Wednesday, November 08, 2006

My Doctor, Unlike the Rest of Peoria, Has No Idea Who I Am

I haven't been blogging much lately because I've been ill, and because it seems like everything in my life has been in the category of "annoying, but not the funny-to-blog-about kind of annoying." Yes, wedding industry, I mean you.

Anyway, I got a sinus infection back in September. September 14, specifically, because I was on vacation and then had to fly transatlantically a couple days later. That's the kind of thing that sears the date into your brain. It's been mostly a low-level sinus infection, the kind that is bad enough to hurt and make me grumpy and miserable, but not bad enough that anyone wants to give me antibiotics for it.

Every time I go to see my doctor, he acts like he has never seen me before in his life. This is a little weird, because he knows who my husband is and remembers, like, every detail about him. In fact, he remembers me when I'm in context with my husband -- we typically go to one another's yearly physicals, primarily because if my husband had an arm entirely cut off and was spurting blood on all available surfaces, when we got to the doctor and they said, "What's your pain level on a scale of 1 to 10?" he'd reply, "Oh, maybe a 2 -- it itches a little bit." In the six years we have been together he has twice required urgent medical care and both times he was an idiot about it, once calling me to say, "I'm gushing blood -- do you think I should call an ambulance? No, I think I'll drive over. It's not that bad." and once refusing ambulance transport from the scene of a car accident and then calling me 20 minutes later to say, "I think I need a doctor." (But when we got to the doctor, he claimed, "Oh, it's not that bad.")

Anyway, every time *I* go to the doctor, he acts like he has never seen me before in his life. I went in for my sinus infection, and he started explaining how sinus infections work to me. This is the FOURTH TIME he's seen me for sinus infections in the two years I've been seeing him. And the FOURTH TIME he's asked me if I've ever had one before. And the FOURTH TIME he's tried to make me go get a CAT scan before he'll diagnose. And the FOURTH TIME he's refused me antibiotics. And the FOURTH TIME he's told me it's probably allergies, not a sinus infection.

This last makes me particularly irritated. I understand how doctors get irate about patients self-diagnosing, so I try to pretend like I'm not self-diagnosing even when I am. However, I've had sinus infections about twice a year since I was 16. I've had allergies for ages. With more than a decade's experience, I'M PRETTY CLEAR ON THE DIFFERENCE IN HOW THEY FEEL IN MY PERSONAL HEAD.

When I was in college, I had a sore throat so swollen I couldn't talk or eat and I felt like crap. When I went to the doctor, he insisted it was strep. I protested (in a whisper) that it didn't feel like strep. He waved off my objection and insisted it was strep, and when the strep test came back negative, said the tests were sometimes wrong, and it was strep. A week later, having not eaten solid food at all in several days, I ended up in the ER for the same thing. The doctor there insisted it was strep. I told him the strep test was negative and the antibiotics obviously were not helping, and IT FELT NOTHING LIKE STREP. He waved off this objection, ran ANOTHER strep test that came back negative, and told me it was strep again.

Well, a week later, I ended up an inpatient in the hospital, semi-conscious for 48 hours and on IV fluids for three days, in the hospital on vicoden and steroids for a week, with a case of advanced, untreated mononucleosis that almost killed me, that the nurse diagnosed as soon as she SAW me, which was GOING AROUND CAMPUS AT THE TIME I GOT SICK!

So you can understand my extra-special suspicion of doctors who refuse to believe me when I say "This doesn't feel like X" or "I've had X 30 times, and this feels like X."

There are basically two kinds of doctors in the world, those who appreciate patients who participate in their own health, and those who find this annoying. My doctor is clearly the 2nd kind. Probably I'm a little more participatory than most people, for two reasons: I refuse to have a repeat of the mono incident, and I'm a lawyer. Someone once told me that the job of being a lawyer is basically to become an expert on a particular area really fast. When I get prescribed a new drug, I go and read all the literature on it. I guess this isn't normal, but I'd do the same if I were working on a case involving the drug, so if I'm putting it in my body, obviously I'm going to do it. I generally ask my doctors to explain the course of treatment and why it's been chosen. Yeah, I'm not a doctor, but I'm accustomed to becoming expert enough on a strange topic to try a case in a very short period of time. If I were trying medical malpractice cases, I'd have to know as much about the particular treatment as the doctors who were doing it.

