Crumble

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“Her primary care doctor, Dr. X, knew that she was experiencing post menopausal bleeding for three years but only recently worked it up. She has now been diagnosed with endometrial cancer and presents today to discuss surgical intervention and the possible need for adjuvant therapy.”

I seethed.

The jerk did not even look at the record.

He had access to my entire record since he was on the same electronic health system. All he had to do was scroll down the screen and take a few minutes to see that I had first met her six months ago. When I heard on that first visit that she had been experiencing post-menopausal bleeding for the past three years, I referred her immediately to gynecology for biopsy.

She did not keep the appointment.

At every visit every month for the next six months as I saw her to get her uncontrolled blood pressure under control and treated her sinus infection and allergies, I begged and pleaded with her to follow up with that gynecologist, to get the biopsy done, explaining and documenting each each time that she may have cancer, that she could die if she continued to ignore this.

Finally, after I made her call the gynecologist to schedule the biopsy yet again, this time while she was still in my office and standing next to me (I dialed the number for her and passed the phone to her), she actually kept the appointment.

That was how she was then referred to this man, a gyn-oncologist.

My hands shook as I dialed his number, burning with anger. He had sent this note to the hospital, to the gynecologist, to the radiation oncologist, to everyone… saying I had dropped the ball.

Bastard.

I was not going to let this go. Oh, no.

His assistant answered.

“I’m sorry. He is in the OR today. Is there something I can do to help?”

I explained to the young woman what had occurred.

“Please communicate to him how upset I am.”

She was extremely apologetic and said that she would call me right back. I was not going to hold my breath. No one ever calls me back after this sort of thing.

I saw a few patients, trying to focus my brain on them. I glued a smile onto my face and worked hard to maintain my perky voice. I willed my hands to stop shaking as I moved the stethoscope around each chest… heart… lungs…

My mind kept wandering back, though, to conversations where I told this oncologist what I thought of him and his lazy ass charting skills…

In exactly 90 minutes I received another call from his assistant.

“I spoke to him and he apologized. He will amend the consult note and send the corrected note to everyone involved.”

“Thank you.” I breathed a sigh of relief.

“Doc? I really am sorry this happened,” she said.

“Me, too. Thank you for following through, I really appreciate that. I will await the amended note.”

Twenty-four hours later, there it was:

“The patient was seen by a new primary care physician and subsequently worked up for her long standing post-menopausal bleeding…”

I still hate him.

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97 thoughts on “Crumble

  1. Oh wow. I can’t hit the like button. What a dick. His assistant sounds decent at least…
    So why didn’t she ever follow up? Three years of bleeding? Yikes. I am also of the type who avoids doctor appointments as much as I can, but if I was bleeding…

    Liked by 3 people

  2. Wow, I can relate to that! I had pain , they kept sending me for chest xrays. Broken ribs, 3 months of this, they kept saying. My primary sent me to see A FEMALE Thorasic surgen. Biopsy revealed 4th stage lymphoma! 3 drs MALES never looked at blood test ect.
    Yes today my primary tells everyone what to do! I’m alive to tell the story.
    Beast cancer, male doctor gives Rx for
    Post memopostal cancer pill. Causes cervical cancer! Out of 90% I got it but
    My gynicologist Female, told him take me off it! He threw temper tandrum.
    No one gives referrals to him. And ge is head of incology!!!
    Thanks for sharing,Isil

    Liked by 1 person

  3. Sigh. Sloppy work again. It is one thing to be sloppy in a professional blog (as I’ve been ranting about on my own place), it is another thing entirely to be sloppy with medical records, for oh so many reasons.

    Sigh. Endometrial cancer. I need to be checked. My periods have never been regular, ever. As I got older they got weirder, heavier, awful-er. No insurance coverage. The periods finally started getting sparser, further between, but I’m 56 and they still haven’t totally stopped. I will finally be covered by Medicaid, soon, but I shudder to think of what I’m in for even if/when I do get checked. Incompetence? The inability to trust an “all clear” Dx? Worse, a bad Dx and being told the treatment isn’t covered?

    I have waited for years to get this checked out, too. I have done my own research online and no where does it explain what is a normal menopause and when to get worried and when not to. No where does it explain where to manufacture money to get things checked.

    Liked by 1 person

  4. I, fortunately, have insurance but I work in a place where many come to be treated who do not have insurance. They always seem to get treatment for ‘what ails them’ (not snarky here) so I’m always a cheerleader to those who do not seek (at least) a consult due to money/insurance…JUST DO IT! Make a phone call and get the ball rolling….Oh…and I’m talking to Laura L. πŸ™‚

    Liked by 1 person

  5. Just a quick note that you can pass on to your OB/GYN colleagues: would it be so hard to have one evening a week devoted to older patients? I won’t go to an OB/GYN because I’m uncomfortable sitting in the waiting room with all those pregnant young women. I didn’t have a PAP smear for 23 years, until finally this year my primary talked me into letting him do one. I don’t know who was more uncomfortable during the procedure, but I’ll give the guy credit for willingness and devotion to his patients. His nurse and a female medical student were also in the room, and both found it a bit amusing, although they tried to keep their expressions neutral.

    Anyway, I figured at age 62, I’d maybe never have to go through it again. After all, I have no need for that part, so what do I care? Wouldn’t you know, I get a call a week later saying the results were abnormal and now I have to go back for a repeat (which, God bless the man, he will do because he knows I won’t go to an OB/GYN). I’m debating just cancelling the appointment and taking my chances, but of course I won’t.

    Liked by 1 person

  6. Doctors need to be very careful when they write comments about what other doctors have done, particularly if they’re just basing it on word of mouth. Patients–and even other healthcare professionals–don’t always get the facts right. And the fact that he could have accessed the records so easily is doubly infuriating. What a frustrating thing to have happen to you. I know the way it eats at a person, because I’ve been in the same shoes. Grrr.

    Liked by 4 people

    • When I am angry about shoddy charting and patient care, I try to tell myself to just do my job and let it go. But, I don’t. I have been known to put those nasty little comments in the chart, but only after reading ALL the records. But not exactly like that. More like: This patient not known to this provider. Requests refills on Norco, Soma, Xanax and Ambien. No opioid contract. No documented exam. No radiology. No pain management. No counseling. No labs. No urine tox..etc. Maybe I should tone it down a bit…

      Liked by 1 person

      • Sounds like you’re recording the facts that are found elsewhere in the record–nothing wrong with that! And you’re probably doing the next provider a favor by summarizing things for him or her. See? It’s all about the spin. πŸ˜‰

        Liked by 1 person

  7. There is really no case for slander in the medical profession. You can document all you want, but in the end, if something is investigated, your six months of accurate charting will trump his sloppy and Ill-informed consult letter. When he amended the letter, did he at least take out your name as the initial primary care Dr who “dropped the ball?”
    I hate him for you

    Liked by 1 person

  8. I am sorry that happened to you. Gone are the days where we knew all of the specialists and PCPs in town and you could pick up the phone and talk about a consult. I do welcome human interaction over electronic notes when possible. I’m glad you set the record straight. I always figure that I only have 1/2 of the story from patients when I see them as a referral. You were justified in being pissed off.

    Liked by 1 person

  9. Poor woman. She is to blame here. I have no words to describe how I feel about the jack ass MD but if he provided the treartment that she needed then I suppose it all evens out- though it was initially you who was falsely accused. It’s was a low blow to your self esteem and being compentent.

    Liked by 1 person

  10. Yikes….you showed great restraint. And this is a good reminder for all of old gals who think the ob-gyn is something of the past.
    We have to tell our clinicians all the time to watch what they put in a note. My favorite was someone who bashed the patient for non-adherence and then in her plan for next visit note put
    “Good luck”… we all had post-it notes with “Good Luck” on them and posted them all over each others desks and stuff. Its a common statement used as a joke now when we do our form of “rounds” or chart review.

    Liked by 1 person

  11. I can’t hit like on this either. As difficult as it is to understand why people ignore these things, they do. Fear is a horrible horrible thing. My aunt ignored it. And though I wish and wish she had not….part of me understands.

