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Miscellaneous thoughts and ramblings
Sunday, October 02, 2005
I'd Like to File a Complaint
Doctor Bean: I think your husband's a little better today. I think after a few more days of intravenous antibiotics I'll be able to send him home.

Patient's wife: Oh, thank you. That's good news. But you know the nurses have been ignoring him all day. He calls for help to get to the bathroom or for his pain medicine and the just ignore him.

DB: Wow. I'm sorry to hear that.

PW: Well I think it's unconscionable, leaving a sick man like that.

DB: I hear you, but you know the nurses at the hospital don't work for me. They work for the hospital. For what it's worth I can tell you they're better here than at the University hospital.

PW: He would call and wait and wait and they just wouldn't come.

DB: You could talk to the nurse supervisor. She could find out what went wrong. Or the Hospital Patient Liaison Office could talk to you and get to the bottom of it and try to make sure that it doesn't happen again.

PW: Well, I can't believe you're taking their side. I thought you cared for my husband.

DB: I'm not taking any side. I hear how dissatisfied you are. I'm just telling you that I have nothing to do with training or disciplining the nurses and I'm pointing you to the people who can help.

PW: Well ... alright. I guess the important thing is that he's getting better. Did you test him for everything?
My previous reflections on doctoring:

Test Me For Everything
Vitamins = Crap (Mostly)
You Should Know Better Than That
I Really Appreciated This Visit
If I could be a doctor...
If I could be an astronaut...
Gawsh, You’re Awful Purdy!
Going Around
What Is It?
The Secret To Longevity
Thank You, Doctor
Senior Sadness
Shit, even complaining to the doctor about things he/she CAN effect is pretty much a waste of time (sorry, I couldn't stop myself) ;)
Just so long as it's clear that it's ALL your fault.
It would have been nice if you (as his doctor) could've at least made a call and expressed your displeasure at the way your patient was treated.
This post stinks.

I wrote it immediately after my conversation with the wife and didn’t spend the time to read it with fresh eyes. It stinks for many reasons, and I will list just a few:

a) it was supposed to be funny. It is not. It may be funny if I read it wearing a rainbow wig and no pants, but as it stands it lacks what Lileks calls har-dee-har.
2) The back story contained many important bits of info that I took for granted that upon rereading the post I realized I omitted. These important bits of info are: the hospital in question has pretty good nurses; the nurse in question had bent over backwards to attend to and accommodate my patient, so much so that she was spending less time with her other patients; the wife is an anxious wreck because of her husband’s declining health, and has been bringing to my attention myriad other perceived problems. In this context (and here’s the important part that my post totally missed) I didn’t believe the wife for a second, and was trying to just placate her without giving the nurse any more undeserved grief.

Stacey’s comment was perfectly reasonable and made it clear that I wrote like an irritated moron and clicked “Publish” before reading what I wrote. I initially considered drowning myself in the toilet. Then I thought I would just delete the post, but I thought that wouldn’t be fair to Stacey and would only cover up my lameness.

The end of the story is that the patient is home, the wife is calmer and she called me today about an entirely reasonable concern which I think I handled with warmth and professionalism. She didn’t know I wasn’t wearing pants.
I'm not wearing pants.
Much to the disdain of my co-workers. The cops seemed pretty startled too.

Watch out for the Shmata Queen. She is detail oriented and she will catch you, I know. Whew. ;)
However, it is true that as the doctor you get blamed for everything. From the receptionsts to the billers. From the ambulance driver to meal service at the hospital. It's all your fault, and as an MD, you sit and take it, because to deflect it is petty and unprofessional.

Just smile and carry a big gun.
Og: I'd bail you out anytime.

Jack: She was right to catch me.

Psychotoddler: The buck stops with us. You're right. BTW, why the sudden upsurge in gun talk?
Dr. Bean: I am glad you decided not to drown yourself in the toilet. That could've been ugly. :)

Thank you for responding. I truly appreciate it.

Due to my own varied experience with doctors, I am very sensitive to the way patients are treated.

I had never much been to the doctor until 5 years ago when I got sick on a trip to Israel and never got better. After a year of bouncing from GI to GI (and being told everything from "it's in your head" to "you must have a troubled marriage" -- wtf??) the 5th one I went to scoped me, diagnosed me and cured me.

For each pompous, ignorant, and condescending doctor out there I believe that there is another who is kind, compassionate and wonderful.

One of my own doctors gave me his personal home email address and pager # when my father took ill earlier this year and told me to contact him anytime, whether he was on call or not. And my father wasn't even his patient. What this man did for my family was so above-and-beyond that I will never forget it.

And I have a few others who are just as amazing. But it isn't easy to find these. Many seem jaded.

I read some of the other "doctor posts" on your blog and I can tell that my initial assessment of you was wrong. I apologize for that. (I really liked the one entitled "Thank you, Doctor.")

I truly believe that there is no more noble profession in this world than the medical profession. How many others get to save lives?

Best wishes for a healthy and joyous new year.
Stacey: Awww. Thanks. A healthy and happy year to you too. Your initial assessment is sometimes right, but I try to do better. And this blog is by no means a reflection of me at my best. On the contrary, it's a place I can anonymously vent my worst aspects -- the ways in which patients make me frustrated, amused or contemptuous. Because I take my calling seriously, these sentiments never see the light of day in my "real life".
Stacey: So, now I'm curious. This is personal, so if you're not using an alias and would prefer we didn't know, just change the subject, but now you've tickled my medical interest. What did you have? Celiac disease? Giardia? Inflammatory bowel disease? Hmmmm... Anyway. It's none of my business, but I'm glad someone took good care of you.
Gun talk? Gun talk? I don't gun talk gun much about guns! gun.
This blog needs more cowbell. And guns.
Psychotoddler: Get your finger off the trigger there, cowboy.

Og: OK. Here you go (sound required). And ... here.
"What did you have? Celiac disease? Giardia? Inflammatory bowel disease?"

No, none of these. After a year of being in pain and bouncing from GI to GI doctor, I finally had an EGD.

But the year until I was diagnosed was sheer hell. I had never had GI issues in my entire life before this.

I told every GI that I got sick in Israel and never got better...you think they would've ordered stool cultures, but no...they just threw drugs at me to empirically treat me. One gave me Flagyl which was 10 days of torture. Another GI told me he thought it was skeletal muscular and gave me Methocarbamol. (It should've told him something when that, too, made the pain worse).

GI #3 told me I was depressed and said to try an anti-depressant. My answer: "You don't know me from Adam. You have talked to me for 3 minutes and decided I am depressed? The only thing upsetting me is that I got sick and never got better. I know there is something organic wrong with me. I want TESTS. You can take your anti-depressant and shove it up your @ss" and I walked out.

Gi #4 did not let spouses in the exam room in case the stomach problem was marital related. Unbelievable. And these were all GIs at respected medical institutions here in Dallas.

I walked into the 5th GI at Baylor U. here in Dallas and told him that I wanted to be scoped. A year was too long to suffer. He said it sounded like IBS and he'd rather I try taking a probiotic first. I told him no, and that I believe IBS is a catch-all diagnosis given when nothing else is found. (I still believe that, btw). I told him I am sick of doctors taking shortcuts. I told him I wanted stool cultures and other tests.

He finally agreed to scope me. When I awoke he told me that my duodenum was covered with ulcers. He also said that my stomach was striped with severe gastritis. (I still have the pictures).

I was so elated that something was found (after a year of doctors insinuating that it was in my head) that I was jumping for joy. He told me that he'd never had a patient so happy to have ulcers.

He took lots of biopsies. They revealed a virulent form of Helicobacter Pylori -- a strain common in the Middle East, which is where I was when I got sick. I felt vindicated.

I took the triple therapy of Clarithromycin, Amoxicillin and Prevacid for 2 weeks and felt as good as new, AFTER SUFFERING FOR A YEAR, EVERYDAY. I even put off having children because I felt so awful.

To me, the moral of the story is to advocate for yourself. You know your body and mind better than any doctor who's met you for 3 minutes. If you think there's something wrong, there probably is. After 30+ years, I know how my body reacts to stress and I will be damned if any doctor ever again tells me that something is caused by stress when I know otherwise.

Incidentally, I was thrilled last Monday to learn that Dr. Barry Marshall of Australia received the Nobel Prize in Medicine for his discovery of H. Pylori. He also was treated horribly by the "establishment" who brushed him off and scoffed at him as a young, unexperienced doctor when he suggested that most ulcers are not really caused by stress, spicy food and caffeine -- but by a bacteria. He was completely ignored until he swallowed the H. Pylori and cured himself.

