Friday, April 06, 2007

Hypertension 45: Waiting for Dr. Godot

Getting the right doctor, without appearing to be "doctor shopping", is always a big challenge for someone with an ongoing medical condition.

The interpersonal politics are significant, at least underneath the surface. You depend on your doctor to give you the right medications, to support you in life and workplace issues, to keep an eye towards your future. You need a decent personal relationship for those reasons. Cheese off your doctor, and you have problems. Also, if you're going to get down and dirty about very private matters, at least you should have a rapport with the person on the other side of the desk.

Yet, if you start changing doctors, you are looked upon with suspicion. Other doctors, and in particular your employer if your medical condition affects your work, start to wonder: are you doctor shopping--continually changing doctors until you find one which will not only stick a needle in your ass but kiss it (the ass, not the needle)? It is a delicate balance--finding and keeping what you need, weighed against what will work with your employer and other doctors.

Doctors are business people, most especially general practitioners. They rely on a steady stream of clients. Apart from all the normal human niceties (is that a word?) of wanting to keep their customers happy and healthy, the doctors also want a happy and healthy cash flow.

For specialists, the elite, this is not a big issue--they have a steady flow of referrals. But for the general practitioner, clients can often be lost to other family doctors. Even when a family doctor is relatively well booked, it still can't be good to lose a client. As a result, general practitioners often appear to be much more vulnerable to patient demands.

Patient demands as in: I need a week off work, gimme a note.

I've seen it happen. It is why the word of a general practitioner in legal issues is helpful, but never nearly as good as that of a specialist. Of course, every g.p. is different. Some are more resistant to pressures than others.

Specialists are another breed. They are the elite. They, in particular, can often appear suspicious of their own clients, and of being manipulated. Ain't no one going to tell a specialist what to do--which is why their evidence is more respected.

I actually had one specialist (none of the ones mentioned in these posts) who appeared to be anti client. I told him that I felt sick and needed a couple of days off work. He was an internist in a medical clinic, I saw him thru the luck of the draw. He almost sneered and refused the sick note request, and only took a throat swab when I insisted. A few days later, the throat swab results came back and I was called in--I had strep throat. He started to talk about how good it was he'd gotten the swab, as if it had been his idea and he was Dr. Kildare. When I pointed out that I had to insist he swab my thorat, and he'd refused me time off work, he actually got angry. I never went back to that guy.

And he is a guy...a human being...even if he is a doctor.

Anyway, I am waiting for a specialist on Hypertension. And it ain't doctor shopping.

The last time I saw my WMD, I gave him a 'diary' he'd asked for about my work experiences. It listed about ten negative side effects. He did not ask a single question about any of the diary, including the side effects. Then I told him I had aching legs, and he did the right thing, ordering a blood test and taking me off Lipitor (no aching legs since then, by the way). I'd gotten his attention in my ten minutes with him. But he never asked a single question about the other nine side effects.

I needed a specialist, someone who would spend more time with me, in particular on the side effects. The prescription meds I'm taking have been very successful in bringing my blood pressure down to "near normal" levels. It's feeling dizzy a lot, forgetting things, getting exhausted easily--that's what I need help with.

My first specialist moved to Alberta. The second was in a hospital clinic who normally did not do follow-ups.

The WMD apparently has done the referral, perhaps a month or so ago, and now I am waiting to hear back. I think in the States it would happen a lot quicker, but maybe not--I do not live in a major population centre, I live in a small city in a small province. There aren't that many specialists to go around. It isn't the fault of socialized medicine, it's the fault of not living in Toronto or Vancouver.

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