June 29, 2017
There have been signs for a long time that the mainstream medical system in this country has lost whatever soul it may have once possessed: pediatricians “firing” patients who are not vaccinated according to the CDC-recommended schedule; doctors of all stripes denying what is right in front of their faces; the proliferation of iatrogenic (doctor-caused) illness to the point where medical mishap is considered the third leading cause of death in the U.S.; the continued push for pharmaceutical or surgical Band-Aids for the chronically ill to mask ever-increasing symptoms and side effects instead of a studied effort to seek out and address root causes. But I was personally rocked by a recent in-your-face example of the worst attitudes in modern medical practice.
A little backstory: Unlike many others with two copies of the MTHFR mutation that significantly reduces the ability to methylate when activated, I had no problem getting pregnant. In fact, between the ages of 37 and 43, I was pregnant four times and two of them went full-term. But one of those full-term pregnancies was my son Zane whose brief life story I have told before. Zane’s absence made me long for another child, and after a miscarriage at 43 I knew that time was running out. My regular gynecologist happened to also be a reproductive endocrinologist (RE), and in a last-ditch Hail Mary pass, we decided to take advantage of the fact that my insurance company would cover one round of in vitro fertilization (IVF).
After significant drama (a story for another day), coupled with a whole lot of negativity on the part of my doctor (“You’re not responding to the drugs,” “Successful pregnancies in women your age are very unlikely,” “You’ve got eight eggs, but don’t expect them all to mature”), I blew away all their statistics and expectations with a BFP (“big fat positive” pregnancy test in infertility circles) that became my BBB (“beautiful baby boy”). You may not know this, but an infertility practice lives and dies by its success rate. While it’s impossible to know which factors contributed most to my results, it’s likely that at least some of it had to do with the sort of person—and patient—I am.
Fast forward eight years (in which I, thankfully, spent very little time in gynecologists’ offices) to November of 2014. At that point, even though I was still menstruating semi-regularly, I knew I had to be knocking on the door of menopause. I had a funky cycle with extra-long bleeding—I don’t remember the details, but I think it was on the order of two weeks. A tiny bit concerned that it might be cancer, I decided to get it checked out. My previous visit had been with my original RE’s partner who was more personable than my original doc, so I was happy to continue with her. She said she couldn’t tell much with a simple sonogram, so I should come back for a sonohysterogram, also known as a “water sonogram”—a more involved (and expensive) procedure that should allow her to see more. At that visit, she told me that I had uterine polyps. Polyps aren’t generally serious, but since I was having symptoms, someone from her office would call and schedule me for a procedure to have them removed. There was no discussion about other options or how I felt about having said procedure.
Of course, I immediately looked up any information I could find on uterine polyps and found, as I had suspected, that polyps are common in perimenopause due to hormonal fluctuations. They can lead to cancer in a very small minority, but in the absence of symptoms, there is generally nothing to worry about. That was an argument for “wait and see” in my book, especially when I didn’t hear from the doctor’s office for a couple of months—a couple of symptom-free months, I might add. If I’m remembering correctly (and frankly, this is all so long ago the memory is dim at best), someone from her office finally called to say that the doctor had scheduled my procedure for some time later that week. I think I legitimately couldn’t make it at that time, but more importantly I didn’t think I really needed the procedure at all, and my insurance company was already hassling me over the cost of the sonohysterogram. I believe we left it that I would call them to reschedule. Since I experienced no further symptoms whatsoever, I completely forgot about it and never did call to reschedule.
Imagine my surprise when in April of 2017, more than two years later, I received a phone call from her office that went something like this:
Her: “Hi, this is Angie from Dr. So-and-So’s office. You remember that procedure you were supposed to have back in January of 2015?”
Me: “Yes . . . ?”
Her: “Are you still interested in having that done?”
Me: (laughing) “No, I’m not. But thanks for calling.”
The following month, on May 23, I received this letter which was stamped “PERSONAL” and “CONFIDENTIAL” and postmarked May 20:
April 21, 2017
Dear Ms. Otoole [might be nice if they got my name right],
I am writing to inform you that I am withdrawing from providing further medical care for you because you have persisted in refusing to follow my medical advice and treatment, which I feel places you at risk of serious consequences to your health.
Because your condition requires medical attention, I suggest that you place yourself under the care of another physician without delay.
Failure to do so could result in a worsening of your condition.
I will be available for the next thirty days (from the date of this letter) for emergency care only. This should give you adequate time to select a physician from the many competent physicians in your area.
Upon your written authorization I will furnish your new physician with information regarding your treatment while under my care and a copy of your medical records. If you require emergency care prior to locating a new physician, please contact the nearest emergency department.
Dr. So-and-So [not her real name]
(The emphases are mine.)
I’m sure you can imagine some of the thoughts I had upon reading this. This is how I responded:
Dear Dr. So-and-So,
On May 23, 2017, I received your letter dated April 21, 2017, ejecting me as a patient from your practice. I have to say that I was surprised and highly disappointed, not because I will no longer have you as a doctor—at this point, I have little need of gynecological care—but because your letter is a crystal-clear example of so much of what I believe has gone wrong in the medical profession in recent years. I find that quite sad as I thought you were a cut above most of the medical doctors I have encountered in my lifetime.
