It's Just a Matter of Time

Well, it happened yet again to me last night.

I call my on-call doctor at 2:00 a.m. to let her know I have increasing right-side abdominal pain. Pain, by the way, which I mentioned when I saw a physician on Monday. Pain, which I mentioned when I saw another one on Tuesday, and pain, which I mentioned to yet another one, on Wednesday.

But, I guess I broke some unwritten on-call doctor rule: I woke her up.

I didn't mean to wake her up - I don't know what time she goes to bed - if she would have called me at 2:00 a.m., I wouldn't have had any problem with it. And, silly me for not timing the severity of my abdominal pain at a "more convenient" time for her.

I got the requisite "Are you vomiting, diarrhea, fever, etc.?" questions - and I answer, "No, no, no, well, yes...but I'm on a drug that does that anyway." The rest of the conversation (and my fleeting ongoing phone-call thoughts) goes a bit like this...

"My pain? Right lower side - it started getting really severe about 30 minutes ago...altho it seems a bit better now. I was just concerned it was appendicitis."

Well, I'm 48 - apparently not the "ideal" age for appendix problems. Silly me, again...I should have checked online first before I called...altho I've been chastised by nearly every single doctor about online self-diagnosis, even if that diagnosis was via WebMD or MayoClinic.com.

"Can you wait until tomorrow to go to Pri-Med?"

"I hope so...what do YOU think? I called you to make sure it didn't sound like appendicitis or something else to really worry about."

"Well, only YOU know if it's bad enough to go to the ER or wait. Apparently it was bad enough for you to wake ME up at 2:00 a.m. to tell me about it."

Well, so sorry to have bothered you - next time I'll try to time my increasing pain better - in fact I'll just set up on appointment next week to have it. (No, I didn't say this...but I was thinking it the whole time.)

Bear in mind I was once verbally scolded by a doctor who said I shouldn't eat apples at night. It felt like a big chunk was lodged in my throat...and, after waiting about five hours for it to dissolve or slide down, I finally gave up and called. I remember the exact exchange like it was yesterday...

"You should be in bed at 4:00 a.m., SLEEPING, like I'm going to get back to doing once I hang up the phone. If you can still breathe...YOU'RE NOT CHOKING!"

"Well, I didn't say I was choking, it just feels like it's stuck in my throat like right where..."

Click.

Yes, he hung up on me in mid-sentence. This happened about eight months ago.

So, after I hung up the phone last night...I cried and cried.

I don't want to be a pain in the butt - I don't want to call doctors on weekends - I don't want to call them at 2:00 a.m. - but, isn't it also a fact that an "on-call" doctor...IS on-call?

I didn't call because I had an eyelash in my eye. I didn't call because my cat scratched me. I called because I honestly was worried I was having something which could lead to a even worsening situation and/or death.

But, after I cried, I cried and cried some more -- feeling like I'm just a waste of skin and promising myself the next time, if something happens off-hours or on weekends, I'll just ignore it - preferring death to their guilt-trip-laden third-degree "How dare you bother ME!" treatment.

Seriously, I felt worse AFTER I hung up than before I called...each of these times...and just ended up taking my Ambien and hoping I'd wake up the next day.

But after several nonchalant dismissals of this nature (for both myself and my children), I'm wondering how many people actually get treated this way - or is it just that I've gotten the "red-flagged...oh it's that whiner again" reputation? Did I do anything I oughtn't to have done? How should I handle things like this in the future?

I don't sit around my house thinking of ways I can piss off yet another doctor. I don't like going to the Emergency Room to waste six hours of my life. But I don't want to be another one of those "Oh, she shouldn't have waited to call" death statistic, either.

I fear if I call to complain or to report them (it's happened with base doctors several times)...I'm sure to get treated worse in the future...and it's not like I can change doctors like I do underwear. So, have any of you been where I've been with this? And if you have...or even if you haven't, what is your suggestion to me?


Truth be told, I've had some very nice responses from on-call doctors...especially the ones in Birmingham. In fact, I've never been treated badly by any doctors in Birmingham...why, I haven't a clue.

(Written, but not published, about a year ago...on a Friday.)

"B" Rating Okay; Berating Not Okay

I was glancing over the "news" stories they feature on AOL's main page the other day (by now "the other week"...as I've sat on this idea for a while) and happened upon one which piqued my interest: Doctors Seek to Silence Online Reviews . Honestly, I'm reluctant to click on any of AOL's "news" links because chances are I'll be shuffled off to some guy's blog who apparently knows someone on AOL to get the prominent front-page link-up...

...but, I was a bit intrigued as it spoke to me in a language I have recently begun to be far too affluent in: medical.

