A Modern Tragedy

A completely avoidable misunderstanding, made possible by a design flaw and human error.  The first party did exactly the right thing, the second party was continually misinformed, by day seven both parties were right to be indignant, both parties were right to think the other a complete asshole.  It took seven days for these things to shake out, once the truth became clear, and it is a modern tragedy completely of the digital age.  The whole ugly thing could have been avoided, but for a failure of technology (and, failing that, human follow-up).

When I was fifty my mother and Sekhnet ganged up on me to make me buy private health insurance [1].   One of the first doctors I saw was wiry a young urologist who introduced himself, with a firm handshake, as Matt.   He looked at my records, smiled and said “fifty years young.”   He was probably thirty-one at the time.   Matt was very good about returning an email.   If I had a concern or question I had his return email within a very short time.   This alert responsiveness to a patient’s concerns is an excellent trait in a caregiver.

Five weeks ago I had a single two-day incident of gross hematuria, blood in the urine (with clot).   The second day I painlessly passed a soft blood clot half the size of a Q-tip and that was the end of the bloody urine.   I went to Matt’s office and had a CAT scan and blood and urine tests at the end of October.   My last test was a cystoscopy (google it) on November 8, when I would also get the other test results and some medical insight, but the cystoscopy had to be postponed at the last minute, for a legitimate, unforeseeable reason.   My new test was scheduled for a month later.   I wanted to know the results of the CT scan and other tests, to know if those tests had ruled out the possibility the hematuria was a final symptom of late stage bladder or prostate cancer.

When the cystoscopy was rescheduled I called to ask Matt the results of the previous tests.  His receptionist told me he’d get right back to me.  When I didn’t hear back, I called the following day and the receptionist expressed surprise, told me she’d given him the message, that he was very good about getting back to patients.   I called back twice more over the next few days and on day four I asked for Matt’s email address to follow up (my last email to him was maybe ten years back and they’ve changed email addresses).  I was told they don’t give out personal email addresses for doctors.  I persisted and was reluctantly given the email address of  the director of the urology office.  She would forward the message to Matt, which was better than nothing.  I sent a detailed email.  I knew once Matt read the email he’d get right back to me.

On the fifth day, still having heard nothing, I was connected to the director of urologic delay who told me she wouldn’t be able to forward the email to him until two days later, when he was physically in the office.   This was some kind of semi-rational but inviolable protocol at the corporation that employs Matt.   When she told me this I restrained a snarl and told her to keep in mind that the next step for me, if I didn’t hear back two days later, was filing an ethics complaint.

In the late afternoon of the day the email was supposed to have been forwarded to Matt I found the number for the Patient Services Administration.   The woman I spoke to placed me on a long hold to speak to the urology department.   I hung up and waited for her return call, which came a few minutes later.   I was promised a call from her supervisor, probably the following day.    A few minutes later I got a call from Matt’s receptionist, telling me the doctor wanted to speak to me.   She put me on hold.  After a minute or two on hold I hung up.  Matt called back, but his number kept coming up “Scam Likely” on my phone and I ignored the first couple of calls.  Thankfully, he persisted.  

He was plainly aggrieved, since he had already done exactly what any patient would have wanted him to.  He didn’t know what was the matter with me, why I was threatening an ethics complaint.  An ethics complaint, seriously?   He told me he’d left me at least four messages since day five, the first time he’d heard that I’d called.  He had all the date and time stamps of his calls on his phone, in case I needed proof that he’d called me numerous times.   He then made an excellent, very cogent argument defending his behavior and questioning mine.  

I told him I’d had only one missed call from “private”, early in the morning of day five, but no message.   I get notifications of missed calls and I’d had only that one.   He told me that I need to learn to use my phone, because he’d left at least four voicemails.   He told me I should perhaps get a “second opinion” from another urologist.   He was clearly hurt and pissed, felt unfairly attacked.  We patched things up, he told me the tests had come back fine, gave me his email address (in violation of hospital policy, he noted), and we said goodbye.

There is a known issue with voicemail on my phone that is now also known to me.  It is known to Samsung, who makes my Galaxy S-8 phone, and known to T-Mobile, the company that provides my cell phone service.   It is impossible to get notification of new voicemails, somehow.   Frustrating, yes, and there are youTube videos and user forums about it, but nobody, including the tech experts at either company has a solution.   I spent almost two hours with experts at both companies and searching the web.   You can’t fucking do it.   Unless you periodically check for voicemail you have no way of knowing if you have any new messages or not.   I didn’t fully grasp this until Matt chided me for not retrieving his several messages.  I rarely check voicemail, most of them left by robots, because people who need to reach me send a text, an email or a WhatsApp and I get right back to them.

I went through my mostly robotic voicemails and found his first, not from five days after the postponed cystoscopy, as he’d told me, but from the moment I was supposed to have been having the procedure, less than half an hour after I spoke to his receptionist. He informed me that the CAT scan was fine, the urine cell test showed nothing suspicious, that to be thorough he needed to take a two minute peek into my bladder, but that there was nothing to worry about.   He said he knows how anxiety producing this kind of thing can be but that I should be reassured that the tests had all come back fine and there was no likelihood of a worst case scenario.

Now, a full week later, he was peeved because an insane patient, probably driven mad by unwarranted anxiety, kept calling, sent a controlled but clearly angry email and was escalating things in the bureaucracy and threatening to put him in front of an ethics board.    I was peeved because I kept being told that the doctor had my message and that I simply had to put my thumb back up my ass and continue waiting for his call.  

He was right to be peeved, since not only had he done nothing wrong, he had done the very thing you want your doctor to do, and he’d been compassionate in his message as well.   I was right to be peeved, because as far as I was being told by his staff, Matt was now simply acting like the bureaucratic, liability alert, ass-covering institution he works for and there was nothing I could do about it, except to stop bothering them.   Nobody I spoke to apparently even bothered to follow up with him until day five.  If his receptionist had talked to him the first time I called back, he would have told her to have the patient check his voicemail.  And — done.  I’d have left him a thank you note.  As it is I sent him an email clarifying and apologizing, though, based on what I was told every time I called his office, I hardly knew what else I could have done, given the information I was getting.

A modern day tragedy, seriously.   Each of us assumed the ubiquitous technology was working as designed, each of us assumed the other was acting badly.   The only saving grace that kept things from getting really ugly is that the doctor I was dealing with is a mensch, something that I also strive to be.

 

[1]  It was fairly expensive, even at the discounted rate for my low income, and my premiums increased by 10% to 20% every year, doubling within a few years.    I pay much, much less now under the Affordable Care Act.

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