Doctor Frustrations

[susiestar]

I am thinking about switching doctors. For the reg doctor part, not for the specialists. I need someone who will work with me and with the docs.

Each of my specialists has shown me letters they have sent to my reg doctor after each visit. They show diagnosis, medications, procedures, recommendations, etc... The usual stuff. When I saw my doctor she had NONE of these in my file and said that none had come in. I find it hard to believe, esp when I have seen the copies at the other docs' offices.

I called several weeks ago. I needed to have some tests redone to see if the thyroid medications were at the right level and if the changes in diet and movement had made changes in the other blood work. also to see if they got the approval for the bone scan and mammogram that I need.

So far I have placed 6 calls to her nurse detailing these things. The pharmacy has tried to get her to auth refill of the thyroid medications. I am now out, no refill is authorized and I cannot pay for an office visit. Lab tests, bone scans, mammograms are all paid at 100% so if she could call in the orders I can get them done. I have gotten NO reply.

Over the years I have had a LOT of problems with her nurses. One told me I did not need help for fibromyalgia and that I needed to go to a psychiatric hospital because I was faking it. All I did was call to ask to have one medication lowered because I was having side effect problems. It was NOT a medication for fibromyalgia and I did not bring up anything related to that, or to pain.

The next nurse took months to submit things to the insurance company for pre-auth. The doctor would give her written orders to schedule things right in front of me, showing me the orders first, and giving verbal orders that matched the list. Then I would have to call over and over and over because the nurse wouldn't bother to do them. It literally took over 2 months to get an MRI of my spine so they could refer me to a surgeon for the spine problems.

The current nurse doesn't return calls and doesn't take messages to the doctor. I cannot even get faxed notes given to the doctor. I LOVE this doctor. She is really really excellent at what she does. Is understanding, gentle but firm, and compassionate. She doesn't talk down to me and doesn't take any bs. If you need something she is happy to help you, but if you want a quick fix for something and it won't help she will tell you up front.

If you go ahead and do it then she will help you with the problems with-o even saying "I told you so".

I just don't think that it is a coincidence that every nurse she has had in almost 9 years has had these types of problems. I am sure the doctor is not aware of most of what goes on because I don't think she gets many of the complaint calls. The times I have told her in person of the problems she has been shocked and unhappy. Nurse #1 was fired or reassigned because my report, but the problems didn't stop happening.

Right now I need a doctor who will work with me. Who will understand that $$ is tight and routine tests can be ordered before the doctor visit if we have already talked about needing them to happen. We spoke about the tests I need when I saw her a while back. When I couldn't pay for an office visit to get the second round of tests ordered it should not have been a big deal. I would have found a way to come in if the tests showed a big problem, but if they showed what was expected we could have handled things on the phone. If it was a problem to do that, esp when we had already talked about it, she could have had the nurse call me.

Instead I heard nothing. No tests were ordered when I checked with the lab. I couldn't get anyone on the phone.

Is it time to find a new doctor? Jessie is seeing a family practice doctor that I really like. I could switch to her fairly easily.

Or should I stay with my doctor and keep trying to get in touch with her? I still would have the record keeping problems because letters from the other docs would likely never show up in my file.

It wouldn't be a hard decision if I didn't LIKE the doctor.

 

[Josie]

I would switch. Even though you like the doctor, you don't like her office staff and that is who you are really dealing with.

I like my dentist, but I don't like her staff. They called me at 7:30 am to tell me it was time to schedule a cleaning! husband had many more problems than that, including problems getting records sent or received, and left. I haven't left because I am not dealing with them very often. Her office staff has been overly aggressive about scheduling for years, through turnovers, so I have concluded that is the way she wants them to be.

Your doctor probably wants things done differently, but hasn't done a very good job of training or supervising her staff. Even though you like her, she/her practice is not meeting your needs.

 

[klmno]

I would start up a conversation with another patient in the waiting room and try to find out if this is a typical problem for other people. If it is, I would politely have another talk with the doctor or business manager or both together. If that doesn't result in improvement, I would switch.

