Medical Tyrants – they are rarely the doctors
I first became conscious of medical tyrants when I was referred to an oncologist. His name was ABC XYZ. I had seen XYZ used as a surname and first name before, and was unfamiliar with the origin of the first name. I typically check out new doctors just as they will check me out.
I called to inquire about which was his first and last name. “He’s a very good doctor.”
I’m sure he is. What is his legal name? “Everybody likes him.”
I’m sure that’s true. Please tell me his name or put your supervisor on the phone. “He’s very well-educated.”
Supervisor. “She’s very busy.”
I’m sure she is. Please transfer me to her and don’t hang up until she comes on the line. “Sir, my time is valuable.”
And mine isn’t? Transfer. Supervisor. Now. “Dial Tone.”
Eventually doctor and I met, became friends, NRI born in US, properly educated, personal friend of my family doctor. I had a brief conversation with “office manager,” really head nurse, and explained that not everybody holds doctors with non-English names in suspicion, I merely wanted to check his credentials as he would check mine.
Later, in check-in line in his office, woman claimed she had appt with doctor DEFG for ten a.m. Front desk clerk demanded to learn who had called her. She didn’t know, it was a prerecorded call from the office. “Until you can tell me who called you, I can’t help you.” Patient wound up fleeing in tears. In an oncology office. I told clerk she had an exciting new career ahead of her just as soon as I could talk to her supervisor and the physician.
Decisions are made every hour about patients by people with insufficient information to make such decisions. I visited the supplemental oxygen supplier to whom my physician had earlier referred me to be fitted for a bipap machine, used to treat hypercapnia, a condition treated by flushing excess dissolved CO2 from the lower lungs using high-pressure oxygen. The fitting technician was unaware of how hypercapnia was treated, and supplemental oxygen and the bipap had to be on the same sheet of paper before they could submit it for insurance. I offered to self-pay. “No.” She had a form to complete and nothing would dissuade her from her mission. We left with the useless machine
My wife asked me if I wanted the machine assembled tonight or tomorrow. “Neither.” She’s indignant, so is my younger daughter. “Just try it.” Flushing the lower lungs with room air (about 75% nitrogen) doesn’t work and just might kill me. Unimportant details. “Monitor the O2.” O2 will show up to 100% as I die. Need to measure blood gasses to be read by a medical professional. Who gets the information? “You do.” How does that help? “So you can monitor the oxygen. Thank you. Following her instructions would endanger my life.
I was seen by an NP (Nurse Practitioner) in a dermatology clinic who diagnosed eczema and prescribed a topical cream. It seemed not quite right to me. On an ambulance visit to an ER caused by untreated hypercapnia, the ER doc noted my psoriasis. That send me scrambling for peer-reviewed professional papers. All forms of psoriasis are autoimmune. I have an autoimmune disease, rheumatoid arthritis. I know of no autoimmune diseases treated only with topical creams.
Finally got in to see Dr. Unpronounceable, a board-certified dermatologist. Took two biopsies, wants me back in two weeks for blood work. He sees all patients first, makes diagnosis and creates treatment plan, turns over execution to RN, LPN, MA as appropriate. That’s how you treat patients. By the way, 95% of eczema diagnoses are made in children under ten; I’m almost 74.
The greatest medical problem facing me is misnamed Normal Pressure Hydrocephalus. Most medical professionals know the correct term should be late-onset hydrocephalus. It will kill me, either next month or next year, or some other time. No other options. I was asked by a nurse in a hospital if I had any concerns; I told her about my NPH. “Well, if it’s normal, there’s no problem.”
This list goes on and on. There must be something in nursing union contracts about responding in 15 minutes to calls. After asking for a nurse, I get a response more than two hours later and an explanation from the nurse that she only received the notice 14 minute earlier. This occurred both too often and in too many separate hospitals for it to be coincidence.
I remember phoning a hospital front desk to learn if my scheduled surgery would occur on time. I was assured it would, and was told to feel free to eat a light meal before surgery. I sequentially requested, asked in a stern voice, and demanded to have the instructions confirmed by a medical professional. I heard from the surgery center immediately. Do NOT take anything by mouth for at least 12 hours before surgery, period. You’re placing yourself and us in danger.
There are gradations of medical personnel and knowledge. I know when visiting a pharmacy that if the instructions are at all “hinky,” to talk to the PharmD. That’s an entry-level professional position, a clinical doctorate. Those beneath them, pharmacists and pharmacy technicians, cannot speak authoritatively. No matter how many years of practice they’ve had. The thinking was that if they held Doctorates, they’d make more money. The problem is that regardless of what your name tag reads there’s only so much money to be spent on pharmacy services. The same applies to physical therapists. They followed pharmacists down the rabbit hole. Now, to call one’s self a physical therapist, one needs a clinical Doctorate. It doesn’t create any greater demand for physical therapy services.
Even among doctors there are degrees of knowledge. I saw a colleague of my primary care provider for what I suspected was not eczema. She looked and told me she didn’t know, which is a GREAT reply. A physician who knows her limitations is the best kind. She noted she could provide symptomatic relief, and wrote two prescriptions, which are working well. I see a real dermatologist next week.
I selected my primary care provider in Northern Virginia because he knew his limitations. I had seen him in the Family Practice teaching organization where my wife worked as a Medical Assistant. As family, I could see anybody I wished. I asked to see someone who had never dealt previously with my condition, trigeminal neuralgia, because I wanted to expose them to the condition. It is rare; it is even rarer in males. I had bilateral trigeminal neuralgia (both sides), which is a black swan in a male.
When Reuben (my neurologist) arrived on site, he asked in blunt terms why he had been called. “The patient knows as much about the disease as I do.” The lesson was not lost on him. He learned to listen carefully to patients and to ask better questions.
As I thought back, I found other examples. The family physician I had seen in the 1980s whose front desk would schedule appointments beginning at 8 a.m., even though the doctor never arrived before 10 a.m. The medic who gave me a controlled substance, and who became irate when the doctor asked what I had received to this point. I wasn’t going to lie. As I ponder it, I find the examples are endless.
My wife and I have taken cruises as our primary means of vacationing for more than three decades. Those days are over; I can no longer travel. My first stop in all cases is at the medical office, where I volunteer as a translator. Most take down my name. It only failed in one case, where I told the physician that Nederlands (we call it Dutch) is simply a dialect of German, and my German was near-native. The doc said “I speak a little German myself” and thereafter ignored me. Such is life (and death).
Just letting you know I received and responded to your email. Getting error messages perhaps for a second recipient of your email with attachment today.
this was heartbreaking and so accurate. As a nurse that has watched the healthcare system evolve into a sea of piranhas, my heart goes out to you and everyone that is having to deal with this market. Thank you for sharing this with all those that will listen.