Monday, March 05, 2012

the danes will not be winning any customer service awards

i have to share with you a letter that i wrote today to my local doctor's office. as those of you who are friends with me on facebook know, i've had a cough for more than two months now. today, i had an appointment for a "lung function" test (it's apparently the last straw when they can't figure out anything else), which i dutifully reported for at the appointed time, only to find that there was no appointment on the books. in frustration, i came home and wrote this letter to the doctor's office. i'm about to print it and deliver it by hand, but i had to share it here, capital letters and all. interestingly, my initial reaction is that this isn't even a question of socialized medicine, just an utter lack of customer service and perhaps empathy (and a little bit of being absent from medical school on latin day).  but i'll be interested in your take on it (and i warn you, it's long and it features two phlebotomists and a mean nurse).

here's a picture of a fluffy bunny to take your mind off how many words there are...


Dear Lægehuset (House of Doctors),

I have to write in English because it’s easier to express myself and I trust that you’ll be able to make it out.  I have had a severe cough since the beginning of January. I’ve been in to your actual clinic 3 times (4 counting an aborted mission today, but we'll get to that).  I’ve called during the 8-9 a.m. calling hours at least 3-4 additional times. And here it is, March 5 and I’m now just really, really good at coughing and we’re no closer to knowing what on earth is causing a cough of such abnormal duration.

I’d like to walk you through what I’ve been through and ask you if think it sounds ok. The first doctor I saw was a young woman who was apparently taking part in a contest to see how many patients she could see in a day (or an hour?) - sadly, I never learned her name, nor was I invited to sit down or even remove my coat, so I cannot tell you who she was (tho’ I could identify her in a line-up if necessary). I was literally in and out in under a minute with nothing but a compliment for my excellent coughing ability.

A week later, after a couple of coughing fits that made me wonder if I should go to the ER, I called during telephone hours. A nice doctor with a very deep voice looked at my medical history and noted that I had had a similar cough in May 2010 and he suggested we try the steroid inhaler that worked at that time, so he called it in to the pharmacy for me and I went and picked it up and began using it as directed.

A couple of weeks later, ragged from the continued coughing, which wasn’t showing any signs of letting up and now getting quite sleep-deprived, I called again and got in to see another gentleman. He was apparently not in a competition that day and actually invited me to take off my coat and sit down, I’ll even grant that he might have told me his name, tho’ I didn’t take note of it and in the haze of my illness, I simply don’t remember. However, I felt that he took my cough seriously and he sent me in for some tests - a blood test and a throat swab, as well as an x-ray. Oddly, other than the x-ray, he didn’t bother to explain to me what he was testing for, nor what I should do next. I went out to the waiting area and was called in for a blood test. The phlebotomist taking my blood was nice, but didn’t explain what the test would be looking for or how long it would take to get results. She just sent me into another nurse’s room, where a nurse who NEVER SAID A SINGLE WORD TO ME (I can only presume because she and I had not met when we were in kindergarden together), not even hello, or “fuck you,” came at me with a long q-tip, not even asking me to open my mouth and say "aah," but leaving me to bewilderedly figure that out for myself while trying not gag on the stick she was wordlessly shoving down my throat. She also failed to explain what the test was for or what I was expected to do next. I made my way to the local hospital for my x-ray and dutifully waited for a call about the results as directed by the nameless doctor.

When no call came, I called in, but having no idea which doctor to ask for by name,  I took the first available doctor in your endless loop phone system. She (again, didn’t catch the name) was a bit short with me; telling me my results weren’t all in and behaving as if I should have known not to call so soon. Not being telepathic and having only dated a medical student during college and thereby only peripherally attended medical school, I had no way of knowing when to call for my test results, since I hadn’t been told. Nor had I been told what I was being tested for, which made it even more challenging to guess (google?) when I should call for the results. So, still coughing, and by this time a real expert, I waited ‘til early the next week and called again. This time, I was blithely told all the test results were negative (but still not told what I had been tested for). I asked if there wasn’t something we could do to get me some relief so I could get proper sleep, rather than waking with coughing fits several times per night. And the nice lady then called in a prescription cough syrup for me (giving me no warnings that I should be careful driving or operating heavy machinery, nor asking me if I had had previous issues with codeine products in the past (hmm, would have thought that was standard)).

I took a few doses of the cough syrup several evenings in a row, trying to get some sleep, but the presence of actual opium in it made me feel worse, so I stopped taking it and just continued coughing, which by now I was doing at Olympic-levels. In desperation, I came in for a third visit. This time, I saw Dr. M and I only got her name because I insisted on it and typed it into my phone as she spelled it to me.

What is up with not introducing yourselves? I realize that I’ve never seen the same doctor twice, so perhaps it’s unnecessary since you apparently have what I can only characterize as an endless supply or consider them disposable like one-time surgical gloves.

