Sunday, April 25, 2010

Not Feeling Like a Lady in the Doctor's Office

Doctor Office 2Image by Subconsci Productions via Flickr

When Jenni at ChronicBabe announced that the theme for the upcoming Grand Rounds Blog carnival was ladylike, I got a case of blogger's block. The first word that came into my mind when I read the word ladylike was dating. Not exactly a topic fit for a medical blog carnival until I realized that navigating the health care system is a lot like dating. Well, that and acknowledging the fact the I don't feel much like a lady when I am in the doctor's office.

Here are some of the ways the health care system treats me less than ladylike:

Getting to Know You

I get it that the best doctors are booked up and busy. So I go with the flow when I have to be on a waiting list or fill out gobs of paperwork just to get in to see the doctor. But lately I've encountered more doctors in Los Angeles who ask for payment up front or ask patients to pay a yearly retainer fee because they have converted their practices to something called "concierge medicine."


Look, if you don't have time to see me, how about just referring me to a colleague. Better yet, how about adding an associate to your practice to handle the excess patient load. While I agree with you that the health insurance system leaves a lot to be desired, asking me to pay up front feels like being asked on a dinner date and then being told you "left your wallet at home." Concierge medicine makes it look like the only thing you care about is money, in which case I'm not really sure I want to see you, even if you are all that and a bag of gold coins.

Seeing Each Other

I saw one doctor for over a year and a half, and I honestly can't tell you what he did for me during that time. I, on the other hand, can tell you that each time I came in, I noticed he had more hair on his head. I met some of his other patients through a community fibromyalgia support group and they shared the same opinion: seeing this doctor was a waste of time and seemed to only serve the purpose of paying for his membership to the Hair Club for Men. After that conversation, I decided to stop seeing him.

This same doctor's staff hassled me every time I came into the office about my co-pay. I explained, over and over, that if they billed both my husband's employer sponsored health insurance and Medicare, Medicare would pay my co-pay. I advised them of this in person. I apprised them of this over the phone. I guess they would rather spend money sending me a bill, month after month, that I refuse to pay instead of just sending a claim to Medicare so that they can get paid.

I guess those hair plugs must really be expensive.

Sharing and Caring

For years, ever since the 1990s, I explained to my primary care doctor that I was having these episodes of dizziness, rapid heart rate, shortness of breath, trembling and sweating. The attacks came on suddenly in places like the grocery store or woke me up in the middle of the night. When he asked if I was having panic attacks I said, No, they don't feel like panic attacks. After I got diagnosed with type 2 diabetes in 1999, I thought my symptoms seemed to fit hypoglycemia, although when I tested my blood sugar during these episodes it wasn't really low. As the symptoms became more frequent and disruptive, my doctor talked about vagus nerve problems and sending me for a tilt table test, but ultimately kept coming back to anxiety and panic attacks despite my reports to the contrary.

Then I tripped and fell and subsequently developed fibromyalgia. Did he refer me to a rheumatologist or pain specialist? No, my doctor said I wouldn't get better if I didn't take an antidepressant. At that point, I decided it was time to see someone else.

I finally got my answer in 2007, a diagnosis that truly fit my symptoms: dysautonomia secondary to the chemotherapy I received to treat leukemia in 1988. Turns out, taking a beta blocker each day really helps to manage the symptoms. As for getting better, under the care of fibromyalgia specialist I have tried just about every medication used to treat fibromyalgia, both FDA approved and off-label, and none have made a difference. That includes antidepressants, just in case you were wondering.

Getting My Clothes Off

It feels almost cliche to mention how ill-fitting hospital gowns are. Sure, there is the lovely posterior exposure, but being well-endowed in the bosom, I struggle to find a gown big enough to cover the girls and my behind. So when I am instructed to take my clothes off and put on a gown, I always try to grab two to cover the front and back. This strategy works everywhere but my gynecologist's office, where the hopelessly small paper top and bottom drape make me think that the better choice is to just sit on the exam table naked waiting for the doctor to come in.

My most embarrassing moment happened during my cancer treatment in 1988. I developed an anal fissure that became infected while I was hospitalized. Every day, a parade of doctors came into my room to inspect the fissure, asking me to get on my hands and knees on my hospital bed and present my tush for inspection. It is only in retrospect that I realized that I willingly flashed a view of my female anatomy to a co-ed group of doctors on a daily basis for several weeks.

Maybe I should have worn underwear with Porn Star written across my butt.

Breaking Up

It's sad, but true--not all the relationships with my doctors work out. It's easier when I decide to move on because I can plan the transition of my care to someone else, interviewing other doctors to take their place. It's much harder when the doctor dumps me. I admit it's hard to feel good about myself when an award winning specialist recognized for outstanding patient care tells me there is nothing more he can do for me and would rather not see me again.

It's probably too much to ask for you to be honest about why you are dumping me. It took some time, but I figured out it has less to do with me and more to do with your frustration when prescribed treatments don't work or your exasperation when it seems like there are no more options to try. I get it; you are only human. But if you have to dump me, could you at least give me some referrals to colleagues and transfer my medical records to someone who can pick up where you left off?

So you see, there are many ways in which the health care system doesn't really treat me like a lady. But I'm not waiting around or holding my breath for the system to change. When I was dating, I learned that you have to kiss a lot of frogs to find your prince. In the health care system, I've learned you need to give each new doctor and treatment modality a trial run and be willing to stop and move on when things don't work out.

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