Friday, October 19, 2012

Between 2 pill-prescription periods (3 months)

Interim between two pill-prescription periods (3 months)
Part III of "Complaint against Dr Alpha and Dr. Beta"
Christmas-Chanukah to Easter-Passover

Please recall that in my plan I see Dr Alpha only four times a year and that there is thus a three-months interim between visits (the maximum length of time I'm permitted before I can get the needed prescription renewal) -- tho additionally I may be required by him to go to the clinic for blood tests (at least three or four days prior to each visit before which a test result may be required). In my plan, I woud have a maximum of four blood-tests a year. On occasions that I don't have access to Alpha in the short time-period before I run out of the prescribeds, presently I have been trying to access Alpha's protégé resident Dr Beta. The uncertainty there is that Beta woud possibly refuse to give me more than 1-month of the pill-prescriptions, instead of the 3-months of prescribeds according to my plan (which latter is not frivolously designed by me but apparently the outer limit set by the Health Ministry's regulations). In other words, I feared being forced by Dr Beta to accept an excess visit to Alpha after just one month.

The fiasco of the diabetes opthamologist who wasn't

Annually, I'm supposed to see a diabetes opthamalogist to have my eyes checked. Since I coudn't repeat the mornings-only fiasco of the downtown Hospital's program for this speciality, I welcomed the later suggestion that I see Dr Eyeball in his office at 701 NorthSouth, in the early evening (in the late Autumn or Winter, this means traveling after dark, which I dread, but this visit was scheduled during the longer lasting light of summer). I had been to Eyeball's in-town office previously, by Dr. Alpha's arrangement. So, much more than a year later, Alpha suggested and arranged an appointment for me with Eyeball (who delights me by having a certificate of his membership in the Christian Medical Society on his office wall), and Alpha had a notice sent to me at home from Nameless Clinic, dated February 9, 2012 (I have this document). The particulars of the appointment: Dr Eyeball; March 21, 2012; 6:00 pm; 701 NorthSouth St; 6th floor.

I knew the way, knew the transportation variation (I have to change from the streetcar along EastWest to a bus north on NorthSouth, knew the time, and knew Eyeball's office location, it was right off the elevator on the 6th floor. I was there before 6 pm, the door was locked, and I waited. Every previous year, the door had been unlocked and patients seated in Eyeball's waiting room, with a receptionist. As the time drew on and the late-hours doctors and other professionals locked up their offices and left the 6th floor, and the cleaning staff continued its work, I stood there waiting, hoping. I checked the details of my notice from Dr Alpha via Dorothy Humperdinckel, Nameless Clinic Referral Office. Right day. Right time. Right place. No doctor Eyeball. No other patients. There was no chair in the hallway for me to sit down, and after my legs began to ache, feeling humiliated by this apparent wild-goose chase, and confused, I left and went home. A waste of my TTC carfare. A waste of my time. And a bitterly humiliating experience.

Subsequently, I tried to phone Dr Eyeball to find out what had happened. But Eyeball has two offices, one in-town and one out of town; he doesn't want people from one practice-location to phone him at the other, and has rigged incoming calls accordingly. So I stuck to trying to reach him at his downtown office, and never got a response to my effort to discover what had happened. My feelings of humiliation, confusion, and frustration kept recurring and growing. I remember wondering whether he had been in a car accident or had died before my appointment (I still don't know). But in the end, for me, this mishap is the responsiblity of Dr Alpha. I'm not in a position to question Dr Eyeball, nor Dorothy Humperdinckel at the Referral Office, nor Dr Alpha's own staff. The buck stops at Alpha – that's normative for responsiblity in bureaucracies.

The fiasco of the diabetes education team which isn't

In an earlier time, before this Interim between my every 3-months prescription visits to Dr Alpha at the Nameless Clinic, Alpha being unavailable (I think because of his late return from the Christmas-Chanukah 2011 vacation), I had had to see Dr Beta for my prescriptions, and in examining me, he had recommended that I see the Diabetes Education Initiative team in our building and affiliated with the Nameless Clinic (it serves patients of two clinics in same building). When I had last seen Dr Alpha (I believe I coud at that time get only a 1-month prescription of my medications from Beta, so I had to go in a month's time again to Alpha), a bit before February 9, I reconstruct -- I mentioned to Alpha that I woud like to try out the Diabetes Education Initiative's program that Beta had recommended to me, tho I didn't have a ghost of an idea what that program entailed. Alpha agreed to sign me up with DEI (it was not his idea, but Beta's). Why Alpha neglected to inform me of this opportunity, I guess we'll never know. In any case, I explicitly and carefully told Alpha that I needed an appointment in the afternoon, so as not to be sabotaged by my multiple sleep-disorders condition.

Well, in due bureaucratic time, I got a notice from the Diabetes Education Initiative (I have a copy of this document) telling me to come in for a first visit, bringing with me all sorts of personal diet analysis and my Glaucometer. I sent word back to them that I coudn't make any morning appointments because of my sleep-disorders and that I didn't have a Glaucometer, and didn't even know what one was. They responded most graciously by phone (I think) and said that they hadn't been notified by Dr Alