The Turkey Finds a Real Doc

I know, I know—I should be writing about football, this being the season. However, I cannot resist making a comment or two about the positive turn in my health care experience of late. I’ve found a new doctor and this one looks like a keeper.

I want to warn you right now that this will be a long-ass story, but it needs to be told.

Before I get to the new situation, let me review the one from whence I came. Recall that I had been quite disgruntled with my last physician, who I only saw once. He essentially felt my pulse, sent off some blood tests, and scheduled a physical exam for five months later. His large, unwieldy group practice, in which by their own, proud admission 65 doctors handled 414,573 appointments last year, seems to be all about profitability. It took them one month to get me blood test results—after several calls, I had to drive to their office and demand them. And when I needed to reschedule the physical exam, giving them two months’ notice, they wanted to make me wait another six months for the next appointment. They wouldn’t even work with me to find a cancellation.

Now, understand that when I scheduled the initial appointment with that doctor (call him Dr. D), I wasn’t feeling well. It took me a month to get in there. I related my abdominal symptoms to Dr. D., who palpated my liver and said that he couldn’t feel anything. My symptoms were reminiscent of those that bothered me in the buildup to gall bladder surgery over 20 years ago. Dr. D didn’t really think there was anything worth looking into for five months. So I left there feeling somewhat uneasy about really having accomplished nothing and wondering whether there would be any help in the offing if I got sicker.

My interactions on the blood test issues convinced me that this practice was pretty unresponsive to patients’ needs. The physical exam rescheduling morass was the final straw. I wrote Dr. D a letter, sending it to both his office and his home, telling him how I felt. He actually did call me to “explain” these issues, but his feeble explanations did not sway me. He offered to reschedule my physical exam to some time convenient for me, but for my money it was too little and too late. The bond of trust had already been broken. If I got sick, these were the last people I could count on. So, I dumped them.

I should note that I was so put off by the machinations of this practice that when I had a simple, uncomplicated ingrown toenail in July, I went to the hospital emergency room for treatment instead of calling Dr. D’s office. Naturally, I was triaged to the overcrowded non-critical care facility and had to wait four hours, but in my mind this was preferable to dealing with Dr. D. and his crew. Obviously, his practice left a very sour taste in my mouth.

The abdominal pains, though diffuse and low-level, continued to annoy me, as were the dull headaches, light-headedness, and general malaise. I becamed fatiqued with moderate exertion. As life-long residents of our bodies, we know when something is wrong. Hell, dogs know when something is wrong with their bodies. When I go to a doctor, which I don’t really enjoy doing in the first place, I expect to get the attention I deserve and I expect my complaints to be taken seriously.

I had a consultation with another doctor, a colorectal surgeon who does my bi-annual colonoscopy. He told me that the symptoms I described suggested two things to him: irritable bowel syndrome and gall bladder disease. (He is also aware that I have no gall bladder.) He scorned my erstwhile primary care doc for his “gatekeeper mentality.”

That was back in June. I got the colonoscopy, which disclosed the usual couple of polyps, and spent the rest of the summer having the same, vague abdominal discomfort that waxed and waned.

So, this brings us up to last weekend, when I had been feeling worse for about a week. I made the mistake of doing what should have been a non-strenuous hike in the woods on Friday, but after two or three miles, I had to lie down. I was feeling weak and fatigued, again with diffuse abdominal and chest pain. My hiking companion was concerned enough to ask me which numbers in my cell phone would be appropriate emergency contacts. She was worried—much more worried than she had been about the large, grumpy eastern diamondback rattlesnake we had awakened tromping down the trail. After a fifteen-minute rest, I felt a bit better and was able to make it back to the trailhead, feeling like warmed-over moose shit.

I went home, showered off the woods, and immediately went to bed, feeling too bad to even consider what I would do if I was really sick. I had no doctor at that point. Should I go crawling back to Dr. D? Hell, the weekend was ahead so he would be of no help anyway. (I could have found his phone number and I would have had the chutzpah to call him, had I thought he could do something for me.) Football Saturday was looming and the big, ill-fated Penn State–Notre Dame game was the piece de resistance. I had an out-of-town friend coming to go with me to the Tampa Bay Bucs game on Sunday. I had no time to be sick. So, I got out of bed at 8 PM to chop the onions and the garlic for my famous Super Bowl chili, and then went back to bed.

I was having left upper quadrant abdominal pain, not severe, but noticeable. I had a sense of fullness in the upper abdomen. When I woke up on Saturday morning it was still there. I had a lot of work ahead of me—about three hours of chili prep and a trip to the airport to leave a car for my arriving friend, who would be arriving during the Notre Dame game with little chance of prying me away from the TV to pick him up. My Penn State homey picked me up at the airport and when I sat down in his car I immediately had some painful abdominal muscle cramps. (Weirdly, I have muscle cramps when I’m generally ill.)

Penn State’s performance was enough to make me sicker, and I was feeling worse on Saturday night, after having actually consumed a bowl of my own chili creation and a couple of glasses of wine. When my out-of-town friend arrived, he noted that I sounded sick, but he was anxious to watch the Tivo of the Clemson game, so I humored him. The next morning I felt worse but I “suited up” for the Tampa Bay game anyway. My friend is a Baltimore Ravens fan, so we were going to sit there and get in each others’ face. But fate was to intervene.

Seeing how I looked and felt, David called his father, a retired doctor, to ask him if I was going to drop dead at the game. His father talked to me for a bit and said that I should be seen at the emergency room. He suspected heart disease first, and then possibly gall bladder disease. He, in fact, had had a cholecystectomy in the past and later had been diagnosed with gall stones. So, he knew all about gall stone formation post-cholecystectomy.