So the last straw for me was with my doctor this week when he tried to send me for a CAT scan for the fourth time (the man is freakishly in love with unnecessary diagnostics, I swear. I can't tell you how many blood tests I've had in two years with him), looked at my meds and said, "Who prescribed THIS?" in shock and didn't believe me when I said, "YOU, LAST YEAR!" and then attempted to put me on a drug regime contraindicated in the latest literature that I, moreover, personally feel is inappropriate for my situation given my prior reaction to the drugs. It's guaranteed to maximize negative side-effects without adequately treating the condition. He brushed of my concerns (which were carefully couched in "I'm not self-diagnosing" language).

So the upshot of all of this is that I'm in the second month of my sinus infection, which has migrated to my ear and my gums, leaving me with an intermittently swollen right side of my face so I look like a demented, lopsided chipmunk. My doctor won't treat the infection at all unless I get a CAT scan to prove it's my sinuses despite my OBVIOUSLY SWOLLEN FACE, despite my excruciating pain, and despite my objections that it's been a low-level, on-and-off sort of infection (and no longer confined to my sinuses!). In the past I've just waited until a Sunday and gone to urgent care, where they give me antibiotics without CAT scans and can't make me go see my regular doctor because it's a Sunday. But I think we've clearly gotten beyond that point and it's time for me to find a new doctor. Preferably one who believe me when I tell him, "I've lived in this body for 28 years."

25 comments:

HeartShadow said...

GET A NEW DOCTOR!

and antibiotics. gods. what an asshat.

Anonymous said...

Eyebrows,
I agree with heartshadow. I think that having a good doctor-patient relationship is so vital, especially if you have to go fairly often for reoccuring illnesses. Hopefully your insurance makes the whole doctor switch thing easy.
BTW, my daughter is 11 and gets frequent sinus infections since she was a baby. I had never had one until last year, and in a weird way, I am glad I had one. I knew she would have headaches and would be irritable, but I guess I had never understood how painful it really is.

Scott J said...

Eyebrows,

Great blog, you have an idea how bad it is out there. Now imagine taking a Parkinsons patient around town and getting the same thing. "So, what's the problem". They don't read the charts EVER. They prescribe meds like candy.

Pammy said...

Definitely get a new doctor. And be sure to let the old one know exactly why. Nothing irritates me more than a doc who thinks that he/she knows someone's body better than the owner does.

C. J. Summers said...

Speaking of unnecessary diagnostics, earlier this year our son was underweight. Our doctor referred us to a gastroenterologist who told us we needed to have our baby hospitalized for three days for observation and testing, which of course we dutifully did. They did all kinds of blood draws to rule out certain diseases, fed him through a tube that went into his stomach through his nose, and generally worried us to death for four days. We spent thousands of dollars.

Final diagnosis: he needs to eat more.

That's it. Give him more calories and he'll grow just fine.

We're still paying off medical bills. And looking for a new pediatrician.

anon e. mouse said...

Sounds like we have all been there.
It seems each time I get a new doctor, I have to educate THEM.

Vinron said...

Good god, get a new doctor immediately. You should be able to see the doctor once when you have the infection, and then later get antibiotics with a simple phone call once or twice a year.

Your doctor must have too many patients, so lighten his load.

Fastolfe said...

Why didn't you just get a second opinion? Your doctor may be clueless and incompetent, but it's also possible his advice is genuinely in your best interests. See another doctor, but I wouldn't necessarily give up on this one just yet.

Also, regarding the extra testing, is it possible he knows you're a lawyer? :)

Anonymous said...

RE: "chipmunk. My doctor won't treat the infection at all unless I get a CAT scan to prove it's my sinuses despite my OBVIOUSLY SWOLLEN FACE, despite my excruciating pain"

Ever think maybe your doctor thought you had more than a "simple sinus" infection given your swollen face? Have you ever heard of the "danger triangle" of the face? Why don't you look it up
since you are so great at research. Do you know the present evidence-based medicine guidelines state NOT to treat acute sinus infections with antibiotics only chronic infections.

re: "in the hospital on vicoden and steroids for a week, with a case of advanced, untreated mononucleosis that almost killed me"

Since you are "such an expert" please do fill us in on the "treatment" for "untreated" mono (EBV).

PS: I hope you do better research on law issues...so far you "research" on medical issues shows you are an idiot.

Anonymous said...

