biopsy

[kaysixteen]

I have been dealing with a skin issue.   Two weeks ago Monday, I happened to be at my PCP's office for a regular diabetic check-up, and he saw the outbreaks on my arm.   He asked me how long it had been there, and by then the answer was probably about a week.   He asked if I had done any yard work, hiking, etc., but no.   I see a dermatologist for an unrelated issue, and she has long prescribed a topical steroid cream for it, so the PCP told me to use it for this as well.   I had actually already been doing that.   I kept on doing it... and it was essentially useless, but beyond that, the skin issue was migrating all over, with pin-point breakouts seemingly caused by nothing, and not generally responding to the cream treatment... and causing tremendous all-over itching.   I had also itch pills for the other issue, but regularly did not need them.   But now I was taking the max dosage with little relief.   After about ten days I gave up, called the dermatologist for an appt.   Saw her Tuesday, and after looking at the issue, all over, and asking some good questions, she decided she'd need to do a biopsy to determine the cause, which if I understood her correctly she feels is either psoriasis or a skin fungus issue.   So she did the biopsy.   We scheduled a follow up appt for two weeks later, but she has not prescribed any treatment yet, presumably because she quite logically would be wanting to know what exactly the issue is.   The after-care photocopy she gave me for the biopsy also notes that patients are 'strongly discouraged' from calling the office and asking for test results.   I can, of course, get no relief for this until and unless some treatment can be prescribed.   I do not think it should take two weeks for this pencil eraser-sized skin biopsy to come back, but I am loathe, as of yet, to violate the 'strong discouragement' to call and ask for the results.   My dilemma is compounded by the reality that in the 6+ years I have been her patient, her staff has distinguished itself in my eyes far and above any other MD I have ever seen, for surly and officious attitudes- indeed, when I was given my copay receipt Tuesday, I also received a photocopy notice of a change of office policy, saying that effective immediately, any and all prescriptions ordered by the doctor will henceforth be called in only at the end of the business day, regardless of when one's appt was.   I confess to not being impressed by either of these developments, but I would be interested in any feedback....

[lightning]

Start looking for a new doctor, but in the meantime, call up the office and ask for test results.

[nebo113]

Agree with lightening on finding  a new doc.  Can you not get test results through an online portal?

[mamselle]

Biopsies can take awhile. I wouldn't fault the doctor if they can't speed up a lab procedure in and of itself.

If they tell you it takes so many days, that's how many days it takes, and if they don't want calls between the biopsy procedure and the result it's because they know they won't have anything to tell you.

It's not all MacDonald's, you know?

M.

[clean]

I hope that you find relief from the symptoms soon and that the answer to the 'what is it?" question is fast, quick to treat and fast resolving!

Feel Better Soon!

[kaysixteen]

Thank you all.   I neglected to ask the doc how long the biopsy would take, but of course it now dawns on me that it may well have had to be cultured before it could be read.  I am seeing the skin condition slowly ameliorate, and will give it at least a few more days before considering calling the office.   I may just wait for my next appt June 2d.

That said, I confess my patience for the surly, officious treatment her office regularly provides is running really thin, esp since it is also 45 minutes away.   I can easily replace her with a local option.   The form memo announcing that effective immediately all prescriptions will only be called in at the end of the day is really bad, just lazy-- say I had the first appt of the day, was sick, was prescribed a med-- would I be expected to wait 8 hours just for the prescription to be called into the pharmacy?

[mamselle]

Have you ever worked in an office? A medical office, in particular?

In the midst of a complex, life-threatening global disease threat?

Have you ever been, as I suspect is the case here, the single support-staff person in a difficult setup where universal precautions around potentially immunocompromised individuals take time, and must be observed for all patients, whether they say they're "clean," vaccinated, or not, because the last thing the staff or the MDs want to do is to become transmission vectors for patients, or each other, or their families?

If it's an oncology practice, the desk staff're probably not only dealing with "taking off," or copying (and entering in the computer the MD's directions for) time-consuming chemo protocols for any given numbers of patients on any given day, filling out hospice forms for those not making it through, and doing daily triage for all the above, plus new-patient intake insurance confirmations, hospital-admitting Medi-Tech entries, X-ray orders, surgery prep orders, and checking medicine compatibility issues for anything from a cold sufferer's aspirin to a dying patient's morphine drip?

They may also be juggling sick kids at home, parents dying on the opposite coast, a court eviction ordered for an impecunious friend, whom they're considering taking in, or a broken down car for which they can't afford the parts right now.

Have some compassion.

Calling in all the scripts at the end if the day is known as "batching," and it's what severely time-compromised administrative folk like beleaguered desk clerks in hospital settings and doctors' offices are taught to do, since they prevent the kinds of errors caused by task interruptions, and collect all of a similar task so it can be done at once.

They may have even been told to call all the Rx's in then, to avoid long wait-times on the phone during the day, and to ensure a quiet office environment for better audibly, lack of interrupted info transmission,etc.

If I were that person (and I have been, or very close to it, without the spice of a pandemic to make everything 16 times more difficult....), I'd be dreading going into work every day because of having to deal with all that stuff, plus the entitled attitudes of folks who really just don't understand, and don't seem to be trying to.

As persons of faith, we're called to go the extra mile.

Go it.

M.

