Is it the doctor or the nurse?

Oh, it must be so much fun to have your health hinged on a game of telephone.

Robot doctors. I swear, it’s overdue.

That’s exactly what it is! A game of telephone. Great way to sum it up. In one step the details of the message are changed or lost.

A few years ago post PCa surgery I required an injection periodically. The dose was slowly increased until I reached the desired level. The following year when I went back for a refill – every part of the prescription was wrong – by a lot. The mix, the dose, even the size of the syringe. I noteced it as I was leaving. I walked back in and they corrected it No explanation why I got the wrong one . Was it someone else’s? Who knows.
They cramming more and more patients into the same length of day. I’m not surprised things can get confused.

I can give you full details if you need them.

I would call back and ask to speak to the doctor, and when you do, tell the doctor your math.

I would write what you’ve written here directly to the doctor. Email is quickest. Mail it if necessary.

If there is a reason she prefers to prescribe it every other day-ish that would matter to me, maybe there is a medical reason I don’t know about? Nurses never think about the logic (not never, some nurses question what the doctors are saying) and they just deliver the message expecting the patient to be obedient. Here’s the thing, if I disagree with, or question the doctor, and I already told you I do, then just telling me to go against what I think is best is not enough. I will need a logical explanation.

You asked what I would do – I would email my physician directly (because she gave me her email address) or indirectly through my electronic medical chart web portal (which might take longer, I haven’t done it before).

In the meanwhile, I would break them in half and try to divide the dust accordingly. I’d take the half pill, lick my finger, touch the dust associated with that day’s half pill and lick it off of my finger. I’d leave the other half + dust on the plate or in the Tupperware or whatever I cut it in for my next dose.

I would also explain my pill-cutting process to my doctor in some detail.

Those little crumbly pills weren’t meant to be cut. You have no idea how much you are getting with each “dose”.

I would be particularly insistent after being overmedicated. It’s an easy solution – get a new prescription. I feel you on this one.

@JLeslie: You mean your thyroid hormone was low, not high, right? If your dose was too high, it would make your TSH too low. If your dose was too low, your TSH would go higher.

@Cupcake I told the nurse I’ll try cutting them for now and get back in touch as the pills run out. I wasn’t going to argue more with someone who wasn’t getting it. I’m out of state for ten days and don’t even have my pill splitter with me, but I had tried to split a pill a week ago when I already felt over medicated. I planned on just doing my best to get half the pill. This week I will skip a full day, and then take as close to half as possible.

This weekend I’ll make the effort to message through the web, but it runs the risk of the nurse delivering the message as, “JL still wants the 5mcg,” with no details and I really hate the idea of being perceived as insistent, and the logic isn’t communicated. Moreover, let’s say there is a medical reason, but not strong enough to “argue” it with me so they just give me what I want. That’s not my goal. I’m not trying to just get what I want. If the every other day is better I would ask for two 5mcg three times a week.

I don’t understand why you don’t ask to speak to the doctor, and insist that you speak to the doctor. I would think the doctor would be available to speak to you if you want her to, @JLeslie.

@jca This doctor happens to be the one who I like very much, but to answer your question, because of how much I know doctors hate to be questioned and I’m seen as a high maintenance patient. Why are people in a doctor’s office so ignorant? Why isn’t the chart accurate? It’s exhausting to question doctors over and over. Not this doctor in particular, I mean in general. When I am face to face with her everything is fine. The last time I had blood drawn she never saw my results and there was a very high number on it. That’s why she told me to call when I have blood drawn again.

Even lay people, even jellies, say things like, “these things never happen to me.” They imply I am high maintenance and a hypochondriac, and it wears on your psyche. I do everything I can to not come across as combative, but I think mostly I realize or know when mistakes are being made more often than the average patient. Although, obviously we all know people who have witnessed and caught medical mistakes.

I think doctors have no idea how patients like me twist ourselves into a knot.

If you don’t have a direct email address, ask the nurse if you can write/type up the issues and fax them. Then the nurse doesn’t have to play telephone (only messenger).

My youngest was on reflux capsules for a long time. Whenever I tried to wean him off, I would open the capsule and divide the little beads into similar sized piles. They had some static cling to them and it was so much more of a pain than you can imagine (general you, not you @JLeslie). But at least all of those little beads had the same amount of medication in them, unlike powdery pills!

I’m not going to fill a new script while out of state anyway, so I can procrastinate addressing it for a week.

