Posted by noa on January 21, 2002, at 14:22:25
In reply to Re: Between pdocs....continued, posted by noa on January 17, 2002, at 17:24:39
OK, where did I leave off…..oh, yeah….
In the car, I realize I'm sad, not just angry. This feels like a loss. My pdoc and I had been through a lot together and he had helped me. I know I want to stop working with him, that I'm comfortable with the decision, but I am sad about it anyway.
When I arrive at the pharmacy it is more crowded than I've ever seen it before. In addition to the line at the pick up counter, there is a line at the drop off counter. And an angry woman at the ask the pharmacist counter. I wait.
There seems to be one pharmacist on duty, a substitute pharmacist. And two clerks, one of whom is moving at a snail's pace and seems to have no awareness of the lines that have formed. The other clerk is arguing with the angry woman about a prescription filled incorrectly but already taken out of the store. Right medicine, wrong number of pills. The woman insists she is entitled to 30 days worth, that it was only filled for 19. The clerk insists the insurance company won't pay for a corrected scrip because the woman had already taken the medicine home. She threatens to sue, threatens to report them to the pharmacy board, writes down the pharmacist's name, is oblivious to the clerk telling her the name on the board isn't the same pharmacist. The woman goes away.
A lady with two little kids is waiting, too. The kids are touching all the stuff that is at eye level. Seems logical to me, like kids' toyshelves. Only they're taking diabetic blood testing kits and chapstick and thermometers and home kits for testing yourself for aids off the shelves. Bright packages within reach. The woman is remarkably calm as she shoos them off the merchandise and tries to distract them while she deals with the slow clerk when her turn comes. Her older son, a preschooler, asks repeatedly about his pskiption. He looks so proud as he says this big, new, word.
I am two away from my turn. Suddenly the pace goes from slow to nonexistent. The guy in front of me says he thinks the computer is down. We wait.
Finally, my turn. I drop it off, they say come back in 30 minutes. I don't mind, even though my scrip is for 6 pills. I start to leave and a customer calls me back, tells me the clerk needs to talk to me. It's not the slow clerk, it's the other one. She caught a problem with the scrip, can't read my last name. I look at it and see how angrily and carelessly it was filled out. How had I not noticed that before? I guess I had shoved it into my pocket without looking. I see that you can't even make out the first letter of my last name. I tell her I'm in the system, have had this medicine filled here for years, she can check it. She says she needs to ask the pharmacist, comes back in a minute and says it isn't just the name. There is no date on the scrip, can't fill it by law. I'm not mad at her or the pharmacist. This rule sounds very reasonable to me. I take the scrip back and realize it is a worthless piece of paper. I decide to save it for Saturday to show my pdoc.
The next day I ration my adderall. I eke out a couple of half doses and save one dose for Friday. I drink a lot of coffee. I get by. On Friday, I talk to my therapist about it, tell him the whole story. He wonders if maybe I should line up my replacement pdoc before firing my current pdoc. I say, no, I'm done with him, enough is enough, I feel comfortable with it. I'd rather just have tomorrow be my last appointment. I tell him I'd thought about whether to bother going in, but needed refills, and besides, I really did want to say goodbye to him and tell him why I was leaving. I wasn't just mad, I was sad, too. He had helped me. My therapist seems satisfied with this.
It is Saturday morning. I try to leave with enough time to get there on time. I still care about getting it right. I have a book, which is good, because even though I am a few minutes late, my pdoc is still with a patient, and there is one waiting in the chairs. The door opens and a young man and his parents come out into the waiting room. The other patient goes in. The threesome that has just finished up with the pdoc are now scheduling an appointment with the secretary. The young man seems like someone who has been through a lot. His parents seem supportive, are respectful about negotiating the next appointment time. They seem happy together. I feel glad for him because he seems like he needs the support.
