Not the Same Doctor

doctor patient

My annual physical with my doctor of more than fifteen years was not at all what I hoped for.  Despite the inconvenience of a 45-minute drive to her office and having to wait over two months for an appointment, I’ve felt the continuity important to my care.  I was looking forward to our usual productive, congenial visit.

I’m grateful not to have serious health issues, but had minor complaints to discuss, previous health concerns to follow up on and idiosyncratic worries to share (including last week’s epic nosebleed). I also expected kudos for finally, completely quitting smoking (not that I was much of a smoker anyhow) and for bringing my weight down to ideal levels.

Our annual appointments typically start with me sitting, fully dressed, in her office talking about my health and risk factors before we move into an examining room. After the exam, we return to her office to discuss recommendations, lab work, prescriptions and next steps. This is not what happened.

After checking in and making a quick trip to the rest room, I sat in the waiting room for only a few minutes before being called in by the nurse, who escorted me straight to the examining room where she weighed me, took my blood pressure and asked questions about changes in medications and allergies.

I was left to change into my gown before the nurse returned, leaving the doctor outside the door. She said, “The doctor uses a recording system for transcribing exams. Someone in another room is listening in and recording what goes on,” she gestured toward the computer. “Is it all right for us to leave that on while you are with the doctor?”

What??  Someone I don’t know in another room listening in on my discussions with my doctor?  Is already listening in?  I never heard of such a procedure and was not at all sure I liked the idea. It seemed intrusive, and I felt inhibited just thinking about it. So I answered, no, I’d rather not.

The nurse informed the doctor as she walked in that I’d said no and she muttered, “Oh great.” I wasn’t sure she meant that as I heard it, negatively, so I asked her whether she was unhappy about my saying no. “Yes,” she said, “it’s more work for me.”

Now I was uncomfortable. How do I open up to an irritated doctor? I was bothered, too; I think this appointment isn’t about what’s good for her, but what’s good for me, the patient.

“You don’t want to do it, that’s fine,” she said, though obviously it wasn’t fine, since she went on to describe how now later she would have to dictate her notes.  My previous low blood pressure steadily rose.  She tried to move on, asking me how I’ve felt this year, but still reacting to her now confirmed annoyance, I said, “I’m still thinking about the recording business.”

“Just forget about that, let’s move on,” she said, pointing to her watch. “You were already late.”

What? Now I’m being rushed?  “I wasn’t late,” I responded, now getting angry that she would add insult to injury.

“Yes you were,” she insisted, looking again at her watch, “it’s 11:10.”

I know I was on the elevator at 10:46, one minute past appointed time, close enough. Checking in took a few minutes as I first fumbled with their new self-check in kiosk and ultimately had to speak to the receptionist after all.

“My appointment was at 10:45 and I was here. I received several (automated) reminders of my 10:45 appointment time; if you need people to arrive 15 minutes early, you should let them know,” I said.

She was curt, I was offended and upset. I told her I didn’t think we could have the appointment after all. I said I didn’t see how I could talk to her when she was annoyed and I didn’t like feeling chastised. She kept insisting it’s fine, let’s just move on. I’m sure our voices raised enough to be heard outside the room.

I stayed only because I waited so long for the appointment and wanted the lab results, but I believe I would have been right to end the appointment right there.

The rest of the exam was perfunctory, the doctor trying to lighten the mood, but it was too late to have the visit I wanted. At one point she apologized for the time it took to enter a prescription into the computer. I responded, “That’s okay, I’m not the one who’s in a hurry.”

“It’s just all the other people …” she replied. Yes, that is the problem, I’m right in front of her and she’s thinking about all those other people.

I don’t know who’s to blame for the changes being imposed on doctors, whether it’s laws about getting everything electronically recorded – although privacy laws seem in conflict with having someone listen in on a private discussion between doctor and patient – or it’s insurance companies dictating what has to happen in a physical exam, or it’s large private medical groups trying to remain profitable by squeezing more patients into a doctor’s schedule. But it doesn’t feel like good medical practice.

On her way out, the doctor held out her hand and said “I’m sorry for the miscommunication.” I don’t think it was a miscommunication at all. I think it was a pressured doctor taking it out on a patient, which is inexcusable.

I was still upset later that night thinking this doctor owes me a huge apology while not expecting that would be forthcoming.  The system has gotten too big, too impersonal.  And that’s worrisome, especially considering I am fortunate to have great insurance and this doctor belongs to a premier group in our area.

My advice is take your health care into your own hands and do your best to get and stay healthy so you don’t need doctors, because the health care system is getting worse, not better. Thank goodness for WebMD.

Nose Bleed

straight hairIt’s so dry in the house with this severe cold weather, I wake up every morning with such a scratchy throat I think I may be coming down with something. Once I’m up and moving around, though, I’m fine after all. The other day as my head was clearing I felt one big sneeze coming on, one of those really satisfying ones, you know, like wow that felt good.

Then my nose started its usual drip, drip, drip, the annoying constant runniness I experience through two out of four seasons of the year. Except this time, I looked down and saw red. I don’t get bloody noses, which is just what my husband said as I reached for a tissue. It stopped quickly enough, leaving me more concerned about the bloodstains on my freshly washed bathrobe as I wished my husband well and he went off to work.

A few minutes later, my nose started up again, this time in earnest. I mean it was a gusher, sending me running into the bathroom grabbing a handful of tissues to catch the bleeding. I’m not sure where I’m supposed to pinch, up high? Down low? I’m tilting my head back and feel blood running down the back of my throat. Yuck. It’s coming so fast I can’t keep up with the flow. I am not good with blood. I sit down at my desk and google bloody noses, thank God for the internet.

I quickly deduce from selectively reading WebMd.com that I must have a posterior, perhaps arterial, bleed because this is too much blood to be coming from the front of my nose and hello, it’s so profuse it’s coming out of both nostrils. The next sentence annoys me more than the blood: “[these nosebleeds] tend to occur more often in elderly people.” I told you 60 is not just a number.

It turns out you’re supposed to tilt your head forward, not back, and you’re not supposed to swallow blood. I further read, “These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist” so it’s time to call my husband in the car on his way to work. My voice is garbled from wads of tissue stuffed up my nose and a gathering thickness at the back of my throat. I have to yell into the speaker so he can hear me.

“This is not a normal nosebleed!” I holler.

“Well, stop walking around and go lie down,” he says. (The internet says not to lie down!)

“The internet says this happens to f*&@ing elderly people,” I shriek.

I go upstairs to tell my son who is getting ready for work he may have to drive me to the doctor. “I’m having a problem,” I can barely speak, my nose and throat feel so clogged and swollen.

“I know,” he responds, “I heard you.”

Following sacred WebMd’s instructions, I sit up straight, head tilted forward, pinching my entire nose for a solid ten minutes (use a timer, they say). The bleeding slows although it takes more than an hour to become blood free during which time I feel a huge glob slide down the back of my throat “which may cause vomiting.” It’s a good thing I don’t have to work today.

I did have work the following day however, so I was more than usually anxious about sleeping that night, afraid my nose would erupt, ruining my pillows and bedding, and keeping me from work. When did it become so hard to feel good enough to go to work? Despite a fitful night’s sleep, my nose and I were fine the next morning and I got to work without incident, albeit with my pockets stuffed with tissues just in case.

On the drive in, I thought about the vaporizer I recently found while emptying out a closet. That would have come in handy, except I just got rid of it. It sat in that closet the entire fifteen years we’ve lived in this house and hasn’t been used since the kids were young. Day before yesterday, a long time ago.