Once I went in for something, I don’t remember what. The next day some chippy called me. I don’t think she had any medical training. Anyway, she told me that the doctor wanted me to “experiment” with my blood pressure medicine.
I said, ‘What do you mean, ‘experiment’?”
She said, “Oh, like skip a day, then double up the next day, take them at different times of the day, like that. See what that does.”
I said, “Have you lost your mind??!”
She got mad, of course. Then she said, “Just, like , don’t take any for the next 3 days and see what happens!”
I said, ‘I know what will happen! My blood pressure will sky rocket to 200+!”
She says, “How do you know? It might not!”
I said, “I’ve been on the meds for 7 years! There have been a couple of times when, for whatever reason, I had to go without for a couple of days! I knew exactly what will happen!”
“Oh, you can’t be sure,” she said, so condescendingly.
At that point I had her transfer me to the front desk, where I bent the ear of the receptionist.
My doctor called me back that evening. He said that she had misunderstood his instructions and would talk to her. He was glad I’d taken the stand I did. I think she got fired.

I have hypothyroid. I’ve had it for decades. It runs in my family. The thyroid hormone is very long-lasting in the system. It doesn’t flush out in mere hours like some medicines. It lasts much longer.

If you are having symptoms that are a problem, you’re doctor must be told.

I understand the desire not to come across as a difficult individual, but this is your health. And the doctor must know.

If this happened to me, I would insist on speaking directly to the doctor. I would not care if s/he thought I was high maintenance.

Thyroid problems can be very serious, and these problems can manifest in many seemingly unrelated ways. Thyroid problems can mimic mental illness. This is nothing to be taken lightly by anyone involved.

Edit to add: I wrote without any research. I found this on the Internet. You should take this as informative only and not authoritative. T4 lasts weeks. T3 lasts about a day.

Instead of providing the “go-between” with any facts at all, when you get back from out of town, just call and request to speak to the doctor because you have a few Qs specifically for the Dr.

Any Dr. I know of generally carves out a specific time period to take care of calls with patients. Most do it at the end of the day, some do it at lunch time but they all have time specifically allocated for patient calls.

Whenever I’m in any kind of situation that is dependent upon a decision maker, I ask to speak with that person directly.

I even do this if I’m dealing with my cell phone provider or other utility. If I ask the frontline person to speak to a manager or supervisor and they say something like “Could you explain more in detail and I’ll ask him” I make it crystal clear that I don’t want to deal with a three-way conversation.

If they need to put me on hold, fine but I want to speak to the person actually making the decision.

Whether it’s medical or anything else, if a decision needs to be made of I want to know WHY a particular decision was made, I will refuse to speak with anyone other than the decision maker.

If that means they’ll label me “high maintenance” I don’t care. Medication changes should be between the Dr. and me without intermediaries.

I quite frankly don’t think that what you want is so out of line. You need to discuss it directly with your Dr. Period. That is your right as a patient.

And what @Hawaii_Jake just said.

This is too important to be playing a game of “telephone” about because we all know how distorted the message gets by the time it reaches the end of the line.

@Hawaii_Jake It’s the T3, which has a relatively short half life compared to T4. Your example of how you handle it helps me though.

@Buttonstc It’s important, but waiting for two weeks won’t be dire, because I need to get the number down. If I didn’t have enough meds to get a number up I would be much more concerned. Most doctors make patients wait 6–8 weeks to get a retest, luckily she let’s me decide for myself. I would have been really bad in another month, and that much longer to get the number down. That would be two months of feeling like crap, risk on my heart, hair loss, etc. It’s why I stick with her and fly out of state to see her. It’s ridiculous I can’t find another doctor that will let me test easily.

Well, if she is that good, I would stick with her too.

But, all the more reason why I would insist upon speaking with her directly rather than any other “go-between”.

Also, since she’s in another state (so you can’t just drop by for an office visit) that’s all the more reason why politely requesting to speak to her directly when she has the time is not at all unreasonable.

But in the future, the less details you provide to the nurse, the less she’s able to get in the middle to play telephone. I’m sure she asks you for the info, but the more general it is, along with the request to speak directly with the Dr., the more likely there won’t be these types of mixups. Plus, in the long run, it saves time all the way around.

I’m not sure why you feel that you aren’t entitled to speak with the Dr. directly for fear of being thought of as high maintenance. The way I see it, you’re just being efficient and avoiding misunderstandings all the way around.

To me, high maintenance would be someone insisting that the Dr. drop everything and speak to them immediately. To be fine with waiting for a call back at her convenience is what I’d consider quite normal.

@Buttonstc The nurse didn’t ask, I just knew it was likely all the details wouldn’t be considered. He actually looked up available doses for me while we were on the phone to give him credit.