I went to you in the first place in order to rule out major problems—mainly cancer—and that’s exactly what you did when you performed the sonohysterogram in November of 2014. You also provided a diagnosis and recommended another, more extensive, procedure, involving a hospital and anesthesia. At no time did you ask how I felt or what I thought of the suggested procedure or “condition”; you merely said your office would be in touch to schedule it. I, as an intelligent and curious human being, immediately learned as much as Google could tell me about “my condition.” I found out that it is generally caused by fluctuating hormones, most commonly in women who are close to menopause. At nearly 54, I was clearly in that category. I also found out that this “condition” does not require treatment at all if there are no symptoms.
Your office didn’t get back to me for quite some time. I have a vague memory that someone called with a date two or three months later. If memory serves, and I’m not at all sure it does, whatever date I was given was impossible for me. But more importantly, by that time I had reservations about doing the procedure at all. I had already had at least one, and probably multiple, normal periods. In addition, I had been hassled by my insurance company about payment for the sonohysterogram that you had already performed. I knew if I did go through with the intended procedure, they were likely to give me a hard time about paying for it. As a single mother with two kids to feed, clothe, and shelter, I couldn’t afford a protracted battle with my insurance company over large sums of money, especially if the procedure was not medically necessary. So instead of calling your office back to schedule the procedure, I waited to see how I felt. And as I continued to feel fine, I forgot all about it. Your office did not call again.
Imagine my surprise then to receive a phone call more than two years later from your office asking me if I wanted the procedure done. Given the laughably low level of follow-up, I naturally assumed your assessment of “my condition” was essentially the same as mine. Imagine my further surprise then to receive a letter warning me of “serious consequences” because my condition “requires medical attention” “without delay.” To which I have to say, if I have such a serious condition, why did no one mention it for more than two years? And why, moreover, did you then write a letter (with a 30-day expiration in it) warning me that I should seek medical attention “without delay” but wait a month to mail it? As there is nothing logical about this bizarre behavior, I can only assume that someone found my file on the floor or stuck between two books and realized that—as “my condition” hadn’t been treated—there was an open potential for liability there; thus, I received the obligatory CYA phone call and subsequent dismissal when I didn’t play along.
The woman who called didn’t ask why I didn’t want to do the procedure, and neither did you. I have no idea what assumptions you have made, but my reasons are entirely rational, which you would know had you treated me like a human being and asked. I have not had one single symptom since before that sonohysterogram in your office two and a half years ago. To me—your patient, the person who sought you out in an effort to heal—the benefits of the suggested procedure (essentially none) did not—and do not—outweigh any potential risks: infection, difficulty healing, large monetary cost, etc. On reflection, the meager possible benefits do not even outweigh the paperwork I would have to do. Moreover, I’m willing to bet you that if you were to perform the procedure, even you would decide that it was entirely unnecessary by the time you were finished. You see, I know my body very well, and I believe in the body’s potential to heal.
So without any attempt at understanding my rational, valid, and personal reasons for choosing a future course for my body that did not match your recommendation, you unilaterally decided you will no longer treat me because I don’t just do what I’m told—even if what I’m told is two and a half years out of date! I’m sorry, but that’s bullying, pure and simple, and such bullying—that does not even take into account the patient’s emotional, mental, or financial condition—has no place in a profession supposedly dedicated to the healing arts. Therefore, I have no regrets whatsoever about leaving your practice, even if it did figure strongly in the start of my son’s life.
I’m going to leave you with some food for thought. I have spent much of the past half century learning about how people heal and why they often don’t, and one thing I can tell you without a doubt: A healer must engage the patient in their own healing in order for treatment to be effective. That can only happen in a collaborative atmosphere. Medical procedures performed under coercive conditions are, understandably, interpreted by the body as assault. You may think that Cassandra Callender’s doctors were right to force her to undergo chemotherapy, but anyone who understands how healing really works (or doesn’t as the case may be) could see that her body and mind could only interpret such treatment as trauma, the opposite of healing. It was no surprise to me that Cassandra’s cancer came back, but at least now as an adult she gets to choose her treatment. As she put it,
“I am so sick of being treated like number and how everything is based off of statistics. I am a patient not a number.”
She is indeed, as are we all. Will she heal? Maybe, maybe not. But she has a much better chance with a practitioner who understands how healing works and will work with her rather than against her. Whether you doctors realize it or not, we the patients are the ones who have to live with the results of our healthcare decisions—not you. And we are all individuals who react to medical treatments—physically as well as mentally—just as individually. Therefore, treatment decisions must be ours to make, and no one else’s. I strongly suspect that if you were a patient in another doctor’s office, you would feel exactly the same way.
I don’t know if you’re aware of it, but there is a revolution afoot in the medical world. As more and more people find themselves living with chronic illness, there is a growing disappointment and disillusionment with the mainstream medical paradigm’s meager offerings of pharmaceutical-based symptom management and surgery. More and more people every day are calling for a new approach that addresses the root causes of illness. In addition, many practitioners have grown disillusioned as well. They became doctors because they wanted to help people get and stay well, and that just isn’t happening in the current paradigm. These practitioners are finding and communicating with people, both doctors and patients, for whom the dream has become a reality, and as a result they are modifying their practices in ways that bring them much more satisfaction. I write this in the hope—as much for your own sake as well as those of your future patients—that this letter triggers an evolution in the way you practice medicine going forward.
Editor-in-Chief of the Blog
The Thinking Moms’ Revolution
For more by Professor, click here.