The Business of Medicine

It never ceases to amaze me that medical businesses are not run like a business.  Every business cross-trains employees so that if somebody is on vacation or out sick, the critical elements of that person’s job are performed.  Apparently that isn’t true in medicine.

My GI referred me to Virginia Mason for a lithotripsy and ERCP.  I could have the ERCP locally, but I’m told there’s no point since it needs to happen after the lithotripsy anyway.  I have to go to Seattle for this one.

I waited a week, then called the GI back:

Didn’t you say they were going to call me to schedule an appointment?

Yes.  They will call you.

Any idea when?  I had hoped this would be done by now.

Let’s see, I sent that on the… oh, my!  You should have heard back by now.  I’ll call them and make sure they got our fax.

Thank you.  Do you think I could get their phone number, too, and call them myself?

A call to the place I was referred got me the run around, but eventually someone told me that the person who handles referrals was out of the office for a week and a half, so it’s taking a while to get through all the referrals that accumulated while she was gone.  No, they would not schedule an appointment for me until their doctor said so.  The doctor did have my information, and they’d call me in 1-3 days.

Three days came and went.  A week later I called the GI office back and left a message asking if they could light a fire under Virginia Mason.  This isn’t a plea to fit me in sooner.  Just call me and schedule an appointment!

A few days later, GI called me back and said that Virginia Mason says they’re still working on it.  You’ve got to be kidding me!  My nine year old knows how to dial the telephone, talk to the person on the other end of the line, then write something on the calendar.  What is the problem here?

Imagine if your furnace quit working and the repairman said that he couldn’t schedule a repairman, but he’d get back to you in a week or two to arrange a good time for someone to take a look at the problem.  What if it was 20 degrees out, the faucets in your house stopped working, and there was a stream of water running out from beneath the house?  Would you do business with a company who wouldn’t return your phone calls or send someone to investigate the problem, or would you call around until you located somebody who wanted the job?

I asked GI to please find someone who actually wants my business.  Monday I will be on the phone looking myself, even if that means finding a different GI in a different city in order to get a referral to someone who will actually make appointments and see patients instead of sitting on their pile of faxes.  There must be somewhere else that this procedure can be done:  UWMC, OHSU

The Surgeon

If you want to read some great writing by a surgeon, try Bongi at Other Things Amanzi or Dr. Bates at Suture for a Living.  Unfortunately, the surgeon to whom I was referred wasn’t like either of those doctors seem to be.  He was nice enough to start with, which was good since I was very nervous and didn’t want to be there.  Once the small-talk was over, he changed.

If I have received questionable medical care, I would hope that another person with enough knowledge to recognize the situation would step in and let me know.  When a person criticizes the medical opinions of everybody else on a case, though, and insists that his knowledge is superior and everyone else is wrong about their areas of expertise, it doesn’t look like he’s helping me avoid bad advice.  It looks like he’s an arrogant jerk.

He criticized my gastroenterologist’s diagnosis.  “Any smart person would know that gallstones cause pancreatitis.  That had to be the cause.  Go for the easy reason.”  So my highly respected gastroenterologist isn’t a smart person?  He was the head of a medical school’s GI department for twenty years! He inspected all my ducts and insisted there was no stretching or scarring or any other evidence of any stones being passed or obstructing things.  I think he knows what he’s talking about when he says he expected to find stones, and went looking for them, but couldn’t find them.

He criticized two radiologists and my other gastroenterologist (yes, I have more than one; they are in the same practice and bounce me back and forth depending on what needs to be done).  According to the CT scans, the occasional pains I feel just beneath my lower ribs on the left ought not to have been ignored (just like gallstone pain, only on the other side).  According to GI and the radiologists, the diagnosis is chronic pancreatitis rather than acute.  This surgeon insisted that only alcoholics get chronic pancreatitis, so those three doctors are wrong:  my dx must be acute no matter what the CTs show.

He criticized my family physician for prescribing a medicine so that I can eat without getting abdominal pains.  In a tone that implied he knows everything, I was informed that he’d never heard of using that medicine for this problem and I shouldn’t be taking it.  It might not be the most common use, but I didn’t have any trouble finding information about it being used for pancreatitis.  Even more important, it allows me to eat.  Sorry if you never heard of it, but that just demonstrates to me that you don’t know everything.

The appointment went on, and this was one time that I really wished I hadn’t provided full information to the doctor.  When he learned that I’d had my first gallbladder attack fifteen years ago, he yelled at me!  I was informed that repeated attacks generate scar tissue and make his job harder.

I thought “watchful waiting” was an acceptable approach to medical problems.  Even if it’s not, what, exactly, am I supposed to do about it now?  Complaining about the difficulty of the job is out of line.  Yelling at the patient is uncalled for.  It doesn’t exactly make me want to put my life in his hands.

I didn’t know if he was just living up to a surgeon’s reputation, or if I should start looking for someone more knowledgeable and professional.  Back I went to my family physician to see if this surgeon is really the best person for the job, or if I could perhaps get a different referral.

Yes to both.

My doctor realized that obviously there was some reason for my question, so he would write a referral to a different surgeon if that’s what I wanted.  He was surprised, however, that this guy yelled at me because from his experience, that’s very out of character.  This surgeon is usually a really nice guy who defies the arrogant surgeon stereotype.  He’s also a very good surgeon.

My doctor suggested that maybe the surgeon was just having an off day.  Since it’s not so long ago that I yelled at the clipboard brigade, I wholeheartedly agree that everyone’s entitled to a bad day once in a while and deserves a second chance.  This is where it helps to have a long-term relationship with a doctor you trust.  Since my doctor says this guy’s the best and not normally a jerk, I decided to try to ignore the fact that he was way out of line during our initial appointment.  After all, I did want the best person possible to perform my operation.

The surgeon was back to his initial “nice guy” persona in the two minutes I saw him prior to the surgery.  We’ll see how follow-up goes.