Dr. M tested me for allergies, as when I came in this time, I suggested that maybe the reason my cough didn’t go away was because it was a symptom of an allergic reaction. (See that, I came with the diagnosis idea and again, me = no medical school.) I learned to my relief that now allergies can be tested via a blood test, rather than the panel of pricks on your back that I had back in 1996 at an allergist in the US. So, I went in to the phlebotomist again and she took a rather alarming amount of rather alarmingly large vials of my blood. This time, probably because I knew her name, Dr. M told me the results would take a week and I should call again then, during the regular telephone hours.

And that brings us ALMOST to the end of our story. I dutifully called a week later and talked to a woman doctor (not Dr. M, as she wasn’t listed among those available on the numbers to press that morning) who said that I was very allergic to birch, but not to milk or wheat (which had been suspects, as I often have a coughing fit after eating dinner). I had to ask if there were any signs of allergy to molds and she looked again at the results and seemed unsure whether the last one was a mold or not (it being listed by the latin name - apparently not covered in medical school?), but yes, it showed that I was allergic to it, whatever it was. I asked what the next step was and she started advising me to have someone out to my house to check for skimmelsvamp. And while I appreciate homeowner’s advice, I was calling for MEDICAL advice. When I pressed her on that, she made me an appointment to come in for a lung function test today at 13:45. Someone along the way had suggested that I might need a lung function test, so I guess she was covering all bases. But, here’s where it gets ever better...I show up today for my appointment and the machine in the lobby tells me that I don’t have an appointment. I ring the bell and ask when my appointment is and the secretary tells me that I don’t have one at all. Now, I grant you that I am not a native speaker of Danish (hence the writing in English, which I assume you already got), but I did not misunderstand this. And I did not fail to note it down correctly. I repeated it back to her and she verbally confirmed on the phone and I noted it in my calendar.

And meanwhile, I continue to cough. My conservative American friends are having a fieldday with the story on Facebook as they think it has all the symptoms of all of the ills of socialized medicine written all over it. But, I don’t think it’s a question of that, it’s a question of customer service, or an astonishing lack thereof. And a symptom of a system where I have never been assigned a doctor that is MY doctor and knows me, but instead get bounced around and “practiced” on by an endless array of one-time doctors. But I can tell you, as limited as my attendance in medical school was, it is NOT NORMAL to cough - really, really cough - for two months straight. Oh, and by the way, tho’ not a single person asked me along the way, I am NOT a smoker.

I’m very interested to see what happens next.


i'll keep you posted.

i guess there's a good reason why they call it "practicing" medicine. they're really just practicing.


Delena said...

Yes, my husband always says "he was a professional firefighter and expected to be while all doctors are practicing! Your health care fest is much like ours in Canada. Sorry about your cough....

Elizabeth said...

What a lovely soap-opera this is becoming. My prediction is that you won't get a reaction at all or a very short one after 6 weeks or so.

Still I keep my fingers cross for you they will find out what the problem is and the cure!

Tomika said...

Wow! I don't know you personally (but I love your blog) but I am outraged for you. It is rediculous that you have been treated with such indecency, and to still not have a answer for your illness. In today world I feel that we are forced to investigate for ourselves what medicine is best or worst for certain conditions or illnesses and you are paying these rude people to treat you this way. I can only suggest taking control if your health by writing down questions prior to your visit, demanding names of people you see and not allowing them to rush you out of their office. That's the only way to make them accountable for what they do and how they treat you. My prayers are with you on your quest to find answers to your questions and a plan to rid you of that cough.

poet said...

Oh wow, that's really bad service! I hope they take note of your letter and write you an apology at least. I also hope that your coughing problem gets resolved.

May I give some unsolicited medical advice anyway? As a person with allergies who has been doing asthma-prevention for the past 15 years or so, and also as the child of a medical doctor whose life work revolves around allergy prevention, I have to agree with the person who told you to check your house for mold and have the mold removed if possible - if it's a contributing factor to your cough, there's no way around it! This is, actually, part of some very sound and progressive medical advice. You should also check if there is a higher-than-average (or even just higher-than-good-for-you) particle density in the air at your home. I imagine this could well be since you keep bunnies and cats and regularly work with yarn and fabric and bake bread from scratch in your home. (Do you also have wood-powered heating or am I imagining this in my envy of your idyllic country life?) I think these are all fabulous things to have and do, by the way, so I hope this doesn't come across as judgmental in the least bit! But there are definitely lung conditions associated with baking, fabric-processing, and animal hair, so you should check if more airing / floor-sweeping / changing bedsheets more often helps. A friend of mine who has very bad hay-fever has to sweep the floors daily and change bedsheets once a week, and his wife has to wash her hair every night, during the times when there's pollen of the wrong kind in the air.

Also: I've done the self-diagnosing-because-doctors-didn't-come-up-with-anything-useful more often than I would have wished for, both in Germany and in the US, but I've only encountered the bouncing-around-with-several-doctors-who-don't-know-me-well in the US!

