Illustration of ovary, Fallopian tube, and top or funds of uterus

Letter to an OB/GYN who did not take my PMDD seriously

This is a copy of a letter from a patient to her former doctor. I commend the author and contributor Amanda for speaking up and advocating on her own behalf and ultimately advancing the cause of educating physicians about premenstrual dysphoric disorder.

Doctor,

I was a patient of your office for about 14 years which included delivery of my two daughters in 2001 and 2004. I last saw you in the spring/summer of 2013. I had come to you for a consultation and to discuss my request for a hysterectomy/oophorectomy. I typed out a list of how my symptoms of PMDD have affected my life for the past 15 plus years. My symptoms were debilitating and affected my life in every way. For two weeks out of the month it affected every relationship (work, children, spouse, family, and friends). I endured impulsive behaviors, suicidal thoughts, hopelessness, self-harm, hating myself, etc. I discussed past treatments, consequences and multiple medications for the past 17 years. Nothing was working anymore and my PMDD was getting worse. I never had the physical effects of PMDD or had bad, heavy periods. After you read my list, you looked at me and said you would never give me a hysterectomy for this and for those reasons. You said I didn’t have heavy bleeding, fibroids, etc. You said that I just need to remember that it’s “PMS” and remember what I was dealing with. You didn’t even acknowledge and address it as PMDD. You didn’t believe me or take it seriously. I said if it was as easy as changing my thoughts, then I wouldn’t be in your office and left. I left your office in tears and felt hopeless. I never wanted to come back and never did.

I am writing you almost six months post operation of a hysterectomy and bi-lateral oophorectomy. I am 37 now and am on an estrogen patch. I have never felt better in my life. I knew that the surgery was my last resort and only hope. I took Lupron injections for six months prior to surgery to ensure that this would end my PMDD. As a doctor and a woman who has dedicated her life to women’s health, I feel you didn’t take me or my issue seriously and ultimately failed me. I have learned through my PMDD treatment there are doctors who don’t even believe this exists and/or don’t even know about it.

I have been active in Facebook groups for PMDD since they started them and they have been my only support as I do not know anyone personally that suffers from it. They have been wonderful to relate to and to know that I am not alone. I have attached this letter from the NAPMDD foundation. They have a great website of resources for the doctors and for the patients. They have asked members of the association to provide the letter to any OB/GYN’s and women’s health services. Most women are self-diagnosed that have PMDD. They are very often misdiagnosed by practitioners for years as having Bi-Polar, Anxiety, Borderline Personality Disorder, Depression, etc. I was fortunate enough to have a therapist who specialized in women’s studies to diagnosis this after years of treatment and wrong diagnoses. I hope that by reading these letters and possibly checking out this website that you can have a different outlook on this disorder, which is said to affect 8% of women.

Sincerely,

Amanda

 

This piece is copyrighted by the author Amanda.

The Real Cost of Healthcare

Are you getting what you pay for? How much is that time in the doctor’s office worth to you? How much is it worth to the doctor?

Let’s examine a case.

The following is based on an interaction between a married couple, Andrew and Dana, and a neurosurgeon. Andrew had been experiencing neck pain for years and found it was worsening in severity. He had an MRI of his neck that showed no major issues. The neurosurgeon reviewed the negative cervical MRI report with Andrew at his initial appointment and ordered a bone scan and an EMG test to try to pinpoint other causes. Andrew and Dana had already learned at the time of the EMG that it was negative. Dana accompanied her husband to his follow up appointment to find out the results of the bone scan.

The couple recorded and transcribed the appointment for my review.

Dana and Andrew arrived at the office at 7:20 for the scheduled appointment time of 7:30. No one showed up to open the office until approximately 8:07. They were taken back to an exam room at about 8:28. The doctor entered the exam room at 8:50.

“If you look right here, you’ll see that there’s an area…an increase…right in here…arthritis…” Dr. Neurosurgeon mumbled, “Have you ever had your shoulder looked at?”

“No, sir,” answered Andrew.