You are an illiterate idiot. I came to your blog through Kevin MD, I think I’ll go back now.

knight in dragonland said...

Woah ... that was harsh and unnecessary. Also, not correct.

Some studies have shown no difference between placebo and antibiotics for acute sinusitis, but the majority show benefit for antibiotics. You don't need anything fancy - nothing has been proven better than good ol' Amoxicillin for 10-14 days. Obviously if you have allergies those need to be treated concurrently, since sinusitis is a common complication of allergic rhinitis - something your doctor should recognize.

Here's a good article:
http://www.aafp.org/afp/981115ap/fagnan.html

As far as the "danger triangle", that doesn't really apply here. I think that's one of those zebras that they always warn you about in med school but hardly ever happen in real life. Because of the way the blood vessels are set up between the corners of your mouth and your nose, an infection (usually cutaneous - i.e. a big zit) can travel retrograde and cause something called cavernous sinus thrombosis - basically a big infected clot in your brain. It's not good, but I've never seen it or even heard about a case anywhere that I've practiced so far.

Regarding mononucleosis - it's often mistaken for strep. It actually looks WORSE than strep. Strep tests are pretty damn accurate, especially if they do a double swab and send one for culture. I'm talking 98-99% accuracy. Someone should have thought of mono.

As far as cause & treatment - yes, it's caused by the EBV virus and there's no treatment for the infection per se. However, I have used steroids to treat patients with tonsils so severely swollen from mono that they could not eat or drink and were in danger of compromising their airway. Pain control is always a good thing.

knight in dragonland said...

C.J.
Regarding the treatment of your son. I obviously don't know the details in his case, but the problem with the differential diagnosis of failure to thrive (FTT) is EXTREMELY broad, so often docs will take somewhat of a shotgun approach to rule out the more dangerous possibilities - metabolic diseases, anemia, congenital heart disease, etc. A 72 hour calorie count with observed feeding is pretty much standard.

Usually it turns out to be poor parent-child interaction (usually young, poor first-time parents with limited education) and the hospital time can be used to provide education and links with resources. Otherwise it's often just temporary poor feeding due to a viral infection, problems with breastfeeding, etc.

With experienced parents, unless there are other red flags, usually it's something that can be followed by frequent office visits and weight checks instead of hospitalization. The shotgun approach almost always yields negative results or false positive lab errors that you end up chasing. If something serious is there, you usually have other lines of evidence.

Eyebrows McGee said...

Knight,

"However, I have used steroids to treat patients with tonsils so severely swollen from mono that they could not eat or drink and were in danger of compromising their airway."

Yep. That's why I ended up in the ER -- compromised airway. Also hadn't eaten in six days. This appeared not to bother the ER doctor particularly. He gave me liquid tylenol (which is like 10% alcohol which with no food in my stomach for 6 days was particularly VILE) so I could open my throat enough to take pills, and antibiotics for strep and sent me on my way.

(Also, if I've had the infection for two months, do I get to count as chronic yet with the sinusitis?)

What's so bizarre is that I really don't think my doctor is a bad doctor; my husband gets excellent care from him. I guess he and I just have a personality mismatch. Or else his patient load really is too heavy and he doesn't have time for me.

CJ: Geez, that SUCKS. I had a friend have a similar experience with a jaundiced baby. Although kids are tricky, because they can't tell you their symptoms. Like cats. :)

I have a strong suspicion, based on my experience with cats, that I'm going to be the parent who can't bear taking pre-verbal children to the doctor. Once they're verbal I don't mind, but when you can't explain to them why they must be poked with a needle, I can't stand it.

C. J. Summers said...

Thanks, Knight. Our son is our youngest of three children, so we were familiar with how much a baby eats (or so we thought). Plus, he's a very good-natured baby; always happy, and never complained like he was hungry or anything.

I guess my only point is, why wouldn't they have suggested increasing his caloric intake as the first step in the diagnosis process, and then if that didn't work put him the hospital for other tests? Why the other way around?

Of course the only important thing is that he's fine now.

knight in dragonland said...

EM,
Up to 30 days its acute, and after 90 days it can be called chronic ... so you currently have "limbo" sinusitis. LoL There's no intermediate category - I guess you could call it persistent acute sinusitis, or just untreated acute sinusitis. You have to have symptoms for at least 7-10 days to get labeled with sinusitis, since it arises as a complication of blocked sinus passages, usually due to swelling from viral infection or allergies.

knight in dragonland said...