 

[Marguerite]

I think you need to schedule an appointment with your current doctor to hand over a letter detailing your concerns. Also if you can, get copies of letters from specialists to hand over personally at this appointment. Don't hand over your only copies - make sure you copy them yourself so you can make the switch if you choose.

Some doctors don't like organising things like repeat prescriptions, without the patient being physically present. It used to be the case for us here, that if I needed a repeat of my regular medications, I could drop in and ask the receptionist in passing to organise it, or get the pharmacist to request it. But then our system changed. At first I thought it was just the doctor's practice that was insisting on personal attendance but then I heard it was happening everywhere - our government and dept of health were clamping down on doctors prescribing at a distance.

Your doctor MUST know more about her staff than she lets on, but she can act shocked and surprised so she's not the bad guy. Paperwork is a big issue for some doctors, they insist on reading it all before it gets put in the file, then they never get around to reading it. If I worked for a doctor like this, I would probably be a bit disgruntled too.

This could be a case of staff being both judgmental of patients and protective of their boss; but it can't happen with a boss who is really on top of the administrative stuff in the workload.

Doctors have to keep up with their reading - not just incoming reports, but also the latest research publications. A doctor who doesn't do this is a doctor whose knowledge and capability is decaying.

I'd be moving on, I think, but at least let the doctor know why and give her a chance to lift the practice's game. I'm betting, though, that her response will be, "Sorry to see you go; I wish you all the best" and then do absolutely nothing about the staff, because what they ARE doing is shielding her from all the hassles of patients with problems.

I really hate it when nurses interfere inappropriately with medical treatment. I've also got similar problems to FM, I've generally been treated well but occasionally there have been big problems, due to someone judging me inappropriately. I had a really raw deal in the hospital when difficult child 3 was born; the specialist had ordered all my usual pain medications (prescribed originally by pain clinic, so it wasn't simply a case of me abusing prescription drugs without proper medical supervision). The nursing staff "lost the key to the drugs cupboard" which, on a floor with post-caesarean patients, was a ludicrous claim. When I said, "Isn't it a good thing I brought in my own supply?" the staff wanted to take my tablets off me. I said, "Where are you going to store them? You have lost the key to the drugs cupboard!"

The interesting thing there, was that although my obgyn had ordered these medications on my file, he didn't do anything to stand up to the nursing staff. Instead, he took the easy way out and let them be the scapegoats, without making them accountable. I later realised he was a big part of the problem. Feet of clay.

No matter how much you like this doctor, she is not meeting your needs and frankly is just too much trouble.

Marg

 

[klmno]

I think you need to schedule an appointment with your current doctor to hand over a letter detailing your concerns. Also if you can, get copies of letters from specialists to hand over personally at this appointment. Don't hand over your only copies - make sure you copy them yourself so you can make the switch if you choose.

Great idea!!

 

[susiestar]

I have already gone to her twice over these problems. The first time she seemed truly shocked and asked other patients if they had problems with the nurse. I know because she called several friends of mine who all had problems with her. If the nurse thought you were on too many medications she would not pass on refill requests even from pharmacists. Several of my friends have had severe complications because maintenance medications were stopped abruptly. One ended up in a psychiatric hospital because her antidepressant was stopped by this nurse who felt that she should "get over it" and that depression is not a medical condition but a sign of weakness that you can just "get over" if you really "want" to. Another ended up in the ER with seizures because a medication that prevents headaches is also an anti seizure medication and was stopped by this nurse's decision that if you have more than 3 medications the oldest one needs to be stopped immediately.

The doctor was shocked, esp because the nurse noted in each chart that a specialist was treating the problem. In NO case that I know of did the person see a specialist. It was a big mess.

The next one she said they "dropped the ball". However this is a big practice with many docs in many offices. I fail to see how any doctor can consistently wind up with nurses who act this way unless the doctor uses poor quality control methods. I generally would NEVER ask a doctor to do tests with-o an office visit unless I had already spoken to her about it. The doctor said it was no big deal to order the lab work with-o seeing her first. ALL the visit would do is have her write the order for the tests. Instead the doctor wanted me to call to ask to have the tests ordered. It was when I called and heard nothing after several calls that I got upset.