I owe him a debt of gratitude. I would still be suffering today if not for him. I am thrilled he won the prestigious Nobel Prize. He changed the face of gastroenterology. Now there are studies being done into possible bacterial causes for IBD, atherosclerosis, etc.

So there's my story (probably more than you ever wanted to know)! :)Sorry to have written a book.
More cowbell for those who really like it.
Stacey: Holy cow! The reason that I guessed the diseases I guessed is that they're kind of obscure and I figured it would take someone very attentive or clever to figure them out. Helicobacter pylori associated gastritis and esophagitis is common as dirt and any decent GI doc should have considered it. Now, I have to be careful, since things always seem obvious in the retrospectoscope, and if this was 10 to 15 years ago when H. pylori was first being understood, lots of doctors might not have heard of it yet, but barring that, it just sounds like you got lousy care. I totally agree that you have to be your own advocate. An informed assertive patient intimidates some doctors but I find that (unless she/he believes completely different things about health and disease than I do, i.e. my symptoms are caused by Candida or the feng shui in my office is giving me liver qi stagnation) he/she usually helps me figure out the diagnosis and put them on the right track. I'm delighted you're better. Here's a croissant, on the house.

Jack: Hillarious. Thank you.
My pleasure.
I know a number of people who came back from Israel with gastrointestinal problems of some kind. Any way to avoid that?
Irina: Vacation in California.

Kidding. Kidding. A little joke there. A trip to Israel is a great way to (1) reconnect with your Jewish roots (2) make memories that will last forever (3) inject badly-needed money into Israel's economy and (4) challenge your intestines with new and exciting bacteria. To avoid (4) check out the CDC recommendations for travel to the Middle East.
Stacey: Unless it is too late, you might want to look into marrying a doctor. There are many downsides, but the upside is terrific medical care. ;)
Doc Bean: Yes, I would love that croissant. (My cholesterol is nice and low so I will overlook that it is a carb and indulge)!

Yes, the whole situation was awful and it consumed an entire year of my life. I wondered if I'd ever feel better again. This was 5 years ago and it is thankfully in the past, but man oh man did I learn from it.

I was even proactive and read up on health concerns much like the web-site link you provided. I even had the Hep. A. shot before I went.

I have since learned that even the bottled water is not safe over there. I should have stuck with Coke. And one of the wonderful doctors I now have said he would never have let me gone over there without taking Cipro while I was there. You live and you learn.

Ball-and-Chain: It is too late to marry a doctor. But my husband's sister and both parents are doctors. They are the ones who told me that I needed to demand tests and to get scoped. And I have always had a huge interest in medicine myself. In my next life I will be a doctor. :)

All I know is that there are so many CRAPPY doctors out there.

Don't even get me started....(I spent 2 weeks at the Mayo Clinic in MN this summer with my father who took very ill this past year and couldn't get properly diagnosed).

Anyway, time for that croissant. Yum.
Too bad you are stuck in Texas and not out in LA with the finest medical care anywhere. ;)

Nothing like sucking up to the host.
Actually, the Cleveland Clinic is rated higher than Cedars-Sinai (or any other L.A. hospital) in all categories. Where you live is not the end-all.
You know, the same thing happened to my cousin, here in L.A. She had stomach problems for years, went to a special "doctor" who diagnosed her with multiple "allergies." Let me tell you that Thanksgiving was no fun; no wheat, pepper, I can't even remember the details. Anyhoo, after quite awhile of this nonsense, she found out she had H. Pylori, took the antibiotics and was cured. Much like you, she suffered for years. Through a pregnancy, if I remember right.
How awful, B&C. Thank goodness she was was cured and finally feels better. I can totally empathize with what your cousin went through.

There is a blood test for H. Pylori, but it is not always accuarate (the breath test is better, but biopsy is the gold standard).

Anyway, I was given the blood test for H. Pylori by GI #3 and it came back in the "indeterminate" range, which means the moron should have done further testing. But instead he told me it came back negative.

Only when I switched GIs and demanded a copy of my results did I see that it truly came back more on the positive side than on the negative.

That's another lesson learned. I always get a copy of EVERY SINGLE test result I've had, whether it be a blood test or radiology.
Knowledge is power.
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