I spent a good deal of this term discussing the state of US medicine with my students. We saw The Constant Gardener, read Gawande's Complications and various essays, Mahar's Money-Driven Medicine, Marcia Angell's essays on line; I didn't have time for Wit and The Doctor, only showed part of Wiseman's Near Death. I hope to show his Hospital next time too. Why? Perpend: To put it another way, I've been impersonal (more or less) blogs on the part of the term my students and I study the way medicine is really practiced in the US. I've not written personally about it, told why I do this. The first in a different sort of series. My adventures go way back and in several cities, different organizations, for different things. But the pattern the same.
I went to the doctor two days ago for my bleeding episodes. I've had 5 hemmorhages: one after a tonsillectomy, after a bad miscarriage that took many hours of bleeding; after I had an ulcer in my colon, I lost more than half of my body blood, and completely transfused that time; then again the same after a C-section for Yvette that was botched at Kaiser Permanente. I had lost too much blood after I gave birth the first time (to Caroline) and had to be given blood to clot and the Admiral had to give blood to replace what mine took from Beth Israel's supply (or a huge bill would have been inflicted on us). this second time they gave me a compound they give nervous horses and it worked. I bleed long when I take aspirin. Dr Mecklenberg, Big Man at Kaiser, said I must never become pregnant again.
I told her all this. She grew impatient. I had had four tests at the Springfield Center, expensive ones and nothing abnormal you see.
If I had not insisted there is a pattern here, she would have tried to get me to agree all that has happened is chance; each case well youngsters often hemorrhage, having a c-Section at 38 is dangerous; the only thing she was willing to knowledge was the oddity of the ulcer in my colon at 33. When it happened, the doctors did say how this was not in books, very unusual, should not be. So book learning and a desire to dismiss if not there was her game. She actually was just as my books with my students tell us doctors are becoming. You see none of her sophisticated tests turned up anything abnormal. So if the machines don't show something, it's not there.
I can go for two more tests (that my clotting factors are not good and another) but basically all I got for my time was this stuff written down on my charts. I have this satisfaction: I've tried and will not blame myself if I find I'm advised for an operation and have little recourse but to insist the doctor watch out for bleeding or if I can refuse these procedures. She didn't even seem to hear my comments that I get nagged to do some procedures which could cut me and don't lest I bleed (colonoscopies which look for cancer). I had had to wait quite a while to see her; a long drive there and back.
I turn up at the Falls church center yesterday, and guess what? this doctor never sent any order for any tests. Took me 50 minutes to get there and back. I had 1 of them because the nurse got on the phone, but the conscientious receptionist could not get the doctor. As before I was not taken seriously -- doctors don't like ailments which are not in their books. While there I saw other people the victim of the divided nature of medicine -- all cost effective so one women wept hysterically because this was the 3rd time she'd come by cab and each time she was defeated because the different things done are in different places. This is even truer in private facilities. I could write a letter of complaint but what good would that do. I did learn more about my problem and when the time comes if I should ever need an operation I know more. What happened today wouldn't matter than for no one would bother read old charts. Sometime read Maggie Mahar's Money-Driven Medicine on all this.
Then last night I get these notes. Oh her name is POORNIMA U PANDELLAPALLI. Anyone reading this, be sure and stay away. A young woman wearing tight dress, her hair carefully frizzed and her face made up.
Dear Ms. ELLEN N MOODY
We got a call from the Falls Church Lab at which time Donna, my nurse, informed me immediately and the blood test was ordered. This morning, the phones were ringing off the hook and the staff can handle a few calls at a time.
I have jotted down all the history as you were telling me the history and it is in the computer records and you can request it at any time. We do appreciate you waiting in the clinic to be seen, and I not only apologized to you but also explained that we were all running late due to several sick cancer patients who were receiving chemo and we had to take care of them.
As I told you at the time of your visit, you did have a severe hemorrhage at the time of your child birth several years back and since then you have not had any spontaneous bleeding. Your blood tests are normal. So at this time, you do not have any risk of significant bleeding at the time of surgery.
I will forward your concerns to your primary doctor as well.
But let me assure you, that I am not a " book bound" when it comes to knowledge of treating patients, I have not dismissed your case but only registered it in our records and at this current time you not need any further work up or hematologic evaluation. If there be a need, presurgical evaluation can be obtained.
POORNIMA U PANDELLAPALLI MD 12/23/2011 12:49 AM
To which I replied:
When I got to the Falls Church facility, there was no order for either test. Your nurse enabled the people to give me the time test. The receptionist called several times and no one answered. I never had the blood clotting test. I noticed you did not write down my last hemmorhage where I almost died in childbirth. I could write a letter of complaint but why return to someone who obviously dismissed my case because I don't fit into textbooks she'd read. It was 50 minutes both ways to you, 30 minute wait. It was almost as long at the Falls Church place. Ellen Moody
Dear Ms. Moody,
The "urea clot lysis test" - that is the last test that we spoke about cannot be done at our labs and it cannot be ordered.
We will have to send the blood out to a special lab if the need arises before surgery.
Bleeding time, PT and PTT are normal.
To which I replied:
You did not do the blood clotting test. I read what you wrote and you left the last one out. You obviously think it's not worth it. It's nonsense to tell me I have no significant risk of bleeding when I've had 5 hemorrhages, when every single time I've had someone cut me for an operation I've had a hemorrhage. But your tests and books don't allow for this.
At any rate, I will not consult you again or go anywhere on the supposition you've set up an order for tests for me. That I have learned.
With a third thought:
So you never intended to do the clotting test? Your talk about my having an unstable clotting problem was just talk? or did you discover how much it cost and thought the better of it. Wait until I'm in an emergency and then do it -- if needed.
I can only wish that you should have had 5-6 hemorrhages, then perhaps you would not be as arrogant, obtuse and indifferent as you've been. Sorry for your dying patients. I recommend two books: Rosenbaum's A Taste of your Own Medicine and Mahara's Money-Driven Medicine. See yourself.
I'll tell about the socially coercive shallow silly psychologist I was sent to there another day.