Closed Door


“Doc, I can’t stand him. I don’t want to go back. Ever.” She sat with her arms crossed across her chest, scowling.

“Oh.” I felt awful. I work hard to refer to the best possible specialists. Did I miss the mark for her somehow? “Tell me why.”

“He told me that my dizziness was because of BPPV and that most doctors don’t even know what those letters mean.” 

Most doctors meaning me?

“Benign paroxysmal positional vertigo?”

“Yes! THAT! You know what it is?” She sounded impressed.

“Uh. Yeah. I was not aware that most doctors don’t know what BPPV is…”

“Well, then he said sarcastically that he knew I would go home and read all about BPPV and then I would know more about it than any doctor… any doctor except for him, that is.”

Any doctor, including me? Why did I feel defensive, like he was pointing the stupid finger at me, too?

“He is one hell of a pompous ass. I know you like him and all but he just rubs me the wrong way.”

I sent this patient because she was convinced that she had had a stroke. 

Sometimes I send patients to specialists because I really don’t know what is going on. I am not supposed to know every single detail about every single possible disease or symptom out there. There is an awful dang lot that can go wrong with the human body. It is my job to try to rule out the easy stuff and refer to a specialist when necessary.

Sometimes, though, I already know what is wrong. Like this time. Not that she remembered the conversation we had had about BPPV some weeks before. She was a super nice, very sweet, intelligent woman but patients are conditioned to regard primary care physicians with a certain amount of suspicion and some just won’t let go of the worst case scenario until they hear it from an “expert”. 

This has become a pattern with him. I guess I will stop referring patients to him. For now. When they start forcing us to only refer to other physicians within the system, I won’t have a choice.


70 thoughts on “Closed Door

  1. It’s too bad that bad treatment from one doc will cause a good doc to get the backlash too. I know I’m not easy on docs myself because I’ve been abused by a couple but I’m never mean to them in a visit. Sorry you got the backlash.

    Liked by 2 people

    • Oh, she wasn’t mean to me! If anything I think she was defensive of me which was part of why she didn’t like the man. I am not sure he understands that when he insults me he is indirectly insulting her for picking me as her primary care physician. This isn’t the first time this sort of thing has occurred with this specialist….

      Liked by 2 people

  2. Just because one patient had a bad experience with him doesn’t mean you should stop referring all your patients to him. Maybe she’s just overly sensitive. (or maybe he really is an ass, but if he’s good, most patients will over look that)

    And no, primaries can’t be expected to know everything. When my oldest daughter was ill for so long, and they couldn’t figure out what was wrong, they finally did an MRI of her head, which showed a “torqued artery.” Freaked me out, and seemed to concern the pediatrician, too. So a specialist was called in, who took a look at the scan and told us it was simply a “variation of normal” and nothing to worry about. Isn’t that why we have specialists? I didn’t expect the pediatrician to be a neurosurgeon and was glad to have been referred to someone who could answer our questions.

    Liked by 2 people

  3. Oh, trigger, trigger! Sigh. My Colo-rectal surgeon got a new job running a hospital in Montreal. He transferred my case (post cancer surgery) to one of his “team” (not sure what that means, as I never did figure this out) who he assured me was the best of the best.- Dr, Friedlich.I was due for a colonscopy as a follow-up to the cancer surgery. Friedlich first checked the colon through the colostomy and then scoped the rectal stub. When he did the rectal stub, I could feel pressure on my bladder – increasing and very uncomfortable. I complained and squirmed and he continued. I squirmed more and grabbed the sides of the test bed pulling automatically. He barked to stop being so childish that I was over reacting and to grow up because I could damage the his table which was new – he was careful to point that out. There was a ripping sound as the pad, which was velcroed to the table top separated. He got very upset and yelled to “Stop it”. He finished the procedure and I had a serious pressure in my bladder. He left the room and I complained to the nurse who showed me to the washroom. When I urinated, there was a loud release of air pressure. I told the nurse on my way out – I was very upset and scared. She had no comment.

    Two days later i was in very bad shape – shaking with a high temperature and fainting spells. I got to the hospital and they were flabbergasted – I had fecal bacteria growing in my bladder. It took 10 days in hospital on intravenous antibiotics before I was reasonably normal again. In the process they did a bunch of imaging and realized that post-cancer , a radiation fistula had developed between the bladder and the rectal stub. Friedlich had transferred fecal material from the colon to the bladder via the rectal stub in his procedure. What pissed me off was that when i complained – he had the info he needed to diagnose this but instead chose to blame me for being childish and complaining unnecessarily.