[AmLitHist]

Having been in Kay's position in a couple of situations myself in recent years, I agree with Mamselle's advice to compassion and going the extra mile--however, that applies to the office staff, too.  For them, the patient is one among many; for the patient awaiting the diagnosis/treatment, the physical and/or emotional toll is much more stressful.  And Kay indicates that this isn't new behavior from the office.

I don't mean to downplay the impact of the pandemic on any practitioner or staff--quite the opposite.  But the pandemic has been a factor for all of us. Even though stress and burnout is intense for some medical workers, It shouldn't be license for providers to treat patients like they're a nuisance, particularly those whose work isn't closely tied to COVID/related health situations.

For the record, last fall/winter ALHS found himself in a medical crisis that was potentially (and, at one point, acutely) life-threatening but completely unrelated to COVID.  He received excellent, compassionate care, including getting worked into busy schedules for emergency exams, "rush" test results, and so on.  He also ran into two physicians (not staff members, though a few of them were rude and got reported to their doctors) who were utter jackasses. At the end of it all, two doctors were reprimanded by their care systems, and one of those lost his hospital affiliation because our complaint mirrored those of many others (it was that, or lose a long and ugly malpractice case).

Yes, I am that person--unapologetically so. Medical professionals know they're often seeing people at their worst moments. Many is the time I've apologized for being a difficult patient/spouse/child, and I've always been treated graciously.  But Kay isn't being unreasonable to want answers ASAP so he can start feeling better. He shouldn't have to walk on eggs to get not only the services he's paying for but also some decent, humane treatment.

Sending you all best wishes, Kay.

[Cheerful]

I understand kaysixteen's concerns.  Unpleasant, stressful. 

Not unreasonable to call the office next week to ask about results:  "Sorry to bother, but I forgot to ask when the results would be in, do you have any info?"

Good news that the condition has improved!  Perhaps a stress or allergic thing.  Best wishes.

[mamselle]

ALH, you are also right, of course.

And if the person you reported has that long of a rap sheet, the office/hospital staff were probably glad for a means of getting rid of them...I have indeed worked with "those MDs," too.

M.

[kaysixteen]

This issue is gradually ameliorating on its own, and I will likely decide not to risk the wrath of this doctor's office by calling up, and rather wait till my next appt next Weds.   That said, after this issue is addressed, I am all but decided to find an alternative dermatologist.   Between the 45 minute ride and the surly, officious staff, I can almost certainly do better.   This is a dermatologist, after all, not an oncologist, and her office staff is not burdened by the chaos and real suffering that might excuse such behavior, especially given the reality that patients in medical practice, regardless of type of specialty, are not hostile fast-food customers whining that their fries are cold.   Patients needed to be treated with compassion, and to have their questions answered accurately, pleasantly, and in a timely fashion.   This new prescription policy, further, is hideous-- lazy and several other things.   Say Patient X goes to the doc at 8:30, being sick right now.  Doc prescribes meds.  Patient leaves doc, heads to pharmacy-- is sick patient supposed to wait 8 hours there waiting for scrip to be sent in (and hope that then the pharmacy in question has the meds to fill it, rather than having to send patient off to another pharm that could)?   Really?   What possible excuse could the dermatologist's office have for such deficient patient care?

[mamselle]

Dermatologists are often the first to spot, diagnose, or give a preliminary assessment of cancerous or pre-cancerous cells, and they are every bit as much an MD with a significant investment in proper patient care and treatment--and all its attendant pressures and difficulties--as an oncolog8st when those cases arise.

Stop looking for excuses to be dismissive of others!

On both this thread and the "fellow-alumni" thread, you seem to be trying to seek a higher level for yourself by putting others down.

It doesn't work that way.

It might if we were all on solid ground, but we're all, always, floating on very uncertain seas. Throughout all of our lives, if we push others down, our supports go down with them.

Construct a support under them, and you give yourself a better standing-place, too.

Drown them in bile, and you poison the air you breathe as well.

You've misjudged what you thought were firm tectonic plates beneath you.

They never were.

They're icebergs, and they're melting....save each other.

M.

[nebo113]

A gentle pushback on Mamselle's comments.  During the pandemic, I have found that medical staff has worked very hard to be supportive of patients and delivery of medical care.  While I am more than willing to cut them slack during these difficult times, what K16 describes seems more like a systemic problem within that office.  I, too, have left practices when staff was not pleasant.  And I have stayed with practices where staff had been there for years and was professional and pleasant.

[spork]

Batch processing of prescriptions is very common in medical offices, as mamselle describes. It is very similar to "we will respond to voicemails by the end of the next business day." Do you reply to every email from students immediately after it shows up in your inbox?

I'd be more concerned with the accuracy of the pathologist's interpretation of the biopsy. False positives and false negatives abound in medicine.

Similar to what nebo113 wrote, I usually see my test results in the online patient portal before my physicians do. No waiting for a phone call that might never come.

[mamselle]

I absolutely agree there are dysfunctional practices, I've been trapped in them, too, and was thankfully able to get out for my own sanity sake, all the while feeling for the poor patients who still had to deal with the idiocy.

So I'm not saying it's impossible that there's also a problem with this office.

And maybe at this point, it would be better, for everyone's sake, if a different one were available.

Just, if you do find another one, be sure not to bring any problems outside your valid health concerns, with you.

M.