Friday, May 22, 2009

Strange Days

Swam at Nitro this morning but had to leave early for a meeting in Killeen. Shared a lane with David, Tom, Lynne, and James. Clint coached. The pool was set up long course.

1000 swim
800 pull, breathing 3/5/3/7 by 100s
600 kick with fins

This week we took my son to see his orthopedist for a follow up visit at Dell Children's Hospital to discuss possible reconstructive surgery on his foot this summer. He had had an operation at Duke in December of 2006 which we thought would be his last. Unfortunately, his foot began tightening up several months later despite ongoing PT. When we arrived in Austin, we planned to continue physical therapy but were told that we would need a referral from an orthopedist. He in turn told us that based on his experience he did not believe there would be any benefit from additional PT, but rather a second operation would be necessary at some point. He reiterated that in December and advised us to follow up with him in the spring so that we could finalize arrangements for surgery during the summer break. But after weeks of dealing with inefficient office staff who failed to return our phone calls, I finally contacted the orthopedist's nurse practitioner who scheduled an appointment for us. On Wednesday we discovered that the appointment had been changed without notifying us, so when we arrived at the appropriate time we found ourselves worked into an already overbooked morning.

Now here is where things get really strange. When the orthopedist walked into the exam room, he brightly announced, "Sounds like we need more physical therapy!" When I gently (no, really) reminded him of our prior conversations, he insisted that he would never have said such a thing. Then he proceeded to fill in the gaps in my son's medical history by asking us questions which we had answered during prior visits. At some point he admitted that he had not reviewed the chart before entering the room. Finally, thinking out loud he talked us through what he wanted to do surgically, seemingly flying by the seat of his pants. Before leaving, he assured us that his scheduling nurse would have the paperwork on her desk that afternoon.

When we called his office the following day to schedule the surgery as instructed, the nurse's voice mailbox was full, and we were told that she most likely would not be calling us back until after Memorial Day. She was so busy, in fact, that she could not come to the phone and tell us this herself. Because we had planned the entire summer around my son's surgery, trying to minimize the impact on the school year, I decided to call his nurse practioner directly to enlist her help once again. She seemed surprised and promised to look into the situation and call me back.

About an hour later I received a call not from her but from the orthopedist himself, chastising me for being rude to her and instructing me to apologize. He indicated that he could not go into a procedure under these conditions. He also informed me that he still had my son's paperwork in his pocket, that scheduling surgery can take a week or more, and that he most definitely had not told us that his office would have the paperwork that same afternoon. He admonished me to think about the conversation I'd had with his NP, with whom he'd worked for years and trusted implicitly.

Needless to say he will not be allowed to operate on my son. Having served on peer review committees throughout my professional career, I have frequently encountered impaired physicians or those with behavioral issues, some quite serious. Not uncommonly they lack insight into their problems. Nevertheless, dealing with such an individual as the parent of a patient is a very different and disquieting experience. I will advise him to seek counseling with little hope that he will do so.

3 comments:

  1. Craig - that's quite a mess you found yourself in. I think you certainly are smart to walk away from that fellow. Can you find other good orthopedists in Austin to help with your son's issue?

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  2. Thanks. I am impressed that you actually read this one. There is no shortage of orthopedic surgeons here, but we may look in Houston at Texas Children's. We are going to focus on PT over the summer and give my son a break after a tough freshman year in high school. Things happen for a reason.

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  3. Some day your path with this doctor will cross again and it will be interesting to see if his tune changes.

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