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No Good Deed-Part 2

No Good Deed - Part Two There are many inherent problems evaluating a new patient in a remote region of the country. First and foremost, our office staff cannot assure that the patient's insurance will reimburse them for their laboratory testing, our clinical staff cannot physically draw the necessary blood for testing and they cannot easily order image testing like we can in the Memphis area. Regional commercial laboratories do not always offer the unique testing panels that I have created for accurate new patient assessments. In addition, most patients have established local doctor-patient relationships, and seeing a new physician far across the country for not only a consult but continued medical care is difficult for many new prospective patient to get their hands around. Even with email, texting and possibly video chatting, it is still difficult to execute effectively.However, my office staff has worked out many of the kinks. They have found ways to navigate the tortuous waters of the out-of-state healthcare industry. Our established protocol is relatively simple: get your blood work done, and when all the results are in, come to Memphis for a face-to-face evaluation with me. Forward me all old medical records. I usually review them prior to their visit to insure all of the appropriate blood tests were drawn before our prospective new patient travels hundreds of miles for their first visit. But when dealing with new patients who have their own opinions about what medical information is necessary for me to use in their assessment or how my office should operate in accordance with their care, we do not always have a smooth and efficient pre-evaluation adventure. Another major confounding factor is that some new patients believe they can save a little money if we deviate from our process to execute their assessment their way: a simple call by phone to discuss their illness and possible treatment. That's when the floor falls out.My staff contacted our established patient's friend and explained the procedure. He was reluctant and did not follow our instructions for laboratory testing. What made matters worse, our established patient was trying to expedite the process, so he became a third party interceding and communicating back and forth with the patient-to-be and our office. It was almost like practicing medicine through an interpreter in the United Nations, getting different ethnic patients to communicate amongst each other using different languages or jargon. It was not too surprising that the prospective new patient blood testing got screwed up.In the meanwhile, hundreds of pages of medical records came into the office. I suspect probably 300 or more pages from different specialists from different states. The patient-to-be had a very complex medical problem and part of his current ailment was due to poor decision making years ago. Much of his disturbance was physician induced and the logic behind their aggressive treatment was severely flawed. I do not think it was a case of malpractice, just very poor decision making by overzealous specialists.Once the blood work was partially complete, a call was made to schedule a face-to-face appointment. The patient-to-be was reluctant to come to Memphis before May 2015. It appeared to my office staff that he was in no hurry to get his symptoms resolved or illnesses treated. The patient-to-be insisted on coming in May despite our established patient's insistence that his friend was ill and needed immediate attention. By now, I had invested over 20 hours or more looking at the patient-to-be's medical records to get some vague idea of his current problems and how his clinical laboratory data could help uncover a solution. I am sure our established patient told the patient-to-be that I would call him, discuss my findings and avoid a visit to Memphis until his planned vacation in May 2015, despite our current back log of established patients trying to get in to visit with me. And I never called. I was waiting until May to see him. The whirlwind of miscommunications and emotional entanglements amplified as time passed. In addition, we had two episodes of inclement weather that stifled our ability to focus on anything other than getting our patients in Memphis rescheduled and seen as quickly as possible. The Patient-to-be started sending angry, caustic emails claiming that my staff was corrupt, dysfunctional and dishonest and if it were not for his friend's confidence in me as a caring, compassionate physician, he would not consider coming to our office. Our established patient began to join in on the fracas on the side of the patient-to-be, berating our performance as a functioning healthcare delivery system. All of this tempestuous drama was creating turmoil in our office. In the end, I stepped in and emailed a kind but firm message to the patient-to-be asking him to stop sending deprecating emails to our office and I made it clear that I did not tolerate any such behavior from anyone coming to see us. I told him that I and my office staff have a high standard of respect and he (the patient-to-be) would need to abide by it or I would walk him to the curb. You might as well guessed it, the next day he sent one last email telling me to tear up his medical records. He would not be coming to see me as a new patient. As an aftershock, our established patient sent a four page single spaced rant about the entire situation, claiming that his friend was suffering greatly and his malicious and spiteful emails were justified because of his pain and suffering which was exacerbated by our dysfunctional office politics. According to our established patient, my email was unwarranted and heartless. He being with good conscious, had to resign as a patient under my care in loyalty to his friend in Florida. His eyes were opened to the truth, I was a charlatan or something like that. Furthermore, he has decided that he would take it upon himself to tell everyone about his personal pitiful experience trying to help his friend. He is committed to enlightening the masses. Where does one begin understanding how illness somehow gives patients the authority to be disrespectful, discourteous and vitriolic? Since when did medical illnesses give patients platforms for self-righteous moralizing? With my grandmother's words sharply emblazoned in my mind, I had agreed to try to help a friend of an established patient who lived hundreds of miles away. There is always more to the story, and in this case, multiple versions of the same unfortunate calamity of errors swirl depending on your point of view. I, my individual staff members, the patient-to-be and our established patient experienced the same emails and episodes of condescending behaviors, and as expected, we all have distinctly different views on how everything transpired. Neither of us agree on anything other than the aggressive disrespect of both the established patient and his friend, the patient-to-be. I suspect there is something, perhaps a demon buried deep inside our established patient and the patient-to-be, locked away for years. I have had other malevolent patients who bore a grudge against life. And when I confronted them with their cruelties, I was in turned threatened. Both the patient-to-be and the established patient had all the rationales and evidence to justify their behaviors to me and my staff. I suspect their wounds are too tender, their grief too raw and their personal sense of righteousness too strong. Whatever past demons they condemned to the prisons of their minds, they cannot forgive those fiends for hurting them. I see both of them as having not only to face the cruelty of their original demons, but also the cruelties they have inflicted on others because of their emotional disturbances. How does one forgive the demons and their own cruelties at the same time? They cannot. I doubt they will ever be able to face the truth of what they've hidden from the world so long ago. Please do not let your demons stay chained up in the dungeons of your minds. Confront them and do not judge the cruelties that have befallen you. If you are being cruel to others especially those who are trying to help you, stop it! If you witness a loved one or friend being cruel to others, tell them to stop it! As you unfold, give grace to the fact that life is sorrowful and painful at times in all of our lives. Mentally healthy people do not use self-righteous moralizing to justify their use of hate or cruelty to anyone, anytime, anywhere and for any reason, even sickness. And always remember, no good deed goes unpunished. That should not stop you from doing them, just use discernment in choosing for whom you do favors for because sometimes, things don't always turn out the way you had envisioned.  Doc
Posted by Amanda Sanders at 9:10 AM
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