muchmorewherethatcamefrom

Healthcare Hot Potato

In Hazelnut, My thyroid, Peanut, Tolkien on September 24, 2013 at 3:23 pm

Oh you poor neglected blog you! I’m glad you’re not a baby human, and I’m sure Child Protective Services is too.

So how’ve you guys been? Things at Casa Much are trucking along. Update, you ask? Oh, you didn’t? Well, since I’ve already started …

On the thyroid front, when I went for my 1-year follow-up in February, my endocrinologist told me I would need to go through treatment again. For a variety of reasons (not even including the utter hassle it would be) this was concerning to us:

a) because of repeat radioactive iodine’s potential effects on fertility or implications for a future secondary malignancy

b) because of the fact that this recommendation did not follow published American Thyroid Association treatment guidelines, and

c) because of the inability to get a clear explanation from my endocrinologist about why he was recommending this. We seemed to have a tough time understanding each other in person (English was not his first language), and he totally ignored an e-mail I sent with my questions.

This latter issue was the straw that broke the camel’s back for me. I know just how chaotic a physician’s day in clinical practice can be, but I have never failed to respond in some way to a patient’s e-mail or phone call. I would have absolutely understood if he didn’t have the time to write out a four-page reply and if he had instead asked me to come in to discuss it — no problem at all there. But to pretend a patient has not communicated with you is unacceptable. So that was when I decided it was time to try to find another endocrinologist. But to pinpoint someone who takes our insurance, is located within 50 miles of us, has expertise in thyroid cancer, and has an opening within the next few months is a daunting task. Eventually, however, I did find someone, a doc who actually graduated in Tolkien’s and my medical school class, although he joined towards the end of our time at school so we didn’t know each other. As well, Dr. Med School Classmate (Dr. MSC) and I have a very close mutual friend who I’ll call Dallas Cowboy (these nicknames are cracking me, if nobody else, up) who also vouched for him. Dr. MSC turned out to be awesome. Really kind and helpful, even after I tortured him with endless questions, and he felt we could do some testing first rather than going right into a repeat round of treatment (which was what Tolkien and I also thought was the best plan.)

So there I was, friends, blissfully skipping along in the care of a new, sane endocrinologist, my long search over. It just so happened that Dallas Cowboy and his wife came to Easter services with Tolkien and I later that month. When we were leaving brunch together in the same car, Dallas Cowboy’s cell phone rang. “Look,” he said, “it’s Dr. MSC!”

“Oh!” I said. “Tell him I said hi!”

And why do you think Dr. MSC was calling Dallas Cowboy? Why, to tell his good friend some exciting news, of course: that he was moving. To join another practice. Out of state.

What are the odds I’d be present to actually hear that phone call sending me back to square one? You can’t make this stuff up! Of course I didn’t blame him at all and I was happy for his opportunity, but I needed a nap just thinking about starting my search anew.

So there I was back at the aforementioned square one: needing to find a new endocrinologist. (For those of you keeping track at home, this would be Endo #4 in the course of one year.) I was out of options as far as covered providers under my insurance, so I had no choice but to go back to [prominent academic hospital.] However, I wanted to see a different physician there since I’d had a less than satisfactory experience with the one prior to Dr. MSC. But roadblock! The endocrinology department at this hospital has an unusual policy — they do not allow you to switch providers without express consent from the first one. What? I’d have to ask my original, less-than-awesome doctor for permission to switch like a meek child, explain to his face why I was uncomfortable with his care, and then abide by his final judgment over whether I could stay or go? It’s not even like we have socialized healthcare in this country — I’m paying my own money for insurance and for these appointments, and it’s clear that the payor system treats patients as as consumers. And as one of those consumers, I still have no choice?

Luckily Dr. MSC trained at said hospital and very kindly offered to intercede on my behalf. (He also told me that he’d had multiple patients switch from Less-Than-Awesome Doctor to him over the course of his time there, which may be why the hospital has this policy in place to begin with, to ensure that Less-Than-Awesome Doctor doesn’t end up with no patients at all.) One endocrinologist did agree to see me, but his office still insisted that I had to write a letter to my original guy. Which I did, simply being grateful that I didn’t actually have to have an awkward conversation with him. (Never heard back from him.)