So, David took me to the ER, where they quickly did an EKG, vitals, and blood enzymes to ensure that I wasn’t going to drop dead of a heart attack on the spot. There followed a three hour wait to see a doctor, during which I exhorted David to take the damn car to Tampa and see what was left of the game. I finally saw the doc, who was fortunately a football fan and was keeping up with all the scores via Yahoo on his computer. He told me that because I had reported chest pains and shoulder pains, plus had two out of three cardiac risk factors, there was no way he could let me go home and was ordering that I go to the “chest pain observation unit” for a while. I would be there at least 24 hours.

I waited two hours to get a bed there and found that it was an intensive care facility, staffed by competent, friendly, articulate people. I was immediately hooked up to a Holter monitor, which would stay attached for the duration. During my time there, I was given an echocardiogram and a treadmill stress test, along with all the appropriate blood tests. Ultimately, they could find nothing wrong with my heart, so they were willing to release me. In fact, once they felt that I wouldn’t drop dead on their watch, they pretty much lost interest. Discharge orders called for an abdominal ultrasound and follow-up with my physician in 2-3 days.

Oy! I should follow up with a non-existent entity, already? Hell, if he actually did exist, I’d probably have to wait a month for an appointment. Now, what was I going to do?

So, I got out of the hospital on Monday and started thinking. No, I wasn’t going to eat shit and crawl back to Dr. D. That was out. Fortunately, I remembered that a while back a friend had told me that her friend’s husband, an internist, was separating from his then current practice to establish his own practice and he was also interested in exploring the notion of concierge medicine. His target date for being in his new quarters, as I recalled, was to be September. Actually, I didn’t have to strain much to remember this factoid, because I had kept the prior conversation with my friend in mind the whole time I was going through the Dr. D fiasco.

What was most interesting about this doc (call him Dr. M) was the reason for his separation from his former practice. His partners essentially tossed him out because of a philosophical dichotomy between them about treating patients versus making money. Dr. M had been spending too much time with patients and not bowing to the insurance gods. He did not buy into the “gatekeeper mentality” and rationing of health care. This did not cut the mustard with his greedy colleagues who apparently cared more about the Bentley than their patients.

I contacted my friend, who quickly called her friend, the doc’s wife. They were able to arrange an appointment for me on Wednesday morning. Terrific! What a load off my mind!

I spent Tuesday gathering medical records and feeling good about the prospect of finally having a real doctor again after a few years of fooling around with guys who were less than interested (the one who showed promise decided to pull up stakes and move to Massachusetts). I wanted to make sure I had everything he needed, as he certainly was going out of his way to see me on short notice. I chased down the hospital records from my recent experience so he would be up to date.

Let me take you on a brief tangent. I also visited my dentist’s office that day for a routine cleaning. My dentist (Dr. P) is a keeper—he treats patients and staff with respect and caring. I’ve mentioned him before in my ramblings. I’ve been with him for 18 years and I will not see a need for changing unless something like his retirement or my expiration gets in the way. So, it did not surprise me to hear from one of his receptionists that he was taking his entire staff to a dental conference in Las Vegas. They were all beaming. A happy staff means happy patients. I’ve always liked that about Dr. P’s practice. Why the hell can’t other medical and dental practices understand that the key to success is treating patients and staff well? It seems to be such a simple-ass formula.

Back to my new doc, I saw him Wednesday morning. Although he was late for a meeting, he gave me all the time I needed. (He didn’t mention the meeting—his wife had told me about it the night before when she asked me if I could come a little earlier than originally planned.)

Dr. M quickly assessed an appropriate level for our conversation. This is one of my pet peeves with medical people. Some of them don’t take the time to understand a patient’s level of education and exposure to medical terminology. [Note to docs: Just because we haven’t completed four years of medical school does not mean that we have absolutely no knowledge of anatomy or medical terminology whatsoever. In the hospital, I got strange looks and questions about my background just because I used some standard medical terminology such as dyspnea to describe symptoms. Hell, I learned some of that stuff in high school biology class! In my experience, most medical folks just assume that we’re all idiots; consequently, they expect and give baby talk. This is sheer laziness. Take the time to glean an appropriate level, damnit!]

Anyhow, my initial impression of Dr. M was very positive. I felt that I once again had someone to rely on for health care. The Turkey was pleased.

Alas, Dr. M’s suspicions are that I have pancreatitis. He ordered a blood test for some appropriate enzymes and I’m scheduled for an abdominal CT scan on Monday. In the meanwhile, football Saturdays or not, I’m to avoid alcohol, fatty foods, and coffee. But I feel that I’m in good hands and I will follow through with this thing enthusiastically, rather than being frustrated by the apathy of my former doc.

You know, that attitude really sucks when one is sick. It is an awful feeling that to call one’s doctor’s office when one is ill is more of a pain in the ass than being sick. In Dr. D’s office, the impetus in fact seemed to be to deflect patients. From start to finish, I did not feel welcome there. Calling that office, I got an automated telephone menu system with a recorded voice first telling me that if I was really sick I should go to the emergency room. Then, after being told to go to the web site to request an appointment, if I still wanted to talk to someone, after wading through four or five levels of menu choices, I could talk to someone. Of course, that someone was disinterested. What a crock!

I’m so glad to be back with a small practice in which people actually care about what they’re doing and don’t regard it as just a job. The nurse has been with Dr. M for many years and she seems to be happy about her work. Moreover, she has great, genuine praise for the doctor and she says, “Everybody loves him.” As an old beer commercial once proffered, “When it’s right, you know it.” This one is right.