As a former emergency medicine doctor with ABEM certification, I anticipate questions about why I sought medical care. At this point, my problems are complex, and I need someone with a clear head to weigh in. At every encounter (and there have been nine or ten in three weeks), I have been both shocked and disappointed, as it seems patient well-being is barely a consideration in health care settings in the U.S.
On March 27, after two weeks of severe foot pain (no trauma), I went to an urgent care nearby for an X-ray of my foot, which was read as negative. I have a high pain threshold. It took me eight days to visit the ED after I fractured two ribs and my sternum a couple of years ago. A month after my visit to urgent care, the pain remained persistent and debilitating, so I decided to visit a doctor of podiatric medicine. He also x-rayed the foot and read it as negative. Over the course of three more visits, I had three ultrasound-guided injections of a corticosteroid into the peroneal tendon sheath for peroneal tendonitis. An MRI was ordered, foot and ankle, but it took several calls to coordinate, and I was only able to get authorization for one scan per day, even though I had to walk on my broken foot for half a mile to the radiology facility each time. The day before leaving for my daughter’s wedding in France, I had my MRI appointment two months after I initially saw a physician for the injury. One of the radiologic studies had been approved – the foot. I left for France the next day in a wheelchair. I did not get the reading until I called the podiatrist two or three times upon my return. I had a cuboid fracture, and he recommended a boot to immobilize.
During the two months I spent chasing a diagnosis, I limped, which resulted in painful bursitis in the opposite hip. Before leaving for France, I scheduled an appointment with an orthopedic clinic, but the receptionist told me that the clinic could only address one joint per day due to reimbursement issues. We addressed the hip. I returned twice again that week for injections to the bursae. The third injection appears to have ultimately resolved the situation after a week or two, but my foot pain was debilitating.
When I arrived in France, the wheelchair people were dumped in a room, and after an hour of hearing “ten minutes and my colleague will come,” I decided to walk. I had been pinned in a laughably named premium economy seat on Delta and could hardly move – I dropped my glasses less than 30 minutes into the flight and could not retrieve them until landing. Worse, I was short of breath – I typically walk 5 to 8 miles daily at a reasonable clip, and my Apple watch rates my cardiovascular fitness as “above average for age.” When I arrived in the hilly village in the Luberon that would be my base, I was unable to climb a flight of ten stairs without stopping three times to catch my breath and allow my heart rate to slow down. It was frightening, but I didn’t want to miss the wedding or worry my daughter.
The foot pain and the dyspnea persisted and resulted in the cancellation of plans to travel to Paris with another daughter and her family. While awaiting my flight, I sat in a square in Avignon for three days. It seems French doctors are not taking new patients at this time. I had not died of a massive saddle embolism, had no fever, and my COVID tests had been negative. Ultimately, I did not seek care because I was too exhausted to do much more and decided to wait till my return to the U.S.
Upon my return, as noted, it took a couple of days to get the MRI results and the boot. Addressing the shortness of breath was another issue- my primary care physician had left the city during the pandemic, so I selected another doctor and made an appointment. I was hopeful. He referred me to a cardiologist within his organization’s umbrella. He ordered a D-dimer, which was at the upper limits of normal. Six days later, I saw the cardiologist. And his medical assistant. And his PA. Separately. The echocardiography and venous doppler exams were normal, but the doctor seemed alarmed and wanted to call EMS to transport me a few blocks away for a CT angiogram. I was certain I could not afford EMS transport for a non-acute problem, nor did the urgency seem appropriate after a month. I took a cab after the doc explained that he could not order the test routinely as it would “take several weeks to get prior authorization.” As a result, I had to check into the ED at the local hospital for about 6 hours. More of the same labs and another ECG – not to mention the inevitable fees associated with emergency care.
Did I mention that the last thing I want to hear when I am dying is the sound of unmonitored alarms going off in unison?
The CT angiogram showed some junk in the lung bases and although the diagnosis will require an outpatient pulmonology consult, the attending decided to cover for community-acquired pneumonia, a distant possibility. And to cover with doxycycline, which is not first line. Yes, I checked when I got home. But I have no idea how to contact this doc to discuss.
Right now, I am going to put on my boot and drag it to CVS to pick up that prescription. And a prescription for topical nystatin for candida superimposed on perioral dermatitis, for which I’ve visited the dermatologist six times in seven months. It took three weeks to obtain the results of a fungal culture obtained in the office. Yes, I am aware that fungal cultures can take a while, but candida? KOH anyone? Also, the prescription they called in was for a swish and swallow, while the cultures were obtained from my lip. So that didn’t work, yet it took two days to get the message through. I never saw a doctor, by the way – just a succession of PAs and NPs. Even though I requested an MD who could perform a palatal biopsy requested by my dentist. It has been a crappy few months.
I have avoided a deep dive into American health care because I’ve seen too much personally and professionally to have much confidence in any random doctor. Recent experiences confirm my impression. I am certain most of the docs who cared for me wanted to be helpful but were constrained the things like insurance pre-authorization or limitations imposed by the corporate entities who now control their practice. It is not what health care should be. In fact, it has very little to do with health care.
There are laws on the books in many states that prevent non-lawyers from owning or making money from the practice of law. Isn’t it time we passed similar laws to prevent the exploitation of sick people for profit?
The author is an anonymous physician.
Image credit: Shutterstock.com
