Quite an experience, this cross-posting.

I’d be interested in knowing your opinion.  Was the piece really that badly written?  Am I doing the crazy patient bit?

Addendum:  Due to excessive spam, comment on this post are now closed.  I can still be contacted via email.


9 thoughts on “Cross-Posting

  1. Hi! Please don’t get discouraged. Matt is a regular poster at Kevin’s and a lawyer. He adds an element of “the other side” that keeps debates lively. Actually, you got off easy. I posted over there recently, and have gained a few cyber-stalkers… even wrote last night that they know where I live (and sure enough they really did). I am expecting to open a box with a dead rat in it soon…….just hoping it’s not my dog!

  2. About your question, “Was the whole point of my post edited out?” I tried to compare the 2 posts and the one on KevinMD’s site seems to be word-for-word the same except it omitted a couple of lines about the tramadol dosing.

    For your other 3 questions, I am assuming you consider the comments by ItIsAName-YMMV and Bruce Small and Matt S to be the not positive responses (3 out of 9 total at this time. Looking at
    it shows that 100 mg tramadol is an acceptable INITIAL dose, up to 400 mg per day. So I have to agree with ItIsAName when he states, “So it would appear that you had a bad reaction to a typical accetable starting dose of a medication. The doctor’s response was that apparently you were sensitive to it. That seems to be a rather accurate and obvious statement.” So I don’t see that as a negative response to your post. The response from Brucer Small also seems obvious to me and not a negative response. Matt’s statement, “that’s an awfully counterproductive strategy” also seems straight forward and not negative.

    So I am questioning why you think the “commentors always make such erroneous assumptions,” and why you are “fuming” about the responses. In your post you describe the doctor as an obnoxious person, a jerk, and Dr. Jerk who dismissed you and blamed you. And in this post you still say the Rx from the other Dr could have killed you. I’m not trying to critisize but you asked for an opinion here, and I think maybe you just used poor examples that did make it seem as though you were over-reacting to the doctors and you also are over-reacting to the 3 comments. Take a deep breath and start over tomorrow! – Teri

    • I enjoy your blog and do want to encourage your efforts. It’s a big job every day. I just don’t want any of us to be antagonistic toward health workers since we need them so much. Unless there is only one doctor in town we can always go to another we like better with no need to give any excuse. And your post did give excellent examples of why there can be communication problems between doctors and patients! – Teri

      • I don’t think it’s antagonistic to question doctors. I think it’s a privilege to be able to do so online. Years ago having a voice like this was nearly impossible. I know it’s a touchy subject, but…doctors are a paid-for service just like a contractor, a teacher, or a consultant. But the patient/doctor relationship makes this service more personal. It can get persnickety because it involves our health (both on an emotional and physical realm). It’s only because patients used the internet to create advocacy and information we are starting to chisel away at what used to be a type of Knights of the Round Table club (but, sadly, some unvirtuous knights were allowed around the table, and their colleagues often covered for them. You know the……all for one…one for all…..type of banter).

        Have you seen the newer website profiled in Forbes recently? I think it’s titled something like, Doctors Behaving Badly? It’s informative and an expose to help patients steer clear of bad doctors (and I should know my daughter had undiagnosed cancer that spread because a specialist misdiagnosed her twice, and cost us about eight months of time). I plan on telling my story ad nauseam to help others. If I were WarmSocks I would comfort myself with the knowledge that often the people you help don’t write (usually because writing causes great insecurities as you lay your emotional self out there for the world to see). I tend to think it’s, ultimately, worth it if you can help others. I believe patients are changing the face of the medical community for the better (not so sure about the government, but surely, doctors behaving badly brought about more regulation to help the patients).

        On that site there is a map with tiny icons representing doctors and it takes you to google maps where the bad doctors will show up as an icon. They don’t have many for my state yet, but they sign up patients and journalists and take newspaper reports, etc. to do what the state medical boards won’t. I think it’s a great service they are providing the public, but it’s a work in progress. It’s also a great service when patients are willing to accept that negative feedback may very well be on the heels of their own personal stories…..but keep telling them….people need to know they are not alone.

    • Thank you. I asked for feedback.