I will call a new doctor tomorrow. I don't want to spend $20 to address her administrative problems and then spend $20 more to see a new doctor. Having brought this to her twice before, I don't feel it is worth the energy to continue to address her staffing problems. Other docs in the practice do not have nurses that act this way. My rheumy and endocrine docs work for teh same company and they have incredible staffs.

Thanks all.

 

[klmno]

Given those details, I don't blame you for moving on now. I thought by your first post that you really like her or thought she was good and would like to keep her if it wasn't for this kind of stuff. But I'm with you on the frustrations of any dr or therapist who thinks they can bash a mental or physical health problem out of a person. That drives me bananas. Or the ones who say "just stop it" or "well, you shouldn't feel that way". What a waste of breathe. If I had $1 for every time a person tried to "cure" my familial tremors this way I would be a rich woman.

 

[susiestar]

The doctor doesn't feel this way at all. She keeps ending up with staff that does. Either she is not picky enough or she takes other docs' problem staff or whatever, I am just tired of dealing with it over and over. She is an awesome doctor in many ways. I have sent many friends there and they almost universally like her. The one friend that doesn't like her wants a doctor to tell her how she is feeling. We never like the same docs.

The doctor is really good at keeping up with research but she seems to be unaware of how her staff treats patients when she isn't there. I know others have complained about this. I just do not have energy to keep fighting it.

 

[klmno]

I've seen and worked in offices where things seem like this (different types of offices but businesses that offer services to people). It appears to me to be one of two things- 1) the "head" person, meaning the dr in this case, wants to be seen as the good guy to the client but intentionally hires people that will do what they really want done in their office no matter what the client thinks about it, or 2) the head person is two-faced as can be and doesn't have the guts to own up to the fact that they really are in support of that way of handling things or that they don't care. I was thinking before though that maybe a dr would have another person between herself and those others you're having problems with that was managing those others and maybe it was that manager who was really responsible for the problems. But, at this point it doesn't matter. If you'd made adequate efforts and she hasn't addressed them, I wouldn't continue to pay to go there either.

 

[janebrain]

Sounds to me like the doctor is a great doctor but terrible manager and supervisor. It seems to me there are a minority of people who are actually good at supervising others-I have certainly found this in most of my jobs. People who have expertise in their fields are often then expected to supervise others and they have no aptitude for it.

I'm glad you are getting another doctor. Sounds like this nurse enjoys the power she has in her position. My late father in law was a doctor with his own practice and sometimes they would have office staff who were not letting patients get through to them. When he discovered this the staff person would be fired. The staff were trying to "protect" him from his own patients!

 

[emotionallybankrupt]

I think you need to schedule an appointment with your current doctor to hand over a letter detailing your concerns. Also if you can, get copies of letters from specialists to hand over personally at this appointment. Don't hand over your only copies - make sure you copy them yourself so you can make the switch if you choose.

Marg

I really like this idea too, but I hear what you're saying about not wanting to spend money for a doctor visit for this. Here's what you can do instead--I did this for a different type of situation where the theme was the same, in which I needed to let the doctor know something important but was not willing to spend money to deliver the message. I would take the letter and other documentation in hand to the office and ask them to stamp each sheet "received" by their office, date it, and sign that it was received. THEN for them to copy that and hand back to me. If it's just a sheet or two or even three, that shouldn't be too much trouble for them.

The alternative would be to take duplicate copies with you, one for them, and one to be stamped received and handed back to you. They'll get the point that they'd better deliver the copies. You can always follow up with a phone call and speak with the doctor about your letter.

If you're REALLY lucky, you might be able to catch the doctor behind the desk, in the hallway etc. and just quickly say something like, "I know you have a schedule and don't need to talk with you at this moment, but I'd just like to give you THIS (give envelope), and if you'd like to discuss further, give me a call." I don't see anything wrong with just asking the receptionist to ask her to come to the "window" or whatever between patients so you can hand her an envelope.

All you can do is give it a reasonable try, but I would not invest too much time, energy, or money getting my point across on this. Just your leaving should send a message, and you're right. Nobody's paying you to fix their office problems.

