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Re: Between pdocs....continued » noa

Posted by Greg on January 18, 2002, at 14:13:29

In reply to Re: Between pdocs....continued, posted by noa on January 17, 2002, at 17:24:39

Noa,

I have known you for a very long time and have always enjoyed reading your posts, but I have never been so riveted by anything you have written before as I have this.

You should write professionally, you really should. Thank you for sharing this with us.

Greg

> The new office is calmer, quieter. I notice the difference that not having to scramble for parking or stand in a crowded, chaotic waiting room makes. My pdoc seems to like venturing out on his own. He gives me the url to his new website, and his email address. He is going to use his computer nerdiness as an advantage. He even asks me to email him links he could put on his site for patients to get information on the web. I give him advice about a disclaimer. He is making eye contact more. I tell him he needs a sound screen because I can hear him and his patient from the waiting room. He thanks me for letting him know. The walls are freshly painted, there is new furniture. He is not so booked, so it is easier to get appointments.
>
> He hires a part time secretary and installs a phone menu that gets you nowhere. I am frustrated again. He tells me to page him, but when I do he sounds unhappy to get a page that isn't really an emergency.
>
> He has more regular secretarial assistance now, people who actually answer the phone or return calls. Paying the copay runs smoother; the secretary has good records of my account, unlike the big practice where they billed the wrong insurance company for three years. My pdoc starts to run late again as his practice books up. I notice myself running a little late in getting to his appointments, and realize I've been doing this for years without it being a problem. I start to book first thing in the morning appointments again. I arrive and wait in the hall, outside the locked office. Sometimes another patient is there, or arrives just after me. The emergency off-book appointments. He comes in late for both of us, unlocks and lets us in. He is not a morning person, clearly.
>
> One day I am quite late and he is running on time. Murphy's law, I think. He is impatient with me. I apologize but let him know he is usually late. He says not anymore. I realize he's never apologized, ever, for being late. The next few appointments I notice that he's right. He has started running on time. It's hard to believe. I make an effort to be more on time.
>
> But I screw up a couple of times. I write down 6:30 instead of 6:15. He's angry. Somehow my appointments get out of sync with my refill needs. I call in at the last minute to get a paper scrip for adderall.
>
> I start to notice that the eye contact and smiles are infrequent. The appointments feel rushed. I have questions, concerns. He is watching the clock. But he works with me about some sleep problems I'm having. Suggests remedies, lets me try one med, lets me change it when it doesn't seem to be the right one. Still, the less concrete concerns and questions, the ones I want to discuss, don't seem to engage his interest. Sometimes he half-heartedly says I could try such and such if I wanted. But his enthusiasm is underwhelming. He doesn't seem interested in figuring it out. I think back to when he used to like figuring it out.
>
> I decide I will seek an outside consult. The whole thing needs fresh eyes, I think. I don't feel in a rush to rock the boat. My cocktail has gotten me this far. I'm functional. I'm not depressed most of the time and even when I am it is not severe. My job performance is improving. I'm doing things, seeing people. But I want to start looking at the whole business more carefully. There are still those annyoing side effects. Tolerable but annoying. Nothing to make me want to rush into a big change, especially knowing how depressed I could get. But it's time for fresh eyes. I want someone to be curious and interested. To help sort it all out. The money isn't a problem like it had been before. I will splurge for the consult.
>
> It occurs to me that I am not availing myself of one major medication that I know helps me with both the depression and some of the side effects. Well, not exactly a medication, but it works like one. Exercise. I haven't been to the gym in ages. I try to cojole myself by recalling how much I grew to love exercising at the gym despite the dread I felt before starting. But the dread I feel now is big. The whole thing makes me anxious. I strike a little bargain with myself, that I will start back at the gym just a little bit, so that when I go for a consultation, I'll be able to report how I feel with the exercise as part of my cocktail. The plan is I'll call for a consult in a month or two.
>
> The plan seems to be going ok. I get myself to the gym for 15 minutes, then 30, then 60. Not often enough, but some.
>
> It is just before the holidays and I am driving to my pdoc appointment. My car starts to veer into oncoming traffic. It rumbles. The steering wheel is fighting me. At the next traffic light, I get out and look at the tire. It is flat. I pull over, call the tow truck, call my pdoc office. The secretary calls back while I am waiting for the truck. We try to reschedule. Nothing until January 12. The tow truck comes, I take the 12th and say gotta run, thanks. I forget that this will get my off my refill rhythm.
>
> One morning I decide to count my adderalls and realize I will run out before the 12th, make a mental note to call pdoc to arrange new scrip. The mental note goes where the others are, wherever that may be. Another morning I see that I only have a about a day and a half left. I call and leave a message asking if I can come in later today to pick up a scrip. The secretary calls back and leaves a message telling me to come between 5:30 and 7, just confirm when I will be coming. I call to let her know but the phone rings and rings. No menu picks up. I try again later and again later. Still no connection. I decide to go since she said it was ok. I bring a book knowing that there will be patients and appointments and I will have to wait. It's ok with me. Especially since I couldn't confirm the exact time I was coming.
>
> The waiting area is busy. I talk to the secretary, explain the phone thing. She is surprised to hear I couldn't get through. She tells me to wait, tells me it could be a while because his next appointment is not a med-management, it's a therapy appointment. I try to imagine my pdoc doing therapy, I'm amused at the idea.
>
> I have a good book and there is an open seat. I'm content. A school age girl and her father are there. I realize she is the therapy appointment. I wonder again how effective my pdoc could be as a therapist. I'm less amused, feel pity for her and her father. They probably don't know any better, it's too bad. The girl asks me about my book, I tell her and ask her about hers. It's about some kind of gory game Harry Potter and his gang play. She's very interested in the goriness of it, describes it to me in detail, looks me in the eye with a fierce stare. I think, she's trying to shock me and wonder if I'm disappointing her by listening without a flinch. I wonder what kind of nightmares this kid must have. We talk about the non-snow snow day that day. The schools closed but nothing came down, a freebie for her. I tell her I want to read some more now. She keeps on talking to me, so I tell her my book is kind of hard and I need to concentrate on it. She's ok with that and goes back to her gory wizard sports book. As she reads, she kicks the wall rhythmically, absentmindedly. The wall shakes, the bookshelf shakes. The glass window that frames the secretary's face shakes. Her dad tells her to stop, but he has to repeat it three times. Now it's not absentmindedly. After the third time, she stops. He tells her too bad we forgot to bring your behavior chart from school for the doctor to see--you've been doing so much better. The girl says no she doesn't want to show the doctor. She sits up suddenly from her reclining position and says dad, come sit with me, patting the chair next to hers, patting her coat on the chair. He is sitting across the room. He says, no thanks I'm fine over here. Please?? No thanks, I said I'm fine over here. Please?? I really want to sit together and there's only one chair over there, but there's two here. Here, I'll move my coat. She tosses her coat onto the remaining empty chair. Dad looks up from his magazine and smiles, gets up and joins her. She puts her head on his shoulder, smiles, cuddles. They look at magazine pictures together.
>
> The pdoc emerges with a patient. The secretary goes into his office and they close the door. A moment later they both emerge, he on his cell phone, she with the office phone in hand. There is urgency in the air. They run around checking all the phone jacks. I hear a discussion about maintenance workers earlier in the day. The pdoc seems to be calling the building management.
>
> He gestures, calls me into his office, but talks to me in the doorway. He is angry, tells me I gotta stop doing this. Can't just show up. I'm taken aback by his tone. He's really angry. I tell him I didn't just show up, I called ahead and the secretary told me it was ok to come between 5:30 and 7, just that I couldn't meet her request to confirm the exact time because the phones didn't go through. No eye contact. He is moving around, has his cell phone in his hand. He huffs she shouldn't have told you that. I think, that's not my problem. He says I shouldn't leave refills til the last minute. I say I'm sorry, I shouldn't have, I should have called a few days ago. I explained that I got thrown off because of the flat tire and not having the appointment before the refill came up. I said I had wanted an appointment sooner, but none were available. He asks when my appointment is. I tell him Saturday, which is 3 days away. He says what, you can't go three days without it? I say no. Now I'm really angry.
>
> I'm still in the doorway, he is standing at a bookshelf near the door, pulling out his scrip pad, asking me what my dose is. I tell him. He gets huffier, says he is just giving me enough until Saturday, scribbles out the scrip hastily, angrily, tears it off. As he hands it to me, he says see you Saturday. I say, and that might just be our last appointment. He makes eye contact. I leave.
>
> In the elevator I am thinking about how mad I am, but I notice I am not that shaken, that I really have decided to fire him and it feels right even though it seems impulsive. But not impulsive, really, since I'd considered it a few times before. This was the clincher. He was unprofessional, I didn't deserve to be treated that way, even if my disorganization is a pain in the butt. I'm angry but I notice it's not the old impotent rage situations like this would engender for me. That helps me feel comfortable with the decision.
>
> In the car, I think about the girl in the waiting room behind me as I stood in the pdoc's office doorway, arguing with him. And her father. I find myself wondering how her therapy appointment went, what she thought of her angry pdoc.
>
> to be continued again.............


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