Thursday, September 6, 2012

A Nasty Phone Call

     The call was from a patient.  She left the message on my home phone, which is listed, and has been the same for almost twenty years.
     I listened to her voice on the message machine and marveled at how righteous she sounded, and how much power and venom she had gathered for this phone call.
     I had some trouble piecing her story together, but I heard her declaration loud and clear, at the end.
     "With the way things are going for you," she said, "you'd better start looking after that office of yours, or you're gonna be in a whole lot more trouble."
     What could she mean?  Was she threatening me?
     Replaying the message, I gathered that she had been to the office as a walk-in patient, and was troubled by a cough she had had for a week.  She saw the physician's assistant (PA), who asked questions and examined her, then requested a strep test and chest x-ray.  Before doing an x-ray we ran a pregnancy test, which is fairly routine on women of childbearing age before exposure to radiation.
     The PA determined that the patient had a virus, and recommended she go home, get some rest, gargle with salt water, and let the illness take its natural course.  She explained the difference between bacterial and viral illnesses, as well as the importance of using antibiotics only when absolutely necessary.
     There are so few new antibiotics being created and tested by drug companies that it won't be long before many commonplace bacteria become resistant to them all.  Then we'll all be as bereft as we were two hundred years ago, when large populations were wiped out by epidemics.  I thought everyone knew this by now.  Probably my patient did know it--but suffering does strange things to one's mind.
     Instead of feeling reassured, she was furious.  She said it was "an abuse of the system" that we did a pregnancy test, and "an example of malpractice" that the PA hadn't prescribed an antibiotic.  The antibiotic she felt she needed was Z-pak.  She had even asked the PA for it by name, and was appalled that, instead of getting the prescription, she had to suffer through another explanation about the proper use of antibiotics.
     When did doctors become prescription-writing machines?  When did patients come to expect this of us?
     Fortunately, the patient said on my message machine, she had recourse to other, better doctors.  She went to the ER, and (because of me) "had to sit there for eight hours" before she saw a medical doctor and got her prescription for Z-pak.  That's when, at 7 am, she came home and gave me the rundown on my answering machine.
     One of the downsides of being investigated by the FBI is that some patients think they can pile more wrongdoing on top of whatever it is the government has already "found" on me.  They are looking for a way to validate their anger, or their distrust.  Sometimes they try to make deals:  "I know you're in trouble...and need patients, so I'll keep being your patient...and then maybe you can give me some of my pain pills."
     Once in a while I get one of these calls:  "I'm going to sue you, because you didn't give me what I want."  Two months ago that happened when I filed a report with the Department of Motor Vehicles on a patient who had just had several epileptic seizures--it's impermissible to drive unless you've been seizure-free for a full year, and I had discussed this with him at the time.  "I need to drive," he yelled.  "You don't understand."  He called several times a day after that, to tell my office staff that he was having my business shut down.
     Ten years ago a patient asked a lawyer to press charges against me because she thought I should have sent her teenage son to an orthopedist for scoliosis.  But after the lawyer completed a video deposition of me, the case was dropped.  I never found out why.  My malpractice insurance company sent a lawyer to talk with me about reducing malpractice risk-- his advice was that I should drop all my Medicaid patients.  Medicaid is government insurance for low-income people.  "When the economy is tight," he said, "there are a lot more lawsuits."   I guess I'm lucky that, so far, I have never been sued.
     I will call the patient who left that message about not getting antibiotics.  It may help for her to go over the experience again, or perhaps she has a bit more to say.  I will tell her that we're doing the best we can,  and that the PA had her overall health in mind.
     Maybe the PA should have given her the Z-pak, despite the latest warning, in May, that people who take Z-pak have a 2.5 times higher death rate from a heart attack while taking it, compared to other antibiotics.  I wonder what kind of trouble I would have been in if she had gotten Z-pak, and had a heart attack.
     

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