The Lost Patient - An Epistolatory Tale

I'm a computer consultant and I consider my job very similar to yours. I was once fired from a client after 14 years with them. A year later they called me and wanted me back. The other consultant was incompetent.

When they told me why they went with my competitor, I considered their reasons extremely weak, but held no ill will towards them. Billable hours are more important that my feelings.

I curious as to why you sent a letter? What was your motivation? Why didnt you just pick up the phone and call them?

I have found one needs to stay on top of ones medial team. If they fail, its no skin off their teeth. I think of myself like the president of the US and my oncologist is my chief general in the war Im fighting. If I dont feel he is doing a good job, Ill fire him in a heartbeat. Remember how many generals Lincoln went through until he found Grant?

Ill cut this off now as I could go on for another 1,000 words.

To Ted:

As with everything I write on this site, the above essay is fictitious. I have never sent a letter to a patient who fired me and never will - what you are reading is best described as a variation of an interior monologue.

Arghh. EVERYTHING you write on this site is fictitious? You might have a disclaimer for newbies to the site.

Now I wonder, are you really an oncologist? Are you a doctor? How can I know?

To Ted:

Hey, I just asked myself those very same questions this morning! I must be having what Sartre would call an existential crisis.

Actually what I was trying to say was that due to HIPPA laws when I write about patient encounters I am not describing any particular living person, just a fictional "composite" patient used to illustrate my point. Assuming I have one. Not to mention my use of annoying sentence fragments. Vide supra.

I don't mean to give you a hard time, but I feel a little bit let down. It's that it's one thing to change the names to protect the innocent. It's another to make something up out of whole cloth and not warn your readers.

My question still stands. Are you truly an oncologist? Are you even a doctor?

I had to fire my primary care doctor last year after ending up in the hospital for 5 days because of her misjudgement. She was not nice about it and did write letters, so the letter writing thing does happen. I can't imagine going back to her and I don't think she'd take me back into her practice even if I wanted to go back. That you were willing to take the patient back is very big of you.

Emmy,
It's a made up story. It never really happened. Read his response to my comment.

Dr. Hildreth is a real oncologist; you can google his name, and it comes up that he practices in Missouri, and that he went to the U. of Iowa medical school.

But I also thought the above letters were real, or that similar correspondence had occurred between Dr. Hildreth and a real patient.

The whole issue of a patient choosing to see another specialist may simply have come about because they went and got a second opinion, and felt more comfortable with the second treatment option they were presented with.

Oh, come now. The title said "An Epistolatory Tale." Can't you recognize a literary device when you see one? The truth is in the emotion.

From the patient's side of the stethoscope, ending a relationship with a physician can be awkward and uncomfortable. Patients don't always like to be forthcoming and explain why. Sometimes they can't even articulate it; they just feel it's not a good fit. Sometimes the issue isn't the doc, it's the office staff or the fact that the parking is inadequate or the bathroom isn't clean. In some cases it's the patient's adult children who may be pressuring him or her to see someone else.

I can understand the doc would take it personally... but it's not always personal.

Sometimes, of course, it *is* personal. If it's some aspect of your personality, well, you can't change who you are. If it's about your communication or your practice style, those are things you *can* change.

I think it's good to get regular feedback from patients via surveys or whatever. It's an opportunity to identify areas that might need more work, and patients usually appreciate being asked.

I guess I just don't see the big deal if your customer goes somewhere else - unless you're losing two a week. In my case, I'd be reluctant to fire my oncologist. If I thought he wasn't being responsive, I'd rather beat on him, until he relented. Squeaky wheels do indeed get greased.

In the beginning I didn't know anything. Now that I've got some miles under my belt, I'm more comfortable asking hard questions.

When I fired my doctor, I had no idea I was supposed to TELL him. I just called up my new one to set up an appointment, then stopped by the old office to pick up my records when I knew he was covering the Urgent Care clinic.

My boyfriend just read that and told me I am a horrible person.

*shrug* Now I've got a doctor who orders tests that make sense, rather than making me get a THIRD pelvic exam in 4 weeks, when he tells me he thinks it might be appendicitis. And when I have a UTI, my new doctor orders antibiotics after the culture comes back positive, instead of making me wait until he had an open appointment the next week.

I am afraid I erred when using the word "fictitious." What I meant to say is "This imaginary exchange of letters [Zoe - you are correct in that it is a device] is based on a true story."

The incident described in the post really happened to me, but in order to protect the privacy of my patients I am required to use creative writing techniques (a.k.a. "Fiction 101") when sharing stories with my readers, thus my literary invention.

I apologize for the misunderstanding.

And yes, I is a real doctor. Just ask my pal Orac!

I wasn't aware either that there is a certain etiquette to dismissing a physician. When I was compelled to fire a primary care doc some years ago, I simply stopped making appointments with him. This was not a mere personality conflict; there were some very clear reasons why I no longer wanted to see him.

I suppose the feedback would have been valuable to him so he could avoid making the same mistakes with other patients, but I would have been uncomfortable being frank and by nature I am not a complainer. Anyway, at the end of the day I doubt he noticed or cared that I was no longer on his patient panel.

I would be interested in hearing what Dr. Hildreth has to say about the correct or preferred way for a patient to jump ship, so to speak.

I am wondering what you think about this situation. I had a consult with a well known oncologist who is primarily a researcher on my specific cancer at a major university. I felt privleged to get the consult (organized by a friend of mine at said university), as this doctor takes very few patients. This doctor was extremely nice and caring, and suggested a course of action. After doing my own research, I decided not to pursue the recommended course of action. My own oncologist wouldn't venture an opinion, saying that either course was reasonable and I should do what made me feel more comfortable. (For what it's worth, I wanted to do a slightly more aggresive chemo than the "big" doctor thought warranted - it was a question of AC vs TAC for stage II, but grade III, breast cancer in a woman under 40). I didn't understand why the 3% - 6% survival benefit everyone agreed it would offer wasn't worth any potential side effects.

In any event. After I made my decision and went against the Big Doc's recommendation, he sent me an email telling me how disappointed he was in my decision, and asking me to reconsider. Making the decision was difficult enough, but the idea that this doctor thought it was such a mistake as to send me an unprompted email sent me into a depression that lasted weeks.

I truly believe that this doctor had all the best intentions - that he really cared about me as a patient. But, I have mixed feelings about how strongly he expressed them.

I'm wondering what you would have done if you were said oncologist.

Thanks.

Laura: The advice you received was likely based on a New England Journal of Medicine study published on June 2, 2005, which showed an improvement in survival by adding "T" to the regimen (assuming that "F" is basically a nonentity in helping kill breast cancer).

As far as what I do in this situation, when counseling a patient about a difficult decision such as yours. I often remind patients that if the proposed treatment was a guaranteed cure I would handcuff them to the table until they agreed to take it. Otherwise it truly is their decision. Remember: the patient is the one with the disease.