My body as profit center …

[kaysixteen]

Random questions:

1) who cares if some doc wrote 'non-compliant' in your medical chart?   What difference would that make?

2) Why would it be wise to disagree with a trained cardiologist's opinion as to your EKG?

[Treehugger]

Random questions:

1) who cares if some doc wrote 'non-compliant' in your medical chart?   What difference would that make?

2) Why would it be wise to disagree with a trained cardiologist's opinion as to your EKG?

I'm interested in hearing people's answers to #1, but as far as question #2 goes — he wasn't a "trained cardiologist," he was my primary.

Also, I have been with this PCP for years and know that he is an alarmist manipulator. Either that or he is incompetent since I have had quite  a few ridiculous false "diagnoses" from him in the past. It may well be a combination of the two. He might not be completely competent and compensates for this by simply suggesting the worst possible thing for every presentation and referring people on to specialists. This strategy would have the double advantage of covering his ass in case there was a real problem and two generating more business for him as the specialists will probs oh send his patients back for more blood tests. He is one of these rare PCPs who still runs his own office, so it's not like he has colleagues looking over his shoulder.

Ridiculous "diagnoses" I have gotten from him in the past:

1) After my pancreatic enzymes came back elevated in a few blood tests, he just wouldn't shut up about what he saw as the likelihood I had pancreatic cancer. I reasoned with him thusly: Pancreatic cancer is a disease of aging. It is extremely rare in someone in her late 40s with no family history of cancer. Also, elevate pancreatic enzymes are absolutely  onot an indication of pancreatic cancer. By far most people with elevated pancreatic enzymes do not have pancreatic cancer and most people diagnosed with pancreatic cancer do not have elevated enzymes. In fact, one of the problems of pancreatic cancer is that there are so few indicators.

2) I went to see him about a boil. I was worried that the boil wasn't healing properly due to immunosuppressive medication I was on. His response: That'd not a boil! That's a melanoma! You need to see a dermatologist ASAP. Um, no. I think I can tell the difference between a melanoma and a boil. For one thing, a boil hurts like hell and a melanoma typically does not. I told him this, but he kept on insisting (wrongly) that it was a melanoma. (It was a boil which eventually healed on its own).

There are more, but this is enough ...

So, why don't I go to another PCP then?

1. This guy is totally reliable in that he will do anything I  husband need and prescribe anything I want. No, I am not seeking things like OxyContin, but he will prescribe me exactly the kind of pill-in-the-pocket beta locker that works for me (metoprolol tartrate), whereas my now fired  electrophysiologist insisted I try metoprolol succinate first, although there was no indication for that and I already knew that metoprolol tartrate worked fine. If I am going on a long vacation to an exotic locale, he will write me just-in-case prescriptions up the wazoo.

2. I have made an informed choice to opt out of most screening tests (colonoscopies are the one exception since they go beyond mere screening) and he is one of the rare doctors who just lets me be and doesn't  bully me about it.

3. For whatever reason my husband thinks our PCP is great and whenever I suggest going elsewhere, he suggests that I am a racist (like a real old-fashioned racist and not the kind of racist that all white supposedly are).

[mamselle]

In answer to no. 1 above: A "Non-compliant" label is like getting a reputation for drug abuse or alcoholism. Anyone (well, any medical caregiver), will see it and start interpreting everything you say based on it.

It's a dogwhistle label, it affects your credibility as a factual reporter of symptoms, and everything else.

It's also, for those caregivers with controlling personalities (which, by close observation, many are) like a red flag to a bull. It sets you up as a target for their insistence that they know best, that you must do what they prescribe, and that any failure to do so is willfully disruptive of their best efforts to help you.

All of which is, by the way, sometimes true: there ARE patients who are willy-nilly about follow-up with a caregiver, dont understand the basics, or who cherry-pick which of their MD's instructions they'll follow, and which they won't.

And the latter can really be dangerous: say your DDS prescribed prophylactic antibiotics before a root canal because they know you have an infection and are concerned it could reach the heart (a serious and strongly possible scenario).

Miss Noncompliance of 1963 won't fill the Rx because she doesn't feel like it, it costs too much, she doesn't like being constipated while on Abx, etc. DDS doesn't realize this, does the procedure, and a couple weeks later, the patient shows up in the ER with serious heart issues, passes out, has to be intubated, and nearly dies (all possible).

The DDS should have checked. If they realized the Pt. had a tendency to play cowgirl with her care, they might have been more assiduous in checking. So in one sense, the NC label is a warning for the patient's own good: it may mean they've shown the inability to understand instructions, an incomplete awareness of the dynamics of systemic interactions (like tooth care and heart chamber vulnerability) even when explained to them, or have financial issues.

The front desk should also have picked up on this: if the patient has state medical ins., the Rx coverage should have been checked out, or even called into the participating pharmacy, to explain the reason for the Rx and its required usage, to facilitate payment, reassure the pt. they wouldn't be out-of-pocket, except for the co-pay, etc.

But if it's undeserved, such a label becomes a pain. Every time one tries to question a treatment plan for good reason, the MD may start bristling and getting defensive. "Here its comes," they think. "Just as the chart says..."

It doesn't help that answering questions takes time--and they have less time than any other resource, ever--but they have to frame a comprehensive answer to a layperson who's possibly swallowed the Mayo Clinic site whole and has the lay equivalent of med. student's disease.

If they're a specialist who has to give the same complex spiel a dozen times a day, they may just be so burnt out on it that they really do wish you'd just trust them to know their job, or go get an MD degree for yourself, and really do do it better than they do--so they don't have to.

Anyway, that's why.

M.

[Treehugger]

mamselle —

Thanks! That's really interesting.

That might explain a run-in I had with my first oncologist.

A nurse at a clinic to which I had been referred all but handed me a copy of my visit notes with the oncologist in question. She came in and said that she had an extra copy of my visit notes and wanted to know if I wanted to see it. I waived her off, but she really insisted, so I took the copy.

This oncologist has gone on and on about me actually being a smoker and denying it. It went well beyond "patient denies smoking." There were about six statements in the report that went something like this: "Patient denies being a smoker, but she smelled like smoke and there was smoke coming out of her mouth when she denied it." "Patient has a smoker's cough." Etc.

As a never smoker with a presumed lung cancer diagnosis, I was mad as heck. A friend of mine (who is in public health) happened to know the VP of the chain of cancer centers at which this oncologist worked, so she passed along my complaint to her and I was given a chance to make things right.

What actually happened: I happened to have a bad head cold on the day I consulted with with oncologist. Also, since I hate elevators I had walked up the stairs. I do not know (since I couldn't smell anything due to the cold) but probably someone had been smoking in the elevator.

When the oncologist confronted me in the office with the fact that I smelled like smoke and was coughing, I related this (100% true) story to him.

Oddly, nothing whatsoever of my explanation was included in the visit notes — only his (mis)perceptions.

[mamselle]

Yes.

That RN did you a favor.

M.

[mamselle]

Interesting commentary on non-compliance:

   https://www.businessinsider.com/past-noncompliance-barred-pig-transplant-patient-from-human-heart-2022-1

M.