Several months later, I finally saw Endo #4, who seems very nice. He, too, felt that a second round of treatment was not warranted without some other testing first. In fact, he felt that another round of treatment was so far out of the bounds of standard practice that I must have misunderstood Less-Than-Awesome Doctor, since LTAD has an accent. I was not thrilled by this suggestion. Although I fully admit, as stated above, that he was not easy to understand, I am the child of immigrants — I’m not exactly scared away by accents. And I know what he recommended because I asked him a million incredulous questions about it. Anyway, it’s all water under the bridge now. More important is that Endo #4 then casually mentioned, after some varied comments about the weather, that he was moving … to Rome.

People, IS IT ME???? Should I start showering? Am I singlehandedly, one by one, driving all endocrinologists out of my state? Can they sense my unhealthy obsession with L. M. Montgomery? Should I instead start carrying around a copy of, I don’t know, The Art of War or some other universally “cool” tome as a talisman against loss of healthcare providers?

All is not lost, however, for two reasons. One is that Endo #4 is just taking a temporary professorship and should be back in the States next spring. The second is that all testing and treatment for me is on hold for now anyway, because of this:

Peanut #2

Yes, I currently have a uterine buddy. We are super-excited for this new addition (especially Peanut, who wants to know when her baby is finally going to exit my stomach into her smothering care) and are praying hard for a safe delivery and healthy baby. Baby Boy (I’m currently taking suggestions for his blog nickname … anyone?) is due in early December, and I’m trying to ignore all the people who have told us that going from 1 to 2 children actually increases your work by more than 100%. We’re concentrating on less important things at the moment, such as name selection. Boys’ names are hard! Forget blog nickname suggestions, anyone have real-life name suggestions? What did you guys name your sons? We are not above theft.

So no more news on the thyroid front for awhile (I hope), for a very welcome reason. I can’t believe that, after 4 years, we are re-entering the baby phase. It’s time to stop procrastinating, get out all that baby gear, and re-learn how to use it. You know, tomorrow.

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  1. Well, yay, that your wonderful blog is back from the dead! Or maybe merely back from the neglected! This post has reminded me of how hard it is to come up with blog names. It took me way too long to realize who Dallas Cowboy is–I got a little distracted thinking how weird it would’ve been if you & Tolkien had gone to Easter services with an actual Dallas Cowboy. That’d probably be pretty dangerous, since you don’t live in Dallas and the Cowboys seem to be pretty hated throughout the rest of the U.S. Whatever, I digress.

    I’m sorry, again, to hear about all your struggles to find a good endocrinologist. Like you’ve said before, it’s amazing how difficult this process has been for you and you’re a doctor yourself! I can’t imagine what civilians (um, i.e., non-MDs) have to go through.

    But congratulations (again) on the uterine buddy! I hope you don’t get to attached to him that you try to keep him in there. It’s been 9 (NINE!) years since my OB/Gyn rotation, but I’m pretty sure he needs to come out at some point (and I’ll be praying that he does so safely…and, somehow, with just the right amount of pizazz befitting his parentage).

    The end (of this monstrous comment).

    • Your knowledge that the Dallas Cowboys are hated throughout the rest of the U.S. is far more football (they are a football team, right?) knowledge than I possess. Maybe DC wasn’t the best nickname. You never cease to amaze me! And I know, can it really have been 9 years since OB-GYN and our amusing, insightful, questionably appropriate group journal? [Insert cliche about time passing here.] I can’t wait for your blog to awake, Rip Van Winkle-style, from its slumber too! “What are all these flying vehicles?”

  2. Two words, one beginning of an iconic name that our boy can be proud of for decades to come…Sebastian Gandolf….Just saying

  3. My two cents? I thought you’d never ask!

    Nickname: “Butter and Jelly” … it checks all the boxes — okay maybe just one — our ethnicity’s, um, penchant for flouting common sense and good taste simply to tenuously match the older siblings moniker

    Actual Name: “Max Power” (Hey great name … Thanks I got it off a hair dryer)

    You’re welcome.

    • Wow. I hardly know what to say. (Although “thank you” wasn’t the first to come to mind.) Except that you shouldn’t knock our traditions, because what would life have been like if your name hadn’t been meant to sort of match mine? Having your own identity? Pfffttt.

  4. Dude, what is up with all these doctors taking off? Geez man! The healthcare system there seems more stressful than the illness itself.

    And, yay! Baby pics!!!

    xxx

    • I know, right?! And yet I can’t be too upset with the vanishing doctors … between insurance companies, lawyers, and student loans, there’s no mystery why there’s a doctor shortage here! Miss you!

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