I Pit My (alleged) Doctor

The BBQ Pit
1

You see, my previous healthcare professional (as opposed to my current doctor) was quite good, treated me nicely, etc. She is currently out on maternity leave, and I am therefore seeing another doctor at her practice. We’ll call him Dr. Bum, which is both appropriate, and far enough from his actual name to avoid any nasty legal crap, but still very vaguely close.

Let us begin the bitching.

  1. I got bit by a tick a few months ago, and went to the emergency room when I noticed a bullseye-esqe red mark around it, as I was fearing lyme disease. I was given a prescription for doxycycline, which is the standard action for such infections. A blood sample taken and supposedly tested for lyme-type antibodies. When I went to my doctor for an appointment, I mentioned what happened, and he said that they would try to get the results for me. A few days later, Dr. Bum’s office drone called the Sane residence to get the phone number for thelocal hospital. Now, I’m no genious, but I figure that a doctor’s office would kinda have the largest local hospital on speed dial at least, or maybe have a office flunky that could actually dial 411. On my second visit to Dr. Bum’s office they still hadn’t gotten the test results, and they just gave me an extension on my antibiotics, and informed me that getting the test results was my concern, not theirs. So much for the hippocratic oath and such.

  2. Between the first and second office visits mentioned above, I went to the pharmacy to get a refill on my medication. I take Effexor XR, which is a time-released seratonin reuptake inhibitor, which is the expensive name for an anti-depressant. It works well for me, and doesn’t make me sleepy like prozac did. It turns out I was out of refills, and since it was a weekend (Dr. Bum’s office was closed) I was given enough medication to hold me over until Tuesday. I went back on Tuesday to pick up my prescription for the next 30 days (that’s what my insurance allows) and I found out that I got 30 pills, take one by mouth, three times daily. My second appointment with Dr. Bum was more than ten days away, so as you could imagine, this caused a problem as well.

  3. I called Dr. Bum’s office, and they promised me that they would call me back to let me know how they would fix the problem. It’s been a few weeks now, and they still are stubbornly still not calling me. After a few days, I went to the pharmacy and found out that they had sent over a prescription of Effexor for me, and with the right amount of pills, and the right size, etc. When I got home, I noticed that the pills were tablets, not capsules, but who cares- I don’t have them because they look pretty anyway, as long as the compound in them is the same, who cares. It pissed me off that I was never given any heads up on the problem getting fixed, but all’s well that ends well, right?

  4. Turns out it was the wrong kind of Effexor. I had been taking Effexor XR, and my alleged doctor, gave me the non-XR version. Now in this case, the XR stands for eXtended Release, and it apparrently matters. For the last week I’ve had a number of side effects including agitation, moodiness, and a general shitty mood. I did some research on possible interactions, but mostly attributed it to my currently-unemployed-but-still-getting-severance status, until last night when further research showed me that Effexor XR only comes in capsules, and non-XR versions come in tablets (that taste icky). Fortunately, due to a rather odd turn of events, my ten-day supply of Effexor XR (mentioned earlier in this rant) had gotten an automatic refill at the pharmacy, and I’m back on those. I currently want to throw rotten fruit at my doctor.

  5. On the visit where I got an extension to my antibiotics prescription of Doxycycline (it’s used for anthrax, I’ve found out). I complained of a body-wide rash. I was getting hives over my arms, legs, neck and (slightly less) back, and I really didn’t like it at all. I described the issue to the medical assistant, and he also was concerned about it, and had the doctor take a look. He told me that I didn’t have hives, but “excoriated lesions”(not that anyone would ever scratch at anything that itched and left a welt). He told me it was from bug bites maybe. After getting home and picking up my prescription for more doxycycline (did you know it’s a tetracycline derivative?) I saw one of the warning labels on my prescription bottle. Yes right there- “May cause increased sensitivity to sunlight”. I’ve noticed that sunlight tends to hit my arms, legs, neck and (slightly less) my back when I am outdoors. That Dr. Bum (not his real name, but close enough) is a fucker, and I want to poke him in the eye with a durian (rind on).