 

[susiestar]

It is a nice plan, EB, but there is no way it would work due to policies in this office. Receptionists/front office people are not permitted to give things to doctors. They give things to the nurses. Phone calls ALL go through nurses. There is no way that you can get someone to call a doctor to the phone - all phone calls must go through the nurses. They will take messages to the doctor and then bring what the doctor says back to you. NO ONE in this practice would call a doctor to the front window. You cannot see back to where the docs and nurses are, and there is no way to get back there until a nurse calls you because the doors are all locked on the patient side. They open to let you out, but not in. If I were to go and try this, it would alert the nurse that I have a problem I don't want her to know about. You can bet that there is NO WAY anything I brought in would be given to the doctor. On my last visit I heard a couple of office people laughing about a patient who tried to do something similar. They were laughing that patients can bring all the complaints they want, but unless it is a big enough deal to pay for the office visit there is no way to contact the docs.

It is part of what made me start thinking about switching docs. That attitude is NOT likely to change. I just spoke with a friend who worked there for a few months in the office. Apparently the nurses and staff all work together to keep patients from being able to contact the docs about problems. If they don't like you, or are bored, they will do even more. She was appalled at the way things like letters from specialists were treated - not put in files, not given to docs, read and laughed about by the entire staff and the docs ignore it. I won't go back after hearing that!

 

[klmno]

That sounds like how our people in court services unit act and manipulate which information gets put in front of the judge and which doesn't.

 

[emotionallybankrupt]

You can bet that there is NO WAY anything I brought in would be given to the doctor. On my last visit I heard a couple of office people laughing about a patient who tried to do something similar. They were laughing that patients can bring all the complaints they want, but unless it is a big enough deal to pay for the office visit there is no way to contact the docs.

It is part of what made me start thinking about switching docs. That attitude is NOT likely to change. I just spoke with a friend who worked there for a few months in the office. Apparently the nurses and staff all work together to keep patients from being able to contact the docs about problems. If they don't like you, or are bored, they will do even more. She was appalled at the way things like letters from specialists were treated - not put in files, not given to docs, read and laughed about by the entire staff and the docs ignore it. I won't go back after hearing that!

If it's such common knowledge that things are handled this way, and it's been going on routinely for this long, I see no way for the doctor to be innocent in this. I think she is hiding behind her staff, and the complaint would do no good even if it reached her. This is not the way things are done in my doctor's office, and if it did happen, I know my doctor well enough to know she would LET THEM HAVE IT.

I'd say spend no more time or energy on it, because it will do no good. Just move on.

 

[Marguerite]

EB, I agree with you. The doctor HAS to know, because some patients at least, would have used subsequent appointments to get a message across.

What SHOULD happen - you're at your appointment, you tell the doctor, "I saw Dr X (specialist) last month," and the doctor says, "I haven't received a letter from him yet." Then doctor gets onto intercom and says to staff, "Please check the files and see if letter from Dr X is there, it has been sent and should have been received already."
When staff come back and say., "letter from Dr X is not there," then the doctor should say to them, "Then get on the phone to Dr X's office now, immediately,while this patient is sitting here, and get them to fax a copy across."

Even if the doctor doesn't do this, there mus tbe enough patients complaining about her staff, at their next appointments, for her to know at some level that there is a problem. But the doctor has a quit life away from patients' problems. And, sorry to say, a lot of doctors take up medicine because they have a phobia about illness and disease; they want to do something about eradicating it all. A lot of medical conferences are set up so patients are nowhere in sight. They use it as an advertising point. I wangled my way into a medical conference or two, as a patient advocate. One I got into had clearly specified "health professionals only" and when I turned up, the officials there (who knew me, but didn't know I HAD professional cred of a sort) tried to have me thrown out. The irony was - the organisers who wanted me gone, and less professional cred than I had, but were allowed to stay. But the keynote speaker, who had invited me there, came over and welcomed me, which really frustrated the officials on so many levels.

The fear is, that if/when doctors mix with patients not fully professionally, that the armchair consultations begin to happen. But I learnt very early, that when I meet doctors NOT in a capacity is patient-doctor, I MUST avoid talking about my own health. Even the local GP, when we bump into one another in the street, who asks me, "How are you?" in polite conversation, knows to not ask me because I will refuse to answer. Or they get the noncommital one-word answer.