It seems some doctors are so miffed about all those "Rate Your Doctor" sites readily available to even the least adept Googler, that there is now a service (or probably a few by now) where, for a fee, your physician can pay some "company" to troll those sites and report all the "bad" findings back to them.

This apparently was enough for some doctors to get so bent out of shape over that they've added yet another form for you to sign when you fill out that ever-growing stack they hand you when you get there: Basically, a promise that you will not go to any of these sites and rate them in any negative or derogatory fashion. Oh, and it doesn't stop there. You also cannot mention anything against them on Facebook, MySpace, Twitter, or even on your personal blog. You are, in essence, being stripped of your First Amendment rights in order to receive medical care from these doctors. And, if the trolling service finds you have indeed breached this contract with your doctor, you are then - terminated. Plus they can also then bring legal action against you. Nice, huh?

So, we are now being told that not only "an apple a day keeps the doctor away" - but also public criticism. This is absolutely ludicrous - it is censorship at its most base level.

I am not aware how many of you have used these ratings sites...or even know of their existence - but I have done so, for obvious reasons. (I have some medical issues for those of you who don't know.) Not that I would use them for any "make or break" decision device as I'd wait to "rate" my doctor after a face-to-face visit. But, I do like having at my disposal, the opportunity to peruse the credentials of a doctor whose name is the only thing known to me. You see...he had MY whole history splayed out in front of him to pre-judge me...way before he opens the door after that obligatory "two-knock" custom they must have learned somewhere between Pre-Med and Residency...and he has it still.

Certainly you've seen it, haven't you? Oh, surely I can't be the only one to sneak a peek at what's inside that mysterious manilla folder they gaze at, and up from, whilst talking to you. You know the one I'm talking about...that one they leave open...enticingly within arm's reach of you - when they are called out of the room for a moment.

Haven't you ever been curious about what's inside that thing? For sure it has lab reports and a little synopsis of your current and past ailments - but aren't you at all just a little interested or even a bit more than nosy to know what else they keep in there? It is, after all, YOUR folder - I've read and signed those disclaimer sheets I spoke of earlier...we are entitled to view it. So, recently, I've taken it upon myself to investigate just what my doctors say about me - you see...this is the stuff they never share - other than between themselves.

At the risk of implicating myself even further than I already have, let me toss out a few things I've surreptitiously gathered about myself during my "I spy with my little eye - super quick-like before the doctor comes back in" waiting game. (Thank goodness for that "two-knock" warning.) I have mastered the art of stealth equivalent to a James Bond Ninja - I can leaf through it - photograph it with my "super memory", return it to the original page and pop back on that papered "couch" with the agile ability even "Grasshopper" from that "Kung Fu" show of the '70s would have envied. Then to complete the whole effect - I don my "mesmerized by the circa 1980s 'worn at the edges from the cheap thumbtacks' human anatomy posters" facial expression. Trust me - I've got that whole dance down to a science - I AM poetry in motion - bad poetry...a Haiku perhaps - but nonetheless, I've yet to be caught.

But in a way I feel like I have been caught - I am that unruly child whose school folder is stamped "TROUBLEMAKER" and passed from one grade's teacher to the next - labeling me before I ever sat in that classroom chair. I have been classified, in the medical community, as "neurotic". I've seen my "medical report cards" - words like "worries unnecessarily", "convinced she has..." and the dreaded "reads WebMD" crop up here and there in my introductory referral letters.

So, while I am allowed to be "rated" and passed from one doctor to the other, I'd like to be afforded the same opportunity as these physicians who are demanding their patients NOT rate them. I DON'T want to be rated either - other than my condition, thank you. Keep your opinions of me to yourselves - you are already swaying the opinion of my next doctor before he ever sits down and talks to me himself. I don't need him coming in with some attitude that I'm going to be a neurotic head-case or troublemaker - calling him for everything I have, might have, or have "convinced" myself through WebMD that I must have. Trust me, like little Johnny in Kindergarten who might have pulled Amy's hair - don't label me because someone "tells" on me - give me the benefit of the doubt...perhaps I'm really not that bad.

And to all you doctors out there thinking of subscribing to (or who have) this "service" which really is a disservice...stop pre-judging your patients - you certainly don't like it when it happens to you. Remember, you took an oath to help people...and it wasn't "The Hypocritical Oath".

Illegal Drug Pens

If you've been keeping up with any of my blogumns, you might know I've a penchant for pocketing pens. Drug company pens to be exact...but I've only "officially" stolen one. It's been my experience if you ask the receptionist or doctor for one of those pens they get by the truckload along with other miscellaneous drug company merchandise like clocks, mouse pads and squishy heads...they will more than likely accommodate you. Unfortunately, I have too many of these free pens lying all over the house, in my car and in my purses to count. I say it's unfortunate because I've been to that many doctors.

Now the way I see it - the pens are free...the drugs are pushed, the drug reps need to unload them and the doctors need to keep those reps busy, so I'm actually doing them a service by providing them more opportunities to drop more pens off. Plus, I'm pretty much paying a lot to see these people, the least they could do is "toss me a cookie" once in a while in the form of a pen.

And having one lying around along with 25 of its "clones" sitting in a drug provided coffee-cup is akin to dangling a carrot in front of Ole Bessie. Two guesses as to whether I'm the carrot or Ole Bessie (and keep the side remarks to yourselves). They won't ever miss ONE - they have a never ending supply of them...plus I DO bother to ask politely. There's plenty of people who just abscond with them without so much as a "howdy do" and a tip of their hat. You know, those hats they don't ever wear anymore - which I referred to in my prior "Men Without Hats" blog. (Yes...this is how I getcha interested in reading another blog...or hopefully get you interested.) As for those pens, in all shapes and sizes, colours and materials, each proudly sporting their drug name emblazoned on it...in near full regalia as it were. Some are very handsome indeed...and therein lies my fascination with drug pen acquisitions. This obsession of mine is purely based on getting something for nothing which is in a pretty package that is useful...especially useful to me, actually, because I sometimes write my blogumns with those very same pens. See? What better justification for an inanimate object infatuation could anyone want?

But it is a sad day indeed. I was gleefully, cheerfully, and oh so set-uppingly administering my "you just can't possibly deny me one little pen when you have hundreds in the back" I've used countless times before when out of her mouth I heard those nine little words that would change my life as I know it. "They aren't allowed to give us drug merchandise anymore." She continued, "These are the last of them...after we run out...we'll have to use our own." Insert one of those Hollywood "Wilhelm Screams" here. Surely, she's just messing with me - she just won't pony up the pretty pen for pathetic me. How dare she...why, I bet she takes those things home and sells them on eBay. And I left.

What fortuitous event met me at the elevator...why it was a drug rep herself with her rolling carrying case of goodies...rolling because all those squishy heads, clocks and pens get rather heavy when you have to lug them around, office door to office door. The glamorous life of a drug rep...must be hard work. Lunches every day...rolling her little personal trolley into doctors' offices day in and day out, whilst a myriad of patients huff "why I never" in unison, and wait until you've uttered your rehearsed drug soliloquy speech - then you bound back out, hands waving and many "see you next weeks" being bantered about with as much enthusiasm as one can muster up for people you don't give one darn about.

So...I gazed longingly at her laden pack and, while never looking up to make eye contact, asked, "I just heard a horrible, vicious rumour...please tell me is not true! The receptionist wouldn't part with a pen...said you guys aren't hawking them anymore...surely she's having some type of mother hen complex with them...correct?"

"No...we aren't allowed to give them out anymore...it's a new law." So, I thought to myself...'bribery disguised in cylindrical plastic form...is...sniff...sniff...a thing of the past; it is, alas, no...sniff...more.'
While I never did condone them wining and dining and schmoozing and trinket-ing the physicians...I really had no problem taking pens promoting drugs I'd never take in my lifetime. My Viagra pens are one of my prized possessions...battles in this house have been won and lost just over coveting rights alone.

Now in case you are wondering just what is and isn't allowed and why the lowly pen has now become a professional pariah...here's a little breakdown, courtesy of the "Code on Interactions with Healthcare Professionals," Pharmaceutical Research and Manufacturers of America, July 2008; that, come January 2009...will go into effect:

Acceptable

Educational items, such as anatomical models, worth less than $100.
"Modest" in-office or in-hospital meals with informational sessions by drug reps.
"Modest" restaurant meals as part of an informational session by an expert speaker.
Funding for CME programs.
Payments for bona fide consulting or advisory arrangements.
"Fair market value" payments for speaker training.
Funding for scholarships chosen by training institution.

Not acceptable

Reminder items such as pens, notepads, coffee mugs and
wall clocks. (New in 2009)
Restaurant meals with drug reps. (New in 2009)
CME grant funding based on marketing objectives. (New in 2009)
Sports equipment; tickets to sports or entertainment events.
Physician travel or lodging subsidies for meetings or CME.
Payments for sham consulting or advisory arrangements.
Financial support "in exchange for prescribing products or

for a commitment to continue prescribing products."

So, stock up on those "not acceptable" items while you still can get your little hands around them...as they might be worth a small fortune one day on eBay...if they don't rescind the laws. Or better yet, send them to me for addition to my own personal stockpile of drug-rep paraphernalia. Hey, those pens just might afford me the opportunity to send my daughter to Med School.

Ahhh...irony. Gotta love it.