  6. When I missed an appointment last Monday (a liver enzyme test to make sure my liver isn’t freaking out from the medication) I didn’t get a callback to reschedule. Not a big deal, as I don’t want to go back there ever again, but I used to get a “Hey, make sure you show up for your appointment tomorrow” call the day before my appointment, and if I had gotten one, I wouldn’t have missed my appointment. A “hey are you dead, or just forgetful” call after I missed my appointment would have been swell as well, but keeping up with the side-effects of the prescription fuckup has kept me very busy this week, thankyou.

I just found out about the prescription fuckup in the last 12 hours or so, and between the general side effects from the dosage issues, and the pissed-offedness at the doctor, I’m quite agitated, angry and unrelaxed, though venting in the 'Pit has helped. Oh, and I still haven’t gotten any kind of results on whether I was infected with the Lyme disease or not. AAAaaaaarrrrrggghh!

Anyone else had problems like this with a “healthcare” provider?

2

All hail the power and the glory of the H.M.O.

3

Copy your OP into your e-mail program, edit it appropriately, and send it to the home address of your doctor-out-on-maternity-leave, with a request for a referral to a physician who is interested in treating you as a patient.

Send a second copy to your insurance or HMO administrator, with a request that they audit the billings from Dr. Bum’s office to assure that proper patient care is being performed for what they’re paying for.

Then sit back, relax, and smile.

4

Actually, your HMO doesn’t give a fuck about this kind of stuff, so copying an E-mail to them won’t do dick. I would, however, copy it to the administrator of your Doctor’s medical Group. They do indeed give a fuck about fuckup doctors.

Sam

5

It’s actually insurance, not an HMO, and I appreciate both the advice and sarcasm. I am tempted to send a few letters and/or emails to the appropriate people. Thank you polycarp for your advice.

My hands are shaking, and it sucks. The shaking was going on earlier this week, but it was only very slight, and I didn’t worry about it, I just figured it was just low blood sugar. I just had a thirteen hundred plus calorie snack (bag of potato chips and two Strawberry Frosted Pop-Tarts (choice!!) a few hours ago, and I’m not angry, so I think it’s a side effect that will work itself out. Typing is difficult due to both the shaking and co-ordination issues. I’m suspect I’m going to be quite pissed after this is over.
Oh and yes, since it’s The Pit… FUCK!

6

You know, state medical boards don’t look kindly on doctors who misprescribe, ignore test results, and other such borderline malpractice-type activities. If I were you, one of those letters should go to those governing authorities, too. Can’t hurt, might help.

7

You have my deepest sympathies. I’m on Effexor XR, myself. Fortunately for me, the only times I’ve had the sort of problems you’re describing since going onto the XR version was when I went out of state and forgot my meds at home. (Doh! :wally ) I started on the XR after telling the doctor that I was having problems remembering to take the regular version twice a day. Since the XR formulation costs about $3 a dose for me, vice $1 for the non XR version, I can understand why the insurance/pharmacy would fill the regular version by preference - but if you’ve been on the other, changing back and forth isn’t going to do you much good. As you’ve found out.

I’m not going to say that you’re wrong to think your alleged doctor is a twit. However, as a patient you can improve the care you get by being as informed as possible about the treatments and diseases you are experiencing, or are worried about. Whenever I’m on new medications always, always, always ask about possible side effects - and if you have a new condition after starting a new medication, ask whether it’s possible that it derives from a medication side effect. Likewise, if you ever get a medication that doesn’t look like what you expect - or if the name is slightly different - ask why it’s been changed.

Again, this is not to say that your alleged doctor isn’t screwing you up unnecessarily - just that being an informed and involved patient can help you avoid such unpleasantness.

8

Although this guy does seem somewhat idiotic and perhaps incompetent, there are a lot of points at which you could have averted problems by being a more involved patient. Calling to get your own test results before your first visit (who wouldn’t want to know ASAP if they’ve got some tickborne disease?) and asking why your pills looked different and why the dosing was different spring immediately to mind.