The doctor said nothing in response.

“What does that mean?” Andrew asked.

“Uh, I’m a neurosurgeon so…I would send you to somebody who takes care of shoulders.”

Silence.

“Okay,” said Andrew. “So like a…?”

“An ortho person?” Dana offered.

“Yeah, that’s who,” said Dr. Neurosurgeon, “a shoulder specialist.”

Silence.

“So give me an idea of what you’re thinking after seeing this. What type of issues…” asked Andrew.

“I think it’s a shoulder issue,” Dr. Neurosurgeon replied.

“So a mechanical issue as opposed to…” they were almost begging for information. “Muscular or…”

“So you have a shoulder problem,” he said.

Silence.

“So who might you recommend?” they asked desperately.

Dr. Neurosurgeon gave them a name and told them that the receptionist would set up an appointment with the shoulder surgeon he named.

That was it. The couple basically had to beg for information and ended up with very little. Now I understand it is outside of Dr. Neurosurgeon’s specialty to identify images in a bone scan but he was not the least bit sympathetic to Andrew and Dana’s desire for information. He could have given at the very least an outline of what the shoulder specialist might look for and explain that he was not qualified to predict the outcome.

He could have said: “I’m sorry, but issues that don’t involve the central nervous system are outside the scope of what I’m comfortable addressing. I am happy to send you to Dr. Boneanmussle who will look at this scan and maybe order more tests to see if you have a shoulder muscle kerfizzle or bone splatazzle or something else entirely. I understand you’re eager to pinpoint the reason for your pain. I wish I could tell you more but our scheduler Ms. Gitterdun will get you set right up with Dr. Boneanmussle’s office. I apologize for your wait and I hope I have given you at least some information.”

That would have taken 45 more seconds.

In 27 years of practice he hadn’t figured out a better way to communicate? As a neurosurgeon he is just not that smart?

No, he is that smart. He is just that uncaring. He sees no reason to expend energy improving his communication skills because he doesn’t think his patients deserve any more than what he currently offers. He doesn’t believe he owes them more than he is already giving them. And no one is holding him to a higher standard of communication.

Would you accept this level of communication from your cell phone company customer service person or from your auto mechanic? Of course not. In a comparable business transaction you probably would have asked for a supervisor or simply taken your business elsewhere. But this is health care.

The encounter lasted 2 and a half minutes. Andrew’s insurance was billed $129.00. His insurance contract reduced the charge to $93.04. That is a billed rate of $51.60 for each minute of face time with the physician. Insurance reduced that charge from $51.60 a minute to a mere $37.22 per minute of doctor face time. My educated guess is that the doctor spent about five minutes reviewing the bone scan and three and a half minutes documenting the appointment. So we’ll say the doctor spent 11 minutes total on Andrew’s case. That’s still a billed rate of $11.73 per minute, reduced to $8.46 per minute by insurance. Andrew’s insurance agreed to a rate of $507.60 per hour.

In contrast the couple had been at the office for one and a half hours. They had a forty minute round trip commute to the office. It took 7 more minutes after seeing the neurosurgeon to schedule with the shoulder specialist. That means Andrew had invested well over 2 hours of his time to get 2 and a half minutes of interaction with a doctor who didn’t tell him shit. He had to dip into his paid time off allowance to go to this appointment. Andrew makes about $37.50/hr. Dana freelances so we’ll leave her income out of the equation. According to work.chron.com, after six years in practice, the average salary for a neurosurgeon is about $589,500 a year, or $283.41/hr, based on a 40 hour work week. This surgeon has been in practice for 27 years so I think that is a conservative salary estimate. Just imagine if Andrew had made the current minimum wage of $7.25 an hour with no paid time off. Imagine how that loss of work would have affected the family’s finances!

With these types of money for time disparities Dr. Neurosurgeon should have been a little more sympathetic to Dana and Andrew’s inquiries. I fully understand the costs of staff and other overhead, but charging $129.00 for 2.5 minutes with a physician who offers very little information is unacceptable.