CJ,
You're absolutely right ... the first step would be to simply increase calories and then follow up with frequent weight checks. If the baby was otherwise acting alright as you say, I think that would have been a reasonable option.

Anonymous said...

Actually knight you are incorrect. You reserve antibiotics for pt's tx'd for 7 days with decongestants/analgesics with failure and with maxillary pain/purulent drainage. Additionally I have seen a cavernous sinus thrombosis (the pt died) and lastly like most use of steroids in medicine, there is no evidence-based guidelines to back up the use of steroids as you have...in fact studies have shown a prolongation of viral infections in the setting of steroids. But that never stopped the overuse of steroids (or antibiotics) in medicine.

Anonymous said...

Are you kidding! You're a lawyer sodomite! I would have cte'd you from Head to Toe, then MRI'd you , then sent you for consultation with an ENT Doc, Immunologist, Neurologist and ID DOc. When you came back from them I would have cte'd you again. I would have put you on such strong antibiotics you'd have ended up hospitalized with Antibiotic associated diarrhea, C-Diff and a rip-roaring yeast infection. You sodomites have ruined our profession, what do you expect us to do? When you walk through the doors and we hear you're a lawyer, a light bulb goes off. You are the enemy.

knight in dragonland said...

Doctor Troll is off his psych meds, apparently. I'm sure everyone that's read this post would just LOVE to be his patient.

Anonymous said...

I had a wicked bout with mono in college, throat almost swelled shut ect. I barely could get to the health center and when I made it in they gave me a shot of cortisone to get the throat swelling down enough so that I could take the codeine and other pills they gave me. The steroid worked and I could take the pain pills and then also eat something and break the cycle that mono gets you in as far as being exhausted and weak and then not eating or drinking and getting worse ect. It sucked!!

Cara said...

Eyebrows, don't know what health plan you are on, but I'd like to recommend my doctor. Amy Mathies-Soliman. She's at the Methodist Family Practice on Main (Peoria). She really does listen to me. Was even seriously interested (or was doing a very good job of sounding so) when I told her about a juice concoction I drink when I'm getting a cold. She wrote down the ingredients and everything!
And I happily give out the juice concoction, so I'll post it here if I find interested posters later.

Leslie said...

WOW! You should be charging admission to this post! Let's leave aside the question of who knows more, what is important is that a doctor explains WHY he is recommending a course of treatment ... or better yet discusses WITH you the options for treatment.

In the meantime, I'm sorry you feel so miserable. Chicken Soup?

pollypeoria said...

After reading the microscopic fine print phamphelt included with a prescription a few years back, I saw that the drug specifically was not recommended for my condition. When I told the Doc, "Uhm, I was reading the drug enclosure and it said..." The doc rolled his eyes, sighed, cut me off, and replied "Oh Jeeze. Another patient who reads." I retorted, "Jeeze. Another doctor with an ego." After a nanosecond of uncomfortable silence he laughed, and answered my concerns. We were good after that. Sometimes you got to remind doctors who works for who.

I feel bad for you C.J. My little niece repeatedly gets hospitalized for pneumonia. Every single cold she gets goes straight to her chest. Hospitalization seems to makes it worse because she always gets a secondary infection - probably from sharing a room with an even sicker kid. The treatments she gets could be easily done at home, (antibiotics, albuterol treatments, and chest "thumpings") but no doc will allow it. The reasoning my sister is always given- Once a little kid goes "bad" (becomes critically ill) recovery is harder and less likely. Don't know what the answer is, there might not be a obvious solution. Is an aggressive doc better or worse than one who thinks the way to go is to monitor the condition and wait and see? Harder to do that with a baby than an adult. My gut feeling is that the root of the problem lies with the enormous amount of patients doctors have and the very small amount of time they have to adequately treat them.

Anonymous said...

MD's just prescribe meds according to kickbacks and symptoms, and they also do surgery. Which is very important. But, first off. These scans are a real money maker and are usually covered by insurance. It doesn't matter that you have previous scans you had gotten one day ago, if they are not that doctors then he/she is not going to want to see them. They will of course want that good guaranteed money.

Anonymous said...

"These scans are a real money maker and are usually covered by insurance."

Ah moron, the doc who orders a chest X-ray does not get paid a cent for it. The radiologist gets paid the reading fee. Why let the truth get in the way of your stupidity.