You can’t put all the responsibility for your health on your doctors, because the best, most conscientious doctor in the world is only human. Sometimes they forget stuff or make careless mistakes. Sometimes they draw the wrong conclusions. Sometimes there are miscommunications and clerical errors. Shit happens, you know? Most practices have measures in place to catch mistakes, but they’re generally not as effective as being active participants in our own care. In day to day care, we are our own strongest line of defense against medical mistakes.

To make things go a little smoother in the future, always check your pills before you leave the pharmacy. If they look different, or there’s a different name, or the dosage or spacing is different, ask about it. Again, sometimes shit happens and the doctor has screwed up the script, or the tech has misread or misfilled it. Check to see how many refills you have left. If you’re out of refills, go on and call the doctor then. That way there’s time to deal with any snags you might hit getting approval for a refill before you need it. Nothing sucks more than to be completely out of something and need approval for a refill, only to find that your doctor is out of town for a week and a half and nobody else will refill it without seeing you. It’s a right pain in the ass.

Read any inserts or pamphlets before starting new medications. It’s not uncommon for people to forget to tell you about side effects and/or drug interactions. I would never have known that I couldn’t take aspirin with my seizure meds if I hadn’t read the little info sheet the pharmacy stapled to my bag. Likewise, I wouldn’t have known that it could make my hair fall out, or that I needed to call my doctor if I had vomiting/diarrhea or menstrual irregularity (which are all things I would have ignored until they got really, really bad.) Dozens of people don’t realize that various meds will interfere with their birth control pills and wind up getting pregnant because they weren’t taking additional precautions.

Good luck and feel better soon.

9

Hey, at least your doctor tested you. When I got a bulls-eye rash I thought it was a spider bite, never mind that I had been out hiking around in the wilds a couple of weeks before, and my doctor said call back if it abcesses. (If I got bit by a tick I never noticed it, never saw the tick, and the sore appeared, as I said, maybe 10 days later so I didn’t make the connection.)

Some months later I noticed that I couldn’t feel my feet, at which point I went online to find out what might be possible causes for foot and leg numbness, none of which I liked much. But one was Lyme disease, which seemed like a preferable alternative to strokes, multiple sclerosis, etc., so I clicked on it and got . . . an identical picture of my bulls-eye rash from the summer. I called my doctor again and mentioned the bulls-eye rash that I’d thought was a spider bite. He said, “There is no Lyme disease in Colorado. It sounds like you might have something else.” (nothing good, of course. strokes, diabetes, brain cancer . . .) So I made an appointment. By the time I went in it was January–I’d been hiking in August. Went in, had a diabetes screen and a bunch of other tests, the usual lecture on smoking, and when I asked about a test for Lyme disease I got it again–there is no Lyme disease in Colorado.

But, to appease me, and probably because I have fairly good insurance and might as well whack it for all it’s worth, they gave me the antibody test anyway. They didn’t call with the results, I kind of forgot about it, and at that point I was more concerned with rehabilitating a strange shoulder injury that was keeping me from most of my exercise. Finally, a couple of months later, I called, and the doctor’s office said, Oh yes. Positive on Lyme disease. You should have been taking an antibiotic for months now. It’s less effective the later you start it.

Gee, if I’d started it when the bulls-eye first appeared, back in August . . . eight months before . . . would I have the shoulder injury? Arthritis symptoms? etc.

There could be MANY instances of Lyme disease in Colorado. The doctors would never notice!

10

Been there.

http://boards.straightdope.com/sdmb/showthread.php?t=241527&highlight=sick

http://boards.straightdope.com/sdmb/showthread.php?t=257633&highlight=sick

Misdiagnosis is no fun, either.

11

I can’t stress CrazyCatLady’s comments enough. Be informed and case manage your own care. It does not relieve the responsibility of the health care professionals to take the best care of you possible, but it is the best line of defense between you and painful (to you) mistakes.