Do you hear doctors talk about patients? I’m sure some doctors are worse than others. Some are good I’m sure. This NP does trust I’m honest and responsible with taking meds and I don’t constantly get blood tests. She knows I only go when I need to, and I’m right 9 out of 10 when I think I’m not dosed correctly.

A dear friend of mine has tons of breast cancer in her family so she had both breasts removed many years ago to hopefully avoid cancer. A couple of years ago she was prescribed a drug, unrelated, and when she looked up side effects it said it can grow breasts in men. She asked the doctor if she should be concerned. He was dismissive and told her not to worry.

6 months ago she felt a lump and called to get an appointment. They wouldn’t squeeze her in so the appointment was 6 weeks out. Finally, she has her appointment. Cancer. The doctor said to her, “I guess next time I know to trust you know your body.” The doctor isn’t 26 years old and new to medicine. He has been treating women over 25 years and he never came across a woman before who knows her body? Who knows if those meds contributed, but it seems possible.

That doctor probably deals with a lot of patients who don’t know what they are talking about or are paranoid, and he just decided all patients are ignorant I guess who knows.

Should she have been more insistent about getting an earlier appointment? Saying I found a lump isn’t enough, when she has never said such a thing and usually just goes in for check ups?

I am a mental health professional. I am also a mental health consumer. We mental health consumers are the most marginalized group of healthcare consumers since we aren’t supposed to be capable of deciding what is best for ourselves.

This began to change in the 70s with the rise of the psychiatric survivors movement. That evolved over the course of a decade or two into the recovery movement. In 2003 under President Bush, there was a presidential commission that recognized the rapid growth of this movement of consumers, and this commission wrote in its findings that the voices of consumers must be heard at all levels of care and policymaking.

We are our own best advocates. This is absolutely true in any arena of health care. It is not just for mental health where we consumers have eons of history relegating us to the lowest status and seen as hopeless.

In mental health, we still fight these battles every day. @JLeslie, you are fighting this battle now as well. It is completely up to you how you choose to make yourself heard.

It is now widely accepted that mental health consumers can recover. I recovered. Caring people helped me at first, but they taught me to stand up for myself and demand correct treatment and medicine. I had to do it for myself.

@JLeslie, you are your own best advocate. Do not rely on anyone else to tell the doctor or the nurse practitioner exactly what is going on. Demand adequate care.

And I personally like nurse practitioners. I was under the care of one for my psychiatric medication management for about 4 or 5 years. She was a fabulous, knowledgeable caregiver.

I love that I can email my doctor. That way exactly what I said is documented.

I’ve dealt with doctors who shouldn’t even be practicing, so no, it’s not just you. Don’t apologize or feel bad about taking control when it comes to your health. “Annoying” or not, it’s your health and you have every right to be as informed as you’d like to be. I won’t see doctors who aren’t willing to explain things to me or who don’t treat me like I’m capable of understanding health-related issues. I acknowledge that they obviously know much more than I do, but that doesn’t mean I don’t want to be knowledgeable about any issues I’m having, either. It makes people feel better about things if they have patient doctors who actually discuss things.

So yes, definitely get ahold of your provider when you get the chance.

@Hawaii_Jake I am very happy with this NP. My hesitation is mostly from past experiences that really caused me incredible anxiety. I think if it’s possible to have a touch of PTSD, then I have a touch of it regarding doctors. I needed the collected to push me, and this Q helped.

I felt like the nurse actually wanted to help, but either didn’t understand my point, didn’t do the math (very likely I think. A lot of people just aren’t math people and have to put their mind to it) to be able to push back confidently to the doctor.

I just really think doctors need to start realizing of they turn down a patients request, they personally should make that call.

Many years ago I thought about creating a business to teach doctor’s office customer service. My staff at Bloomingdale’s selling clothing had better customer service skills than most staff at doctor’s offices, and health care is way more important. I know there has been more emphasis put on it compared to years past, but it’s still lacking too often.

Mental health is even more tricky, because health professionals can easily dismiss the patient as being paranoid, anxious, depressed, etc., and not take their concerns or demands seriously. Dealing with the health care system (physical health issues) has been one of the biggest taxes on my mental health in my adult life.

@Judi Good point, I’ll do it in writing through the portal.

Bloomies and the Average Joe Doctor’s Office have different end-games.

The customer service staff at Bloomingdale’s have a main goal of getting customers to return and buy more stuff. The staff in an average doctor’s office is scheduling appointments, battling vendors, and making collection calls.

Something more like, say, Comcast.