There is No Valid Reason for Medical Delays, which Undermine Our Health

By: Loolwa Khazzoom, Founder, Dancing with Pain

August 26th, 2009 • Patient AdvocacyPrint Print

I woke up sick today.  With pus on my tonsils.  I called the doctor’s office and said just that, asking for an appointment today or tomorrow.  “You can come in on Friday,” the receptionist told me.  “No,” I replied, “I’m sick and I have pus on my tonsils.  I need to come in today or tomorrow.”

Why do I need to have the wherewithal, the assertiveness, the strength, the learned-the-hard-way training to push back, when simply trying to schedule an appointment when I’m sick?  Why isn’t it a no-brainer that when someone is ill, she is fast-tracked to an appointment?  Worst-case scenario, it should be automatic that if it is truly, but only really, impossible to see a doctor at the practice, we should be informed of other options for immediate, urgent care.  They should all be playing on our team, helping us get and stay well.

Following my insistence, I was squeezed in at 2:00 p.m., with a doctor-in-residence.  I brought along my swimming goggles, just in case I felt comfortable and safe enough with her to ask her to remove my wart.  In case swimming goggles seem to you like the physical equivalent of a non sequitur, allow me to explain:

Almost 2 years ago, when I went in for a teeny tiny wart removal, the doctor (also not my regular doctor, different practice) thought it would be really fun to dump the cup of liquid nitrogen in between my legs, without warning or permission, so that he could see the bubbles bounce around.  Immediately, I felt stinging in my right eye.  Apparently, some of the liquid nitrogen had splashed into it.  I was left with severe, debilitating headaches and eye pain for months and varying degrees of headaches and eye pain even through today, leading to a whole chain reaction of chaos and problems in my life.

Apparently, when going in for wart removal, one must give the doctor a heads-up, “Oh, and please no funny stuff with the liquid nitrogen.”  So that’s exactly what I was prepared to do.  Replete with the swimming goggles for an added layer of protection.

Well the resident doctor was a total sweetheart.  She had exactly the kind of energetic vibe that I seek in a medical practitioner — caring, patient, gentle.  So when she asked me to tell her why I was there, I decided not only to tell her about the sickness and pussy tonsils, but also about the wart (which had been growing in my foot for months, because of my now ever-present anxiety about getting warts removed). 

I also gave her a heads-up about my swimming goggles, sharing with her what had happened to me.  While most doctors I have encountered in the past would have used this information for their entertainment pleasure, this doctor simply exuded empathy and was totally understanding about why I would dress like a swimmer in her office.

As it turned out, the wart has grown so deep that it is beyond normal treatment; so I need to go to a podiatrist.  And there you have another consequence of the behavior of that doctor two years back. At any rate, this doctor and her supervisor checked my tonsils and throat, diagnosing me with strep.  Good thing I got an appointment today, no?

Well before I left, I asked if I could get a referral for hand therapy.  About a week ago, my right wrist banged against the edge of a door handle that is rather pointy.  I didn’t think much of it at the time, so I didn’t stop what I was in the middle of doing to ice it for 10-20 minutes.  But as it turned out, it set off something in my nervous system.  I have since been having shooting nerve pain in my fingertips and the palm of my hand.  As the days have gone by, I even have been getting those sensations a little bit in my left hand and my right foot.  Go figure.

At any rate, the doctor’s response was to tell me to wait and see how my wrist came along over the next few days, whether it stayed the same, got worse, or improved.  We did a little back-and-forth, with me pushing to get the referral right away and her insisting I wait. Finally I let it go.  I figured I could speak with or fax my primary care physician, to pursue the matter. 

I already had made a fuss about getting a strep culture (she had just wanted to give me a clinical evaluation) and about using a different popsicle stick (hygiene drama).  She was clearly starting to feel irritated with me, and I figured it was not worth the difference of a couple of days.

But honestly, what is up with doctors who delay our treatment?  Once they put in the referral, we have to wait up to another month for approval, as it is. Why add another few weeks to the ordeal?

Back around 2003 or 2004, I fell off my bike and hurt my hip.  I asked my doctor for an MRI, because by that time, I had discovered that an MRI would give more information than an x-ray.  The doctor told me to wait — for six months!  — for any kind of test, to first see how my hip was doing.

Then after six months, I approached her again, and she still didn’t want to give me a test.  Mind you, this was one of your super-caring kind of doctors.  Well I wrote a letter pushing her for the test, and I got it.  By that time, my hip had developed arthritis.  She deliver the news like this: “You have arthritis.”  Shoulder shrug.  As in, oh well.  No apology, no attempt to get me into treatment.

Unfortunately, I find that this kind of delay in treatment and apathy toward the potential or actual consequence in a patient’s life are more the norm than not.  And in fact, it is the very refusal to give me tests back in 1997 that launched the whole series of events leading to the chronic pain I have experienced for nearly a decade and a half since.



Comments

R' Daniel March 2nd, 2010

Loolwa,

As a doctor, I read this article with deep interest. Sadly, patient care is not something you can learn in school. You either care or you don’t. It is a matter of personality. I have trained many medical students who should not be working with people in my opinion due to their caustic and arrogant personalities, but who should instead be pathologists, anesthesiologists, radiologists, or just researchers. Doctors are people, and people don’t always have an understanding heart or kind spirit. I honor my patients’ concerns and when they request a test, I generally order it. I feel that if the patient took the time to research something germane to what exactly their symptoms are, then chances are it is a good idea to order that test.

A reason why your doctor probably was reluctant to order the test is the constraints of managed care. Doctors who take insurance are sadly prostittues to the insurance companies in one form or another. These companies have many doctors by the teeth and the quality of patient care is obviously compromised and limited. If you order too many tests for a patient as a doctor, you do suffer negative ramifications from the insurance companies. Sad, but true.

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