Faults & Foibles

Suicide Watch

Prescribing Suicidal Thoughts

Even before my wife was diagnosed with terminal cancer in 2009, my primary care doctor prescribed Prozac for me and then periodically ask me whether I had suicidal thoughts. I thought that was strange and wondered whether I was displaying some behavior that made me suspect. After 2009 I was asked more often whether I was suicidal and was referred to psychotherapists four times. This caused a lot of anxiety and I subjected myself to severe introspection in search of clues. I started thinking often about suicide. I wondered whether my doctor had experienced suicide sometime in his life and was obsessed.

I said, “If I were seriously considering suicide, I would never tell anyone. I would just do it.”

On his fourth referral to psychotherapy I had had enough. When the therapist asked me why I was there to see him, I said it was so he could reassure my doctor that I was not suicidal, not even a likely candidate.

After the first session with the therapist, he wrote a letter to my doctor to report that I was not suicidal and had no need for psychotherapy.

At my next routine appointment my doctor asked again whether I had suicidal thoughts. “Why are you still asking me that,” I demanded. “Because you are still taking Prozac,” he said. “Then I will stop taking Prozac, because I am only taking it on your recommendation,” I answered. “As long as you are taking it I am required by our standards of practice to ask you the question for our records,” he said.

Oh great, my primary doctor doesn’t think or care if I’m suicidal he’s concerned about malpractice insurance and corporate guidelines. At least now, I thought, I know he sees no suicidal symptoms in me and I can stop worrying.

DATA SCALE

 

For six years I took Pravastatin for high cholesterol, but my cholesterol level remained the same. When I began feeling terrible all over all the time with flu-like symptoms, I remembered the side effects of statins: muscular pain, tiredness and weakness. I was reminded that the drug was recommended for patients with multiple risk factors for heart and vascular disease.

When my doctor confirmed that I had no other risk factors associated with high cholesterol I told him I would stop taking Pravastatin because I believed it caused my symptoms, including a chronic dry cough. I said that after six months I wanted a blood test to see whether my cholesterol level was higher without statins.

When we looked at the blood test my doctor displayed a computer graph of my cholesterol test results, but it covered six years, not the last six months. It was practically a straight line. The tail end of the line, just one-twelfth of it depicted the last six months. I knew that a scale in years was useless for exposing moderate changes over just six months. Disappointingly, he didn’t understand the significance of scaling in order to read data correctly, nor did he know how to change the scale to display just six months.

Since my cough had subsided and I felt better now without statins, I said I would no longer take them. He advised me otherwise and I think he resented me refusing his advice.

I resented his lack of technical ability and scientific method in using data to measure the results of his treatment. He didn’t see the need to offer me proof. I now saw him as just another cheerleader on the statins-for-all bandwagon of big pharma. I do believe he was sincere, but misguided.

 

Whose Colon Is This Anyway?

Colonoscopy: Whose Colon Is This Anyway

For years I declined the colonoscopy my doctor recommended, but I never explained why because it would detract from the purpose of my current appointment. My choice for colorectal cancer screening was an annual fecal occult blood test. What annoyed me was that I had to request this test every year even though it was a viable and accredited means of screening.

One day a letter arrived from my MD’s practice touting the benefits of a colonoscopy and I decided it was time to fully explain why I continued to decline and end this harangue.

His reply was startling and disappointing because all of this time I thought he was concerned about my ultimate welfare and genuinely believed a colonoscopy was superior to my chosen screening.

Here is what he had to say that shed a new light of our relationship:

“My own chart notes have stated for several years that you do not want a colonoscopy. The letter (you are referring to) was sent out by our head office to all patients that, on computer analysis, did not have a colonoscopy. The computer is unable to detect that you decline to have one.

“Insurance companies and Medicare are auditing us on the percentage of patients having colonoscopies or sigmoidoscopies. If we fall below a certain percentage we may be penalized. Your refusal will not put me below that line!

“No problem.”

What might he or his head office have done, I wondered, if my declining were to put him below that line? And what kind of computer records fail to display case notes completely?

He said nothing about the eight reasons I had provided for declining a colonoscopy.

Back MRI

No News Is Not Good News

An orthopedic surgeon who operated on my back in August 2011 ordered a follow up MRI at the same time I was getting a left hip MRI to see if I had a hip joint fracture.

When I met with him he said the MRI of my hip showed I had a hairline fracture of the hip joint that would heal itself with rest. When he said nothing about the surgery site MRI I asked about it. He said there was nothing to report.

Having adopted the practice of reading all medical reports myself, I got a copy of the radiologist’s report from my primary care doctor. The report stated:

  • Degenerative endplate changes throughout the lumbar spine.
  • New left central disc protrusion.
  • New disc material appears to contact and displace the traversing left S1 nerve root.
  • There is new left central disc protrusion at L5-S1 which produces moderate lateral canal stenosis and displaces the traversing left S1 nerve root.

My primary care doctor, who received a copy of this report, also said nothing.

Since I considered my back surgery a failure because the symptoms that prompted surgery never abated, I was left wondering whether the cause was these new findings.