Nurses in the practice need to insulate their doctors form anything inappropriate or time-wasting. But it sounds like these nurses are a tad too power-hungry. It also sounds very inappropriate and major breaches of confidentiality.

I had a problem with one local doctor, some years ago. That doctor then split with the practice I had been part of for years. A messy split. The new practice was hallmarked by some very bad behaviour form the nurse-receptionist (the schism doctor's wife) who encouraged (and often started) untrue gossip about the original doctor. It was vicious, it was unethical and it was damaging. Any supporters of the original doctor were also gossiped about, and I know there were things about me that were spread around the town. I complained officially but there wasn't enough solid evidence, although I had a lot of circumstantial evidence and witnesses. The schism doctor and his wife left town, but maintained ownership of the new practice building. That meant that until they ceded ownership, they could walk back in at any time and read the files. I didn't trust them, so I avoided visiting that practice because my list of medications would be enough to do a lot of damage to my reputation if it got out into the wrong hands.

That said - my complaint was based on known and obvious breaches in ethics, especially confidentiality. There are strict laws on this in Australia and I find it hard to believe that regulations in the US would be softer on this. I would at least be putting in a phone call to the medical board, and asking what you can do in this situation - your specialists' letters aren't being filed, the nurses aren't passing on your messages and you have been told by a former staff member that patients are often gossiped about and actively blocked from access to the doctor.

Then see what the board says.

The other method of tying to get to the doctor - passing over an "eyes only" letter - doesn't work, I know from experience. We have a political system here where you can have access to various Ministers. You write to the Minister (for Education, for example) and you get a reply. But the reply is usually written by a public servant; the Minister might sign it personally (but usually doesn't) but rarely reads it all. So you wonder - is tis the genuine attitude of the Minister? Or is it the "Sir Humphrey" (public servant) response?

I was part of an activist group years ago when my kids were little, trying to get better childcare facilities. I had written to the Minister and got a Sir Humphrey reply. Legally, that was all I had to be given. But then the Minister was due to open our new child care centre - so I turned up, with my letter. I handed it directly to the Minister, who thanked me - and then immediately turned and handed my letter, unopened, to the "Sir Humphrey" standing at his shoulder. Like the Queen's ladies-in-waiting who carry the many bouquets, flowers, cards etc handed to the Queen as she's walking around, these accompanying people of the Minster field the stuff handed over and put it all in the same pigeonhole when they get back, as all the other incoming mail.

I have since managed to achieve amazing things through Ministerial involvement, but I had to find a way around the officials. The most effective way was the personal connection - I made friends with another politician, who made a point of personally handing over my letter to the Minister with a lecture about the issue. It's not the sort of trick you can pull too often, so you should only use it for something really important.

There are too many reasons for you to move on. This doctor would have to be exceptionally brilliant, to justify staying with this practice. And frankly, the behaviour of the nurses shouldn't be possible if the doctor is sufficiently competent.

Marg

 

[emotionallybankrupt]

When I saw this article last night, I immediately thought of this thread. Interesting concept.... http://www.msnbc.msn.com/id/38312472/ns/health-health_care/

 

[Marguerite]

Thanks for that link, EB. We don't have anything formal like that, but for years I used to read my doctor's notes and letters, by reading upside down across the desk. One time when I was at a new specialist (a rehab specialist, allegedly to help me regain some lost fitness) I noted my favourite specialist had commented on my "addiction to opiate medication". I was cranky, because we had discussed it in depth and I had dug out information to show that while I was habituated to it, I was not an addict. Fix the pain and you fix the dependence. The problem was one of semantics - by my specialist's definition of addiction (someone whose body is used to the medications and whose body will go into withdrawal if the medications are stopped suddenly) then yes, I am an addict. But that is not the definition of addiction.

The rehab specialist very quickly dismissed the addiction issue as a non-issue but I made a point of raising it with my pain specialist, who communicated HIS views to my specialist.