    And then there’s that doctor’s note….. I concur with your diagnosis of the matter doc.

    Liked by 1 person

    • I am so glad that you say you understand! A friend’s mother had a giant, fungating mass coming out of her rectum and refused to mention it to anyone until she had an obstruction and ended up dying from metastatic colon cancer. It is so easy to say that would never be me, but you just never know how you will react in the situation because fear is more powerful even than pain. There is a part of me that would absolutely chose to live in that place denial because it is more comfortable in some ways…

      Liked by 2 people

  12. No offense, but being good at one thing (like treating cancer) doesn’t make you good at other things (like accuracy in documentation summarizing another’s history). Doctors are just as fallible as anyone else, particularly in paperwork. I would hate him for damaging my reputation, too, don’t get me wrong, but I would feel compassion for him being so busy he doesn’t feel able to be thorough and accurate. Something is broken in how rushed we all feel. Doing things quickly has taken the place of doing things to the best of one’s ability. We all suffer because of this trend, in every profession.

    Liked by 1 person

      • I know. And I’m not saying that histories aren’t important. Just that not everyone is good at everything, even if they are doctors and smart humans. Oh, and I forgot to answer your direct question in my other comment. Type away, do what you have to do to get home and be sane. I am never offended by someone working diligently to help me and accurately record what we are discussing.

        Liked by 1 person

  13. That’s a rough one Victo. When talking to doctors, I try to see it from their perspective and I try to separate what I know from what I suspect. I too am guilty of not getting things checked. It’s like Schrodinger’s cat – as long as I don’have it checked it can be either OKor bad. As soon as it’s checked, if it comes up bad, then i have no choice but to start down that long and painfuland never-ending road of treatment. I find communication between doctors to be less than what one would expect. In my experience (and I exclude you here Victo) doctors’ egos get in the way of communication with colleagues. I have sat, more than once, and listened while two doctors fought over what they each thought was right – and refused to consider the other’s opinion. Once I was actually on the examinattion table in interventional radiology, prepped , drapped, sedated and ready for the prodecudre while the two doctors argued loudly over which one was right and which procedure they were going to do. i guess they figured I couldn’t hear them. In the last 10 years i’ve spent a lot of time wth doctors and by far they are professional and caring and efficient.\ Seeing that many doctors soon makes one realize that they are also human and suffer from the same issues as we all do sometimes – pride, ego, etc.

    Cool post Victo and it reinforces what I have already observed, but to see it actually admitted is not soemthing I have ever seen from a doctor. in fact I’ve never heard one even apologze eeven when thye have been shown to be blatantly wrong. thank you.

    Liked by 1 person

      • Indeed and you say that as if i should know that – human=emotions and feelings. And yet it is my understanding that doctors are trained to deliberately NOT show emotion, to not empathize, to not exhibit any of their humanity. And many do that well – that which they were trained for. Kudos to the system. If I came across a human who refused to ever apologize for errors made, I would say they needed some professional intevention and strive to get them help. However when I meet a doctor like that, i’m supposed to say “Well done. You are a credit to your training.”?

        Keep in mind that not all doctors are like that Victo – I actually try to choose those who exhibit human characteristics – feels more honest.

        Great post – Thank you.

        Liked by 1 person

      • This is true. And not showing empathy or humanity, keeping that professional distance, is often a coping mechanism and can become a means for survival, albeit not a positive one for patients. You add so much with your comments here. Thank you! πŸ™‚

        Liked by 1 person

    • You know, in the past I would have said alcohol. Lots of alcohol as a coping mechanism. Now, not so much. Truthfully, I don’t know that I deal with it very well but I don’t really talk about it to people outside the blogosphere…. It is probably true of a lot of physicians that we don’t deal with the stress very constructively.

      Liked by 1 person

  14. Pingback: My Article Read (2-22-2015) (2-23-2015) | My Daily Musing

  15. *SIGH* His behavior is inexcusable, and he will surely rot in hell if he continues to act so flippant with people’s lives. Or maybe he’ll at least bit bitten by the Karma Bug a few times before he meets his maker.

    Liked by 1 person

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