Frustrated Dr

 I just finished seeing a woman who is 70 years old and complaining of intermittent abdominal pain and nausea for 6 years. She also has constipation for 4 years or so. She sees a general cardiologist, an arrhythmia expert (also a cardiologist), a gastroenterologist (“stomach”), a family doctor and a general internist. They have no explanation for her onset of constipation which makes her VERY uncomfortable. They have spent oodles and boodles to work up her abdominal pain and nausea. Each visit lasts for 14.38 seconds (approximately). She was placed on drugs to decrease the acid in her stomach. She has been on them on and off for 3 years!!!!!!! The gastroenterologist told her it “takes time” for the drugs to work! (Would that be a century, half a century- perhaps a millennium!????) So, I spent some time with her. After reviewing her meds, I found out that her pain symptoms pretty much correspond with the statin drug (simvistatin) she is taking. The constipation corresponds to one of the heart medicines she is taking.

This was like a revelation to the patient. NO ONE ever spent the time I did reviewing her case! Second, no one ever explained the logic that they used in making the tentative diagnosis. I asked if the medicines she was given to cut stomach pain and nausea helped. She said, “I don’t know.” “Well, has it made the symptoms better?” “No!” “So why are you taking them?” “Because my doctor told me to do so.”

In fact, her internist and family doctor (why she needs both God only knows) are encouraging her not only to take the stomach acid drugs which in her case are useless, but to take the statin drug (probably the culprit of her abdominal pain to begin with) for her elevated cholesterol . They told her that it is “good” for her!!!!! (No matter that it increases cognition issues in women, causes the symptoms she is complaining of, predisposes her to diabetes and may not be particularly effective in decreasing the cardiovascular risks associated with her elevated cholesterol to begin with because she is a woman).

One of the heart drugs she is taking (and she needs to take) is well known to cause constipation and its’ use is temporally related to when she began to have constipation.

I explained my logic, my plans, the branching logic tree of how WE (she and I) will get to the bottom of this and it was, she said, the first time she had hope.

Her major complaints are caused, I am certain, by iatrogenesis (caused by the very drugs she has been given for other issues). So why am I upset? First, the “quality measures” set down by Obama’s Federal Team (Meaningful Use) does not even touch what has gone on here. All of the docs in this case who have been negligent in my opinion would pass through the Obama “quality” standards. Next, ALL of these guys are paid 2-4 times my income and spend a FRACTION of the time I have with the patient! The gastroenterologist is a “specialist”!!!!! Sounds like he is a specialist in getting out of rooms early!! The needs we have in health care- compassion, time, listening, reasoning, looking up data (I did while I was with the patient.), etc. has not and WILL NOT BE FIXED by the Feds or Insurance companies! The paradigm is the same.