Now it's my turn. The pdoc is in his rocker, hunkering, looking up his notes. I start by telling him I couldn't fill the scrip--it was worthless, that he had made it so through his anger. He nods, um-hmms. I tell him I'm angry, feel he had been unprofessional, unfair. Um-hmm. I wait. He says, I was angry, but you have to understand what was underlying that anger. I give him a curious look and say, and? He tells me I have to realize he's human too, that I had been the 4th person that day to just show up for a refill. I say that may be, but I still think you acted unprofessionally. He um-hmms again. Pause. Then he says, look, I know you’re a fine person, you’re not one of those who is rude and demanding and doesn’t come in for an appointment for a year and then calls in demanding a refill, you should see how some people behave. I know you’re not like that. I say, their behavior is not my fault—the way you treated me was unprofessional. He says, look, you need to understand that I’m human and be able to accept that.
I say, I do understand that. I’ve been working with you for over 8 years, and you know I’ve had issues with all the disorganization, having to wait while you are running late, not being able to get in touch with you. I’ve considered going elsewhere before. Obviously I’ve accepted that you’re human if I’ve decided to keep working with you all these years. Um-hmm. And you never once apologized for all those late appointments.
I tell him about my plans to get an outside consult because he has been seeming blasé about my concerns regarding side effects. Um-hmm. I tell him that now, after the other day, I've made the decision to stop working with him and find a doctor who is more interested in figuring it out. In response, he throws me a bone—you could try a dopamine agonist It breaks my resolve for a few seconds. I am curious, want to know more. He suggests I look it up. My resolve returns.
He asks me if I need names, who am I thinking about going to. I tell him two names. He is familiar with one. He asks if they are on my plan, I say, no, practically no one even takes insurance. He nods. He says, I hear Dr. So-and-so is kind of disorganized, too--that he has to fish around on his desk for lab results, too. I am struck by his defensiveness.
We then turn to the business of what scrips I need right now, and he writes them out. I check them all before leaving the office—dates, names, etc. As I exit his office, he says see you later.
Later, I realize I had only referred to my pdoc once, and that was in my first year working with him. People had asked, and I’d told them honestly about his strengths and weaknesses, and they’d agreed he was hard to recommend. The past few days I find myself wondering about that—I hadn’t been able to recommend him, but have stayed with him myself all these years. Does this say something about my own self-respect? I’ve decided it is more complicated than that. I’d considered leaving, even consulted another doctor once, who seemed hard to connect to and didn’t seem as knowledgeable. I’d gotten names of other pdocs from friends but none of them took my insurance and at the time, I didn’t have the kind of money needed to put out up front. I had decided I could learn to deal with the lateness, the chaos, because my doctor knew his stuff, knew my history and reactions to medications, had helped me, and took my insurance.
But now, he was seeming complacent about my experience with my medication. And the anger toward me about being late. And then, the final straw.
I don’t know why this aspect of his work with me changed. Maybe the pressures of managed care. After all, when I started seeing him, his outpatient work was a supplement to his job at the psych hospital. His time was more flexible, there was no packed waiting room. And, it was almost a decade ago, a decade during which the burdens of managed care have managed to change the way many doctors run their practices. I’d seen the changes in my internist’s office, too. In these past few months when my pdoc had become a clock watcher, his waiting room fuller, that is when he went from being my disorganized, late, sometimes exasperatingly inaccessible, but still benevolent and helpful, pdoc, to being more distant, complacent, not so very interested in my concerns, and angry. Maybe that's it, maybe not. I'll never know.
Today I will call these other doctors. I will make an appointment, bring my records along, try to reconstruct the intricate history of my life on medication. I don't know if there are solutions to the problems I am experiencing. It isn't urgent. I am doing pretty well. Maybe it is a sign of how well I am doing that these side effect issues feel like they are detracting from my quality of life---that my life actually has quality to detract from.
I am sad, but content with the decision. I don't feel I've burned my bridges, either, that despite how unlikely, I really could go back to see my pdoc if need be. Afterall, he was the one who said see you later....
poster:noa
thread:16861
URL: http://www.dr-bob.org/babble/social/20020112/msgs/17039.html