Discontinuity

For those who’ve read and commented on my medical adventures and subsequent musings, my thanks and an update. It’s been a little over a year since I walked out of the hospital and I can report that readers of Tap-Repeatedly know more about my medical history than the medical professionals treating me. Seem odd? Tag along on my most recent doctor visit and judge for yourself.

Continuity of Care

A big part of modern medicine’s sales pitch revolves around the possibility of better care through better communication. Patient information — test results, diagnosis, procedures, prescribed drugs — can be instantaneously shared with all those involved with the patient’s treatment. There are no longer any cracks for vital data to fall through. There is a “continuity of care” that promises optimal outcomes.

That, at least, is the claim. By the time the nurse finished asking her first question, that inspiring vision of crystalline transparency and instantly omnipresent information was pretty much kaput.

“Have you ever had a colonoscopy?”

Had my snark batteries been fully charged (the appointment was at 6:30 AM) I might have said something like, “Oh, is that where you drink 14 glasses of gritty liquid, poop it all out, have three enemas, and then a guy shoves a camera up your butt? Seems familiar but I couldn’t be sure.”

Instead, I simply sat there, looking at the nurse and wondering why, since I had seen her every office visit for the past four years, she was going through a new patient check list. Then I remembered. My doctor knew nothing about my first massive GI bleed and the colonoscopy that accompanied it. The continuity of care doesn’t yet extend from the hospital to his office. The nurse apparently had no record of my hospital visits and thus no memory of the procedures I’d been through.

Then she asked if I’d had a eye test in the last year. Again, no continuity. The eye clinic is downstairs from the doctor’s office. I answered yes and she told me I should plan on having an eye test every year because I could go blind really quickly from diabetes. Not what my eye doctor said, but, no matter.

She took my blood pressure through my shirt sleeve and went off to find the doctor.

I sat in the quiet small room and wondered what else I had to look forward to. In a few minutes the doctor arrived and my wondering was over.

Do I know you? And, if so, why?

I started by telling my physician that I was now using a walking desk and putting in 360 to 420 minutes per week walking at 1 mile per hour. And when I’m not walking, I’m standing. His reply was, “No cardio?”

Ah, yes. Good, meet your enemy: Perfect.

Then we moved on to the drugs I was currently taking. I’d added some vitamin B6 and B12 to my fish oil and lisinopril. His concerned comment was, “No aspirin?”

I gently reminded him that he was the one who wrote, in my chart, that I was allergic to aspirin and under no circumstances was I to go anywhere near aspirin or anything like it. I mentioned that since our last appointment I had come to the conclusion that it was more likely a drug interaction between metoprolol and aspirin which blunted my blood’s ability to coagulate. He told me I could never prove it and proceeded to repeat the case for aspirin.

Low dose aspirin is the standard of care for heart attack survivors and here I was, a heart attack survivor, not taking it. Hell, I wasn’t even taking a statin. And if I wasn’t taking aspirin and wasn’t taking a statin, I was going to die of a heart attack.

Not quite a tantrum, but close.

When he cooled off, he could understand why I might not want to take aspirin because the last time I took three of those tiny little pills I spent four days in the hospital, needed seven units of blood, and burned through more than $30,000 of my health insurer’s money.

We finished with him writing a prescription for a year’s worth of lisinopril and sending me on to the lab for my blood tests. If nothing changes, I’ll see him next December.

Good, if modest, news

When my blood test results showed up a week later, I was pleased. My total cholesterol has fallen over the past three years from 283 to 242 and my LDL from 183 to 170. While not the sort of magical drop one can get from a statin, it’s a drop with no side effects. (Given how sensitive I appear to be to drugs, I have no desire to find out if I am one of those rare folks who responds to statins by developing rhabdomyolysis [rab-do-mi-OL-ih-sis]- a condition characterized by severe muscle pain, liver damage, kidney failure and, you knew this was coming: death. I don’t even want to experience the much more common statin side effect of myalgia – a potentially disabling muscle pain.) And given the research that suggests a higher level of cholesterol is beneficial as one ages, I think I’ll be satisfied with what I’ve got.

I wish I were more satisfied with the quality of care I was getting. My confidence in the health care system, which was none-too-high after my bleeding adventures, has slipped a bit. The whole point of seeing the same medical professionals over time is continuity and familiarity. When they no longer seem to know you, what’s the point of going back to them?

Meanwhile, I walk on my treadmill and get a big smile when I look at the steadily rising number of steps on my shiny new pedometer. Though I’m not quite at 10,000 steps a day yet, I’m getting closer. And that makes it seem like a game.

Benediction

My humble thanks to the Tappers who’ve read and commented on this unexpected odyssey. It’s my hope that it’s been of value to you. May you be well.

Send an email to the author of this post at mrlipid@tap-repeatedly.com.