    You know the condition is rare although not unheard of, and Friedlich should have done the procedure in reverse order to avoid any problem..Even so, doctors make mistakes or are sideswiped by unexpected conditions and I am a forgiving soul. I have made errors in my professional life as well. My issue was that his arrogance was so great that he failed to even consider that when i complained there was a problem and instead he chose to accuse me of being childish. I was so angry that his arrogance put me in the hospital for 10 days and threatened my life, that i called my old surgeon and ripped a strip off of him for referring me to such and arrogant asshole (pardon the pun). He was very apologetic and arranged for me to get a replacement surgeon. I never went back to Friedlich. I didn’t make any official complaint, but i trashed his reputation every chance i got to whoever would listen.

    Sorry Victo, but I can most certainly empathize with your patient who complained about the arrogant asshole she ended up with. In my case Friedlich was one of the most experienced, most skilled surgeons in town It was his attitude that resulted in his failure and my pain. many will say that they would rather an asshole who was skilled than a doctor with a good bedside manner. In my case it turned out that the inability to listen to the patient cause d what could easily be categorized as a malpractice situation. Here in Canada our courts will not find for patients in these kinds of cases where there is no permanent damage to the patients, so there was no point in starting legal proceedings. I’m not a very vindictive peson, so I likely would not have gone any further anyway. I just like to complain. Thanks for letting me rant. πŸ˜€

    If this is too personal, feel free to edit it out – that is fine . i just wanted you to know that your patient has every right to bitch about an arrogant doctor as his arrogance could lead to damage to her – I know, I’ve been there..

    Liked by 3 people

    • She absolutely had the right and I appreciate the feedback. As you see, it affects how I refer. You jack with my patients and it pisses me off, whether or not my reputation is at stake or not, is really a moot point.

      Liked by 2 people

      • Thank you Elyse – that was some years ago. Because of my colon cancer, I have had many scopes – they are safe and, with sedatives, very innocuous, once you understand what is happening. I am very clear now to any doctor doing the procedure on me, what my personal issues are and have not had any problem since. I encourage people to get a colonoscopy as a preventative procedure. It is good that you had it done. Many will avoid it until there is a problem.

        Liked by 3 people

      • I have crohn’s and doctors removed my colon 30+ years ago. So I have them every year and don’t really worry. Except when I hear a story.

        In my jobs, I read about risks and balances all day. There’s always a risk. But nothing in life is risk free!

        Liked by 3 people

  4. No matter what the profession, or how brilliant the person, good communication skills — and civility… are important. This guy seems to be lacking in both. I’m sorry it put a bump in your road.
    You know… there are just too many adults who think they’re being “cute” when they’re really just being a$$h***s. I know because i work with too many of them.
    Wishing you a bump free week. Hugs. πŸ™‚

    Liked by 2 people

  5. A doctor can have an ego the size of the grand canyon, but if he/she can’t/doesn’t listen then there is no point in going to him/her. Because they need to know how you’re feeling, what hurts, what doesn’t, so many whats, where’s, hows and how longs — to have any chance of diagnosing and treating. And so listening is the number one thing I look for.

    It sounds like this one will be losing a valuable source of patients. Maybe he will learn from it.

    My husband wants to retire and move away from here. When I mention my doctors — who are wonderful — he stares at me with a look of total incomprehension… But with a chronic, serious illness, finding the right doctor is vital. It’s not like finding a good restaurant!

    Liked by 2 people

    • One of the reasons I hate the thought of moving is having to relearn who is good and who is not for patients again. I completely understand. MIT is like finding a mechanic and a plumber you can trust. It has taken years of trial and error to find the right ones. I am happy to try new people to a point but I feel terribly guilty when patients don’t like them, like it is an indictment of me for whatever reason. I guess on some level it IS a reflection on me, who I send patients to. It makes me look good when they are happy and well cared for.

      Liked by 1 person

  6. Ugh. This is part of why the NP I saw a few weeks ago ticked me off, insulting my primary care physician. One may not agree about something for whatever reason, but there are better ways to go about it than insult the physician they’ve built up a relationship with.

    Liked by 2 people

  7. I trust my primary care physician. He’s possibly the smartest doctor I’ve ever met, and that’s saying something. But he has a good bedside manner and doesn’t balk at referring me to specialists when I request one. (Because I have a half-dozen serious medical conditions, I make it a point to see a specialist for each condition at least once a year.) And the knows the best in the business. When I needed a referral to a Rheumatology doctor, he got me in with one of the top 10 in the country. When I didn’t like that doctor (he got mad at ME when he made a mistake), my GP referred me to another guy who’s in the top 10 in the state. Please understand that I didn’t ask for someone with such a high reputation, that’s just the type of doctor to whom my GP refers people.

    I don’t trust that these specialists know what they’re doing because they have a high ranking. I trust them because my GP does. And I have a feeling that’s what your patients expect of you. If one guy’s a jerk, stop using him (as long as you can, under the circumstances). You owe that to your patients.

