The Good, the Bad, and the Mediocre

It's been a dramatic spate of days over in the kingdom. 

Riding out that perfect storm? Not so easy after all. I didn't think it would be. But I didn't think it would be that hard. 

And it turns out that when I panic, everyone who knows I'm panicking 

Which is how I spent a lot of time as a patient in various settings over the past 10 days or so. Which showed me a deeper time and appreciation of what it means to be on the receiving end of health care in this country. 

The Good

It's really awful that the Endo is leaving at the end of the fiscal year -- AKA, just a few short weeks away. But, it is likewise understandable. 

Because damn, she is awesome. So of course she would get recruited away from here. The good people looking for advancement and balance usually do. (Last year was a doozy -- Endo V1, and Dr. BIEL, within just a few months of each other.)

After receiving a panicked message from me Friday morning (after I sent Therapist 3.0 a panicked email, asking if it was appropriate to message the docs looking for help, and getting a response of yes, do it), she explained her stance, but offered immediately to get me in Monday morning. 

Come Monday, we spent a good 20 minutes discussing the issue, and my issues overall, and what we needed to look at as next steps. I felt listened to, and while I was still upset, I could understand her perspective -- and likewise, I felt like she understood where I was coming from, and put words and feelings to why this was all so awful. 

Part of what came out of that conversation was the decision to get me in with Sports Medicine primary care. 

Despite my saying that no, no it wasn't an emergency, and I just needed to see someone before my next race, they scheduled me for an appointment just 72 hours later. Score one awesome point for them.

But considering they're really the clinical money making arm for the network, also not surprising. 

The true good came from the appointment with the Sports Med doc. I'd previously seen her after a concussion in 2012, and had a sense that she would understand these nuances and concerns without being preachy, dismissive, or overreactive. 

That sense was right. 

We spent another 20 minutes or so discussing my concerns, and how to plan and mitigate moving forward. Lots of science. An explanation that while I didn't like it, at least I could understand it. I could understand the science and methodology going on, and from a physical perspective, could comprehend. 

She had her concerns, of course (they all seem to, these days), and made a similar suggestion to what PT had made a few weeks before the half. I explained my concerns with that recommendation, and she offered to call the other provider, explain my concerns, explain the situation, and have him contact me directly if they both agreed that he could be helpful. 

And the outcome? Still no call from the new provider, but I was willing to go along with the plan. Because if you tell me the methodology, I can understand what I need to do among it all.

This is how you provide good patient care.

The Mediocre

Oh, primary care. 

I'd sent my GP a similar message that I sent the Endo. Sure enough, like her, he wasn't comfortable accommodating the request without a visit. Fair enough.

The first problem? 

No appointments for 20 days unless I wanted to see another provider. And with something like this, and in the emotional state at the time, waiting 20 days was not an option.

The second problem?

No follow up. I never responded to his message, and likewise, he never followed up, seeing if things were better. 

And the Endo's office doesn't get an entirely free pass on this one. 

She ordered labwork, and I knew thanks to the patient portal that the results were back in Monday night. I saw some things that made me side eye, but decided that I'd not worry until the office contacted me. Because why invite trouble?

Late Wednesday morning, I get a call from her staff nurse, requesting a call back. I call back, get her voice mail, and leave a message.

Here we are, Monday, and I've still heard nothing back.

Maybe they changed their minds. Maybe the nurse was on vacation Thursday and Friday. But again, why not follow up? Why no call back of "Hey, this is what's going on" or "Hey, our error, no need to touch base."

How do providers think that is OK? Why do we as patients accept this as typical? 

The Bad

When things are bad, they are very very bad. 

Thanks to the combination of the laptop-toe injury and the fact that I've got fewer years of un-medication-induced normal menstruation than I do fingers, my gynecologist agreed that doing a Dexa scan wouldn't be the worst thing ever. 

The results came in, and I was concerned. 

Much to my surprise, the gynecologist's office called the next day. 

Now, admittedly, the gynecologist was one of the ones who congratulated the weight loss, so I shouldn't have had high hopes for this encounter with her office. 

To them, I think, I'm still just another fat girl in a box. Since I'm not anorexic, there must not be a problem. I don't know what was going through her head, or the nurse's head. Or if anything was at all. 

The nurse explained that they'd come in, and that yes, there was osteopenia, and I needed a second scan in two years. She then rattled off the boilerplate instructions for next steps: calcium, Vitamin D, and weight-bearing exercise. (And since these were almost word-for-word what was on the bottom of the results slip, I'm pretty confident that they were boilerplate.) And to have a good weekend. 

end scene

Solid instructions. I suppose. But obviously not coming from a place of "We know the patient." 

Because this patient? It's in my medical record that I have an eating disorder. It's in my medical record that I am Vitamin D deficient, and that I am on weekly prescription supplementation (which ironically, gets finished this weekend). It's clear that no one actually bothered to read my record before calling me with the results. 

Maybe I'm overreacting, but I can't imagine in what universe it's OK to tell the eating disorder patient to up her weight-bearing exercise, and to not give further instructions as to how exactly I'm supposed to come up with this calcium and Vitamin D.

And damnit, it's exhausting having to always be the advocate.

It was a good thing, I suppose, that I was in a better headspace this Friday afternoon than I had been the previous week. Because I could squeak out that well, I'm a distance runner, so the weight-bearing exercise is not a concern. The nurse had no response, and again wished me a good weekend. 

If I hadn't been in a better space? That's a nice excuse that the office just gave me to keep pounding my bones and joints into the ground. Nice way to keep continuing the female athlete triad there. 

But that's what happens when you've got an office who puts the patient in a box.

The patient experience in this country, in this region, should not be like this.