      I really felt like the first commentor jumped to the assumption that the the right dose had been prescribed, without considering that perhaps a mistake had been made.

      I checked the site you linked. It says 100mg is an acceptable dose for extended release, which is not what I was taking. What I took is supposed to start at 25mg per day. I’m not exaggerating when I say that the overdose could have killed me. I feel lucky to be alive after that.

      Bruce jumped to the conclusion that I wonder at poor outcomes. False.

      I appreciate the feedback. I’ll try to edit my posts a bit more carefully in the future.

    • With respect Teri I suggest you read that page a bit more carefully. 25mg is the normal starting does of Tramadol and it should be titrated upward gradually, just as Socks mentioned. The page states that 100 mg may be acceptable in cases of severe pain where immediate relief is desirable, but also makes it clear that this should only be done where the benefits of immediate pain relief would exceed the risk of discontinuation from starting at such a high dose. In other words, starting at such a high dose is more likely to produce adverse effects which are not necessarily the result of “sensitivity” so much as the dosage involved.

      Dismissive behavior like that of the doctor in question can result in patients failing to be properly diagnosed and thus suffering pain, injury or death. His behavior was disgusting and unprofessional, and calling him an obnoxious jerk was pretty mild compared to the emotion he would generate in any rational person. Socks was not overreacting when you consider this man was putting her health and possibly her life at risk with his arrogant stupidity. Her response was pretty tame, indeed.

  3. There is nothing wrong with your writing or how you presented yourself. Your tone was measured and civil, and your writing clear and concise. It isn’t that you weren’t making yourself clear, it’s that some just don’t want to hear what your saying, so they don’t. With the exception of JSmith who is a pretty decent guy, most of the posters completely missed the part where a doctor dismissed your problem with “it’s all in your head” hand-waving, and how this led you to be understandably reluctant to discuss your medical problems with him. Without any sense of irony at all they jumped to blame you on a post about doctors blaming patients.

    To put this in perspective, how many patients do you think are injured or killed every year by doctors dismissing patient symptoms with pseudoscientific quackery like this? How many are injured psychologically, or come to distrust doctors as a result of interactions like this, which are appallingly common? How many patients have suffered and died as a result of that particular doctor’s dismissive and unprofessional behavior?

    Now let me ask you this: how many people have you injured, abused or killed this year? How many have you bullied? Not a one, I’d wager. Yet somehow you’re the problem, not the doctor.

    Could the bias here be any clearer?

    It’s clear to me you’ve thought through these issues and your post on “making demands” was excellent and insightful. For what it’s worth it’s doubtful many doctor blogs out there would publish something like your article as the profession as a whole just isn’t willing to deal with criticism from patients or face up to the severe flaws in the system. Kevin MD is the rare exception that will allow critical patient input, though his moderation policy has become a bit heavy-handed of late. {-}

  4. WS,
    There is absolutely nothing wrong with what you said or how you said it. I’m saddened that there are often two clear sides: doctors and patients. Clearly we both need each other. And, I’ve found you to be quite objective in your views as a patient. It’s unfortunate that it seems as though no real dialogue can become ongoing about patient needs without someone interpreting them as demands.

    Thank you for posting as you do. It takes great courage and you are speaking for so many of us who don’t or are unable to put similar/same views into words.

  5. I thought the postings were right on target. We all have some bad experiences with healthcare providers in our medical history. I had a surgeon break a bone in my hand during surgery once and never told me (I discovered it when I got the hand scanned for another reason about a year later). I could go on and on — we all could.

    And yet physicians and nurses could go on and on about bad experiences with patients. I’ve been one of those too. I cursed like a sailor at all the docs and nurses in recover and on the room floor after another surgery. Turns out the anesthesia completely changed my personality.

    There are so many variables from both sides — patients and providers. It would be nice if we could all remain open-minded and learn to LISTEN to each other. If a physician doesn’t listen to me the first time I see him/her or makes me wait for longer than 20 minutes, I’m outta there and I file a complaint with my insurance company and instruct them not to pay the doctor visit bill.

    Yeah patients do have to make demands sometimes. Not that it always works but once you walk out on a doc, there’s a chance they’ll take you more seriously.

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