    Liked by 1 person

    • I am not sure that patients are aware what is coming regarding referrals. No longer will it be up to your PCP to refer you to who is the best choice for you. It will be limited by he system they practice within. It is already mandatory in a number of places. I find it very upsetting.

      Liked by 1 person

      • All you can do is your best within the constraints you find yourself…unfortunately. But at least as long as you’re in there punching away, the patient has at least ONE person on their side in this mess…

        Liked by 2 people

  8. Things really do change when you can only refer within one system. I know my husband will refer out but always asks the patient how doctor was – just checking I guess. Too bad the patient had a bad experience but to paraphrase Gump, “Choosing a physician is kinda of like choosing from a box of chocolates…”

    Liked by 2 people

    • I value patient input about their experience. You can try to match someone with the perfect specialist but you cannot be 100% spot on. No physician can make every patient 100% happy and that alone does not make them a bad physician, but when it is an ongoing trend…


  9. I agree with you and with your patient. Most General Practitioners that I have come across in medicine and teaching and motor mechanics etc are well rounded in most of what they do, but many specialists become arrogant and pompous and seem to know an awful lot about a small area and forget all that is outside their field. It is especially so in my area – teaching – where the science teacher can stand in front of a class of young teenagers and proudly say, “Oh, I never could understand History (or Literature or Geography). Right Royal pains in the butt.
    Have a nice day!

    Liked by 2 people

  10. When this happens, do you feel your credibility is diminished? It’s like if you recommend a plumber to a neighbor and your neighbor ends up with seriously damaged pipes. You feel kind of bad for the recommendation. Or are you able to separate yourself? Because it really has nothing to do with you, you know.

    Liked by 2 people

    • It IS a credibility thing to some extent. When my patients are happy it makes me look good. The other part of that is a certain sense of betrayal. I spend time with every referral talking to the patient about the person I am sending them to, building up that specialist. I would like some of that favor returned. I learned this from a cardiologist who told a patient of mine that I had saved their life. Not her. Me. That patient in return thought that cardiologist was the best thing since sliced bread because she had validated her choice of PCP. It makes a difference to the patient experience and builds good referral relationships.


  11. Do doctors get any kind of communication training as part of their education? I just helped a med student research his doctoral thesis, we were studying how personality affects surgery recommendations (yes, it does). We talked about how some doctors cannot/do not communicate with their patients effectively and whether this could be researched. I have been subscribed to this blog for a while and it seems that a lot of issues revolve around people not communicating effectively. Do you think this is something that we should dig in to?

    Liked by 2 people

  12. I identify on the family level. Exhibit A: I tell teen something. Teen ignores it. Coach tells teen the same thing. Coach is brilliant! I would give you an exhibit B but that might entail me throwing my husband under the bus πŸ™‚

    Liked by 1 person

  13. My daughter suffers from this condition…so I was distracted from the professional courtesy issue of your post. She has this in combination with debilitating migraines. Claims she needs a head transplant. Don’t we all ??? Van

    Liked by 1 person

  14. I am going to wait to see what you write about the article you added to this post. However, it is upsetting me so I am going to write on my blog about my latest experience. the topic will be about the harm of not using patient satisfaction techniques to enhance the patient experience in anticipation of your next post. I went to see this specialist on the recommendation of my GP. Although I do not harbor ill will against the GP, I am not sure I would recommend the specialist.

    Liked by 2 people

  15. Pingback: I can’t get no satisfaction | Out of the Rabbit Hole

  16. Arrogant, pompous? I am not an expert or even a qualified professional. When dealing with situations and people sometimes certain individuals use a set of behavioural characteristics for certain situations: their mask.

    I am used to switching masks for several situations. Sometimes though a person is needed. Sometimes people too often rely on their masks…


  17. Do you think it would matter if you worded your referral letters differently? Ie, Im confident this patient has BPPV, but she wants a second opinion? Either way. To say that most Drs don’t know what BPPV is… That is downright insulting!

    Liked by 1 person

    • People often have a hard time with the fact that physicians and their office staffs don’t know the details of their coverage. There is no possible way with hundreds of plans out there, the details of which change every year. I hate placing that responsibility on patients because often they don’t understand what they are reading, either. Stupid, stupid system.

      Liked by 1 person

      • Yeah, I can appreciate your frustration with that… Having been a paralegal for so long, I’ve seen so many people who don’t even know what their own auto insurance coverage is, much less how the law works around it. But this stupid health insurance system is beyond stupid! When we settle a case and I call the health insurance company to determine the amount of their subrogation lien, they often pass me around and make me jump through hoops for hours. It’s ridiculous the amount of work I have to do in order to PAY THEM money!

        Liked by 1 person

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