Also: Do not trust lung function tests - they will put your lungs under stressful irritation that is entirely unlike anything you encounter in real life. According to a lung function test I did when I was 14, I supposedly have mild asthma, but I haven't had a single asthmatic fit in my life either before or after that test, and my hay-fever is mild at best. So whatever happens, take it with a grain of salt.

I hope you get better soon, and in particular before birch pollen start flying!

Unknown said...

Oh you poor thing! Unfortunately we had a similar experience in the UK last year when The Husband had a suspected sarcoma (not that anyone was ever brave enough to utter the word cancer to us until long after the never-ending test results came back all clear). We decided that medicine is not a science, it's an art that many doctors are very poor at. Really hope you get some answers soon. xx

Unknown said...

Oh, forgot to say - I'm very sensitive to mold spores. In fact, as soon as I start wheezing and coughing I know there's a patch of mold/damp not very far away.

julochka said...

delena - i don't know why we don't insist on more professionalism! we need a medical revolution.

E - i'm also sure they'll just ignore it. but if they do, i'm going to write a more serious letter to the Region that's responsible for the health care.

Tomika - i will definitely be insisting on names of everyone from now on and writing them all down. where we lived before, we had an actual doctor that was "ours." i think i'm going to insist on that as well.

Poet - i'm SURE there's mold everywhere in this house and that's what's causing this - however, tearing it all down at the moment isn't an option. :-( we do have lots of animals, but only one cat is in the house and i tested negative for cat allergies. :-) i have been changing the sheets on a weekly basis (it's worse when the birch pollen comes). and my allergies have also been better since we got our own bees/honey. my sister sent some filter masks that i'm going to try. and thanks for advice about lung function tests! it's yet another thing that hasn't been explained to me in the least - neither the purpose nor the procedure. :-(

eggdipdip - where did we get the idea that doctors are all-knowing? they quite obviously are not! and as for the mold, i'm sure that's at the bottom of this.

Tracy Golightly-Garcia said...

Hello Julie

Sorry you having to go throught this. Ask your dr about a z-pack. It seems to take care of everything!

Hope you get over this soon.

Tracy :)

celkalee said...

I am so sorry this is still going on. As you suspect, mold may be a culprit. Are dear Husband and Daughter affected? Hope you find the answer soon.

Unknown said... sad....I am sorry that you are sick. I had a cough recently....and made a very strong ginger tea, out of sliced fresh ginger and hot water, steeped for at least 5 minutes, sweetened with honey.....I feel better...and hope you do too soon....smiles

Jody Pearl said...

It's a universal phenomena - recently had a similar series of unfortunate events occur here in West Australia.

Good luck with the letter and the cough - look forward to hearing the results.

j. wilson said...

oh no! two months? my cough was for three days and i was in tears due to the lack of sleep. i cannot imagine two months. i have debilitating allergies and the cough is so difficult to manage. while not a fan of the evil prednisone i take it so i can breathe. i do hope you get a swift response and that they figure out how to help you.

Elise Ann Wormuth said...

Wow. Great (but sad) story. Has anyone suggested pertussis (whooping cough)? I had that a couple of years ago and was *really* sick for five weeks -- not eight, but still . . . I thought I would die from all the coughing.

(long time no see!)

Sandra said...

I hate to ask this because it seems obvious that they would, but have you been checked for asthma? I have asthma and when it was out of control I coughed and coughed.

If they practice long enough, perhaps they will get it right. I really hope so.

Veronica Roth said...

Aarg, I would have strangled somebody halfway thru your post! With medical help like that hope you get better on your own. (Canada's not much better and I'm saying that being the daughter of 2 Dr.s)

Jasmine said...

Hi- (first time commenting, I found you on pinterest... oh the internets!)

I would thoroughly second poet's mold advice. If there's spots that mold is visible a US paint product "Killz" is supposed to be amazing. Use it like a primer. It kills the mold. My mother swears by it, having lived in old houses in the pacific northwest (Seattle area) for years.

Specifically for the birch allergy (and especially since your own local - micro-region- honey helps) I would HIGHLY reccomend birch sap. Here in AK, I know many folks with birch allergies who have no bad reactions to it whatsoever because of drinking sap. Basically you tap your trees (like you were going to make myrup -birch, maple- when the sap is running in the spring). The sap will be thin as water. Freeze it - apparently ice cube trays work really well - and the next year, a couple of months BEFORE there would be any pollen in the air, start drinking sap daily. It lets your body super gradually build up antigens and tolerance and all that good stuff, without the violent reactions of get this out of my system now!

For more immediate relief, I imagine that coltsfoot grows in the woods near to you. (though you might have to wait until it leafs out) Coltsfoot tea with honey is the best cough cure.

Disclaimer: NOT a medical doctor! Just an amateur natural health geek.

Googled pix of coltsfoot for wood wanderings: