Saturday, August 02, 2008

Why I'm NOT changing doctors

On Thursday I had two medical appointments. One in the morning with my surgeon and one in the afternoon with my primary care physician (hereafter known as PCP to save me some typing - it is, after all, Saturday.)

The purpose of both appointments was to address the mysterious sore spot on my leg. Yes, I know, me and the PT guy think we've got it licked already, but it has come back slightly since the massage and medically I still wanted to make sure that we were on-track. My PT is great but he's not a physician who has been through 4+ years of med school.

First, the Surgeon. I told him that the massage had made it better and he was happy with this (you and me both, dude) because this indicated to him that this was probably scar tissue from when I bled internally after the op. He layed me on my side and poked and prodded again some more, this time announcing that he did, indeed, feel a difference in the soft tissue around where I said it hurted. (Um, this is only like 4 appointments later... you think he could have paid a bit more attention before.) So, I thought, mystery solved. More excrutiating massage was all I needed.

Second, my PCP. In addition to dealing with my leg issue, I wanted to talk to her about why I have been so disappointed in the Mercy Medical Group's level of care and referral choices, and why I was seriously considering switching back to my old medical group, Hill Physicians.

For those of you who have not read previous posts, I should reiterate here that I LOVE my PCP - she has a very caring bedside manner, a wicked sense of humor (a must for me - I can't be serious about anything), she listens without hurrying you, never leaves you waiting in the patient room, knows her way around the system and advocates for you, and best of all, is the kind of person I think I would actually be good friends with if I had met her outside of our patient-doctor relationship.

My plan was to let her know that, if she saw me disappear off the books one day, that it had nothing to do with her and everything to do with the system she works in. I know she can't really do anything about this directly or immediately but I honestly believe that if every patient took the time to be this honest with their doctor, some things would change. Maybe not much but, as a service provider, I think that feedback is helpful when she looks at her practice at the end of the year and assesses whether she is in the right spot for her and her patients - she has a choice too! At the very least, as a professional, she would know that she had not done anything to offend or upset me and, if I were her, I would like to know that.

So, I laid it out for her. I told her that she was awesome but the options for referrals were underwhelming in comparison to what I had been used to at my previous group; that the cattle-market system for tests and labs was unappealing and inconvenient; that I was frustrated that I couldn't find a skilled surgeon for my surgery and had to resort to the surgeon from my previous group scrubbing in to 'teach' the Mercy surgeon how to do my procedure; that the physical therapy I received from the system was less and less quality for my post-surgery hip than I had received for a cricked neck in the previous system; and that I was shelling out $300 a month to get myself back in shape because services at the Mercy system didn't cut it.

I wasn't angry or indignant, I was sad and disappointed. I didn't want to switch doctors again but I had to be an advocate for my own health.

She listened and nodded and apologized. "Well, you know, you're going to do the right thing for you and I respect that," she said. "But, before you go through switching systems, the wait period, and having to get a whole new set of doctors up-to-speed on your conditions, let me at least see if we can't take care of whatever is going on with that sore spot on your leg."

Sounded reasonable to me, so I jumped up on the table for her examination.

I KID YOU NOT, she pushed and prodded that damn 'mystery' sore spot for less than 10 seconds before she announced "Oh yeah! I feel that. Your tensor fasciae is all ropey." Then she proceded to follow the pain up the side of my thigh without direction, following it as it got less and less. "Yeah, that thing is like a rod."

Less than two minutes in the room and I had a diagnosis. It wasn't a nerve, it wasn't a soft tissue issue, and it wasn't scar tissue. It was my flippin' IT band! (The TFL (tensor fasciae latae) is connected to your IT band). It made total sense because I had problems with it before the surgery, it probably got pissed-off during traction, and almost everyone I've seen has identified that my IT band is indeed tight. It's just that nobody has linked the sore spot with it. Quite honestly, it's mind blowing to me that five months and God knows how many poking, prodding appointments later, my PCP made that connection in a nanosecond. It's also the reason I get knee pain occasionally. Everything started coming together.

Fortunately, the treatment is the same. Stretching (which, seriously, I can't do any more of unless I make it my day job) and manual therapy.

She also took a look at my psoas, which we've been guessing has been causing the tightness in my groin, and said that my PT really needs to work more on that. She suggested resistance stretching instead of plain-ole stretching and showed me one simple exercise my PT could do on me that, in just three 3-5 second bursts, increased my flexibility by about 5-6 inches!

Wow! This was the most productive appointment I'd had with a doctor in more than five months.

So, this is the reason that, for now at least, I have decided to stay put. Also, there was just one last thing that my PCP said to me - a 'bone' if you will - that made me stop and think. "You know," she said, "it won't be like this forever."

Of course, she could have been referring to the fact that she expects a Democrat to get into the WhiteHouse this year and shake up the system (God, please, God) but I like to think she was indicating that there was a smidgin' of hope that she would, eventually, leave the Mercy system and start an independent practice of her own. Which, in turn, would enable her to become part of Hill Physicians (which is the largest network of independent practitioners and specialists in Northern California.)

I guess we'll see but, for now, I'm giving the system a second chance. They don't know how lucky they are to have doctors like her.

1 comment:

e said...

That is AWESOME. It makes such a huge huge difference when you go to the doctor, and they can figure out what's happening. Ta daaah! I felt like that when I met my surgeon. In about 5 minutes he'd figured out what was happening, and then it was all downhill from there.

What a relief that it's your IT band and not a nerve thing. Can you imagine? No, no, don't. At least now you know what it is and you can take a proactive approach to taking care of it, which I know you will.

Hurrah! for your PCP.

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