My specialist had a go at me for my reading upside down across the desk - I said that a patient's gotta do what a patient's gotta do. He said that I had been hurt by doing it. I said I wouldn't have been hurt, if he had listened to me and kept up with his reading; and in fact, we had both learned and resolved issues because of my reading habits.

Some years later my specialist retired. He had a huge patient caseload and knew he wasn't being replaced with the same sort of specialist, so there was nobody who could take over all his patients. Because I was a long-termer and more able to look out for myself (compared to someone till feeling their way around the medical system) he cut me loose. He gave me my entire medical file (posted it out, it was too big to carry away with me). I found he had not only included all his notes, all his letters to other doctors, but also all my letters I had sent him, including Christmas cards. When he had been critical of where we chose to live, for example (he was concerned about how far we have to drive to get to a hospital) I sent him a postcard of the village beach and said, "This is the best medicine for me, to live here." It was all there.

Another specialist of mine (somewhat different modality, but has taken over as my main specialist now) sends a letter about me to my GP after each visit. He dictates that letter to his organiser while I am still there. he will ask me if there is anything I think he needs to include.

I am a firm believer in patients being a vital part of the health management team.

In my lifetime I have seen a lot of change in how medicine is carried out. My mother had chronic health problems and was often in hospital, in days when young children were often not permitted to visit the wards. But I was too young to be left home alone, so I would have to go to the hospital as well, then sit outside the ward in the waiting room. Visiting hour was for one hour in the evening. Usually my family would persuade the ward matron to let me in to see that my mother was still alive - the matron would peer out at me sitting still and quiet in the waiting room (I had been primed by my sisters) and sometimes I would be allowed in for five minutes.

We read "Readers Digest" and read of medical breakthroughs as well as that interesting series, "I Am Joe's [insert organ of your choice here]". We watched medical shows like "Dr Kildare" and "Ben Casey". There were some interesting ethical dilemmas concerning how much you tell the patients, and when. A young girl had a brain tumour and in removing the tumour, the surgeon also had to remove her visual cortex (or cut the optic nerve, or something - no details given) and the girl woke up wondering why everything was dark. Then the double episode dealing with the arrival of a very new dialysis machine (they were a very recent and expensive development) and there were more patients needing dialysis than the machine would be able to service; the doctors had to decide who was to get the treatment, and who would have to die. Lifestyle, occupation and age were all factors to be considered in the very painful decisions. The program dealt with the emotional responses of the patients and their families. It was, I felt, a benchmark program in that it acknowledged more than previous shows, that the whole patient and lifestyle, family etc need to be considered when making medical decisions. But what still struck me commonly in these shows, was the doctor on a pedestal. Also, the doctor often had the ethical dilemma of "Do I tell my patient that she is dying?" with the tragedy of the patient generally NOT being told because it would be too cruel.

In Readers Digest I read about Kay Kendall, who was diagnosed with leukemia while her husband Rex Harrison was performing on stage in "My Fair Lady" in London. As her husband, HE was told her her leukemia, but said she was not to be told; his wife was so full of life and love, he didn't want her final months to be filled with doom and gloom. And over those months he was glad to see that she continued happy and enjoying life, although complaining at times of still feeling tired. The article went on to comment on how pleased and gratified Rex was, that she never knew she had leukemia. She remained positive to the end. But reading between the lines, I believe she knew, realised he didn't want her to know, and spent her final months pretending to be ignorant of her impending death to spare HIM the pain. Don't be critical of the doctors or the husband - this was how things were done back then. But what opportunities they missed, to really talk! How tragic!

We know now that to have the opportunity to know, is a blessing. You have choices you can make in better knowledge. I think back to me recent brush with cancer and think back to the bad old 50s and how it could have been handled - there were a lot of choices to make and I am so glad I was given the chance, quickly, to make them. If there had been a lot of subterfuge and telling of the husband but not the wife, I would have been very suspicious and not taken it well. I also know husband - I don't think it is a burden he could handle on his own. But then, even in the 50s, I think husband would have walked out to the waiting room, called me in and then said to the doctor, "OK, now tell her what you just told me."

Times have changed a lot so it will be interesting to see what changes there are in the next 50 years!

Marg