Case in point: I was hospitalized a couple of months ago for a superinfection bout of colitis (I had taken antibiotics for another minor ailment and something I ingested ran rampant in my colon because all the good bugs had been killed. Talk about lousy timing.) Anyway, my doc had just switched me from IV Flagyl to po Flagyl. The evening nurse brought me my med and the following conversation ensued:

nurse: “Here is your flagyl.”
me: (looking at the labeled unit dose) “I don’t think this is flagyl.”
nurse: “Yes it is”
me: “No, it looks different”
nurse: “It’s the generic.”
me: “The name on the label does not seem to be flagyl. I don’t remember the exact generic name (not having a PDR in my robe pocket) but I’m sure it should end in -zole and not -lol.”
nurse: “But…it is your medicine…because it scanned correctly with your name."
me: "Look… this is not my medicine and I will not take it. Go look it up and bring me my medicine.”

I was astounded by how many times I had to prevent the same error. Her first response to my concern should have been to go double check. And I am not ragging on nurses here, I am one, but in this instance I felt I needed to inform her supervisor, not becasue she made a mistake but because she didn’t listen when a patient tried to be a partner in their healthcare.

Sorry for the slight hijack, but I think it is relevant. Sure your doctor’s care, or lack thereof, is wrong. Inform his medical group that you are not happy. But don’t let these errors and the suffering it has caused you be for naught.

Question, question, question…question everything!!

Good luck in feeling better and getting better care!

12

I’m confused by this part:

You realize that Doxycycline is used to treat about a bazillion different problems, right? What on earth does anthrax have to do with your current problem?

I think your doctor is a jerkwad, but I agree with the poster who say you MUST be involved in your own health care- highly involved. If a pill you’re taking looks different, you have to ask why. (The pharmacist really should have double checked that too- especially if you’ve been taking Effexor EX for a while now) You have to persue your own test results and make sure things are taken care of. And if you get substandard care, you need to get another doctor lined up and stop going back- don’t give them the opportunity to make you sicker then you are already.

13

Anthrax has nothing to do with my current problem. I just found it interesting, and I tend to be a bit scatterbrained sometimes. I figure anything that can fight anthrax is some bad-ass shit. I did my research and found out independantly that the standard prescription for Lyme is indeed doxycycline. Interestingly, doxycycline gave me no intestinal issues which is what antibiotics usually do to me.

I have seen the light, and you are right. I was told it was a refill, and I just assumed it was a different form of the same thing. I did do some resarch on it because it looked different, but the pics looked exactly the same, so I figured I was in the clear. However, I was looking at Effexor pictures, not Effexor XR pictures. The XR makes a big difference, and I didn’t notice that on the webpage. I’m pretty sure I was tired, it was late, and I probably was ingesting some fermented maltose with hops flavoring.

I’ll be more carful next time.

Thanks for the well wishes Bosda.

Anyone know a good doctor in the New Brunswick, NJ area?

14

Oh, and I added the bolding in the quote. I don’t want to risk the wrath of the admins. I bolded it for emphasis and it’s application to my current situation.

That is all.

15

While I have no patience with incompetent doctors, I have to say that almost all of the above situations have occurred in my practice at one time or another. Let me take it point by point, if you don’t mind.

Unfortunately, under the new HIPAA laws, it is very difficult to get results that you have not ordered. Many, many times, my staff has called the local hospital to get results from one of my patients that was seen in the ER, and we have been told that they are unavailable without a signed release from the patient. If you are not the patient’s usual doctor, such a release should by law be mandatory. We have also, on occasion, called our local hospital and found no results, and then had to call the patient to ask “Just what hospital was it where you were seen, again?” That said, I agree that the doctor should be able to find numbers for the local hospitals, and should have known enough to get you to sign a release for the results when you were seen in the office.

To be fair here, Effexor XR is usually taken once a day. Even people who take more than one pill daily usually take them all at once. This sounds like a misunderstanding in the communication process, either between you and the doctor’s office or between them and the pharmacy.

Here again, a misunderstanding caused by the fact that you take Effexor XR three times a day, while most people take it once a day. I can visualize this kind of conversation.

You, to Dr’s staff: You only filled my Effexor for 30 pills, but I take it three times a day.

Dr. Bum to pharmacist: I need to correct an earlier prescription. Mr. Sane takes his Effexor three times a day and needs 90 pills.

Pharmacist (thinking-or not): OK, he will need Effexor regular in this dose, three times a day.

Again, this is a communication problem. I am assuming that the doctor did not have your chart at hand. I don’t know how many times patients call for prescriptions and fail to specify XR, or XL, or ER, and when questioned don’t know if their medication is extended release or not. I am not saying it is your fault, since sometimes my staff fails to write the letters down too (although I tell them again and again to do so). I do think that you should have gotten a call saying your prescription was called in, though. This is also a lesson that everybody should always check your medication and if it looks different from usual, ASK the pharmacist or doctor before taking it as this will save you potential injury.

Sun sensitivity from doxycycline is just that, sensitivity to the sun, which means that you sunburn much more easily. It sounds like you might have had an allergic reaction to the medication, or you might have had bugbites. I can’t comment further since I didn’t see the rash, but the doctor may have been correct on this one.

This is an individual doctor thing. Some doctors don’t do this because their patients feel it is babying them.

Overall, it seems that this new doctor has some problems with communication. It’s not that he did anything that was medically wrong, but these are the cases in which a simple call to say “I’m sorry for all the trouble, we’ve corrected your prescription and tracked down the test results and here they are” would have made up for a lot. They really should teach that in medical school (along with plumbing-but that is another rant).

16

Hypochondria.

Check in to it.

17

Yeah, I’m on regular prescriptions for my mental health, and I can’t imagine not knowing exactly what drug I was on, what it looked like (in fact, I know what the particular generic versions of Ritalin at several area pharmacies look like) and what the dosage was. If I got a prescription that was wrong, I wouldn’t leave the doctor’s office because I would notice right away; if the pills weren’t what I was expecting, or the label on the pill bottle didn’t specify what I thought it was, I’d notice right away. If you don’t realize you’re on an extended release version of a drug, or know the exact dosage you take, that seems kinda strange to me. I wouldn’t assume that the doctor would get that right without fail, because as conscientious as my primary care physician is (she’s excellent) she has a lot of patients to treat and it’s easy to screw those things up the way the health care system works. I don’t mean to blame you, because the doctor sounds pretty lame, but you’re putting your own life in the hands of the pharmacy, doctor, and computer system’s hands if you don’t know exactly what pill you’re taking.

18

When I first came to Saudi in '87 I started feeling very ill one day and had a slight fever and headache along with a stiff neck. I took a few aspirin for the pain and went to the local hospital on the way to work. After the usual poking and measuring, the doc told me I had “nervous tension headaches” and prescribed a few pills. It sounded funny but I’ve misplaced my medical degree so I took the pills and went to work. By lunch time I was much worse, my neck had almost completely seized up and sunlight was extremely painful.
Back to the doctor.
More poking and prodding followed by the solemn verdict of “nervous tension headaches” and more pills.
By now I just wanted to sleep and went home. When I woke up at 0200 I had a fever of 106 and was shaking like a belly dancer. The pain was astonishing. I drove back to the same hospital where they laid me on a table, checked me thoroughly . . . and told me I had “nervous tension headaches.” At that point I grabbed the doctor by the neck and asked him how that squared with the fever.
His response (somewhat gargled) was that I was also irritable and should be admitted.
Later that morning they discovered that I had meningitis and was due for some serious dying if they didn’t fix it.
It ended well but ever since then I’ve been a bit unwilling to simply accept whatever a doctor says at face value. Dig into it with those guys. The better ones don’t mind explaining things and if they aren’t willing then maybe it would pay to talk to another doctor.

Regards

Testy

19

And some posters to this board do have REAL, EXTENDED and COMPLEX health problems. A concern about an acute medical condition combined with a chronic medical condition is NOT hypochondria.

I suppose that you consider a diabetic being concerned with tingly toes to be a hypochondriac when they also notice a lot more floaties in the eyes…and not having peripheral neuropathy with an upswing in macular degeneration

20

Personally, I’m just glad nobody is trolling in the pit…

Regarding the callback from the doctor regarding the prescription fix, the flunkie on the phone did say she would call me back so I actually assumed she would do so. Also, I made a special trip to fill out the “Dammit, I say it’s ok for my doctor to have access to my medical records” forms, weeks earlier.

I’m heading to the hospital to get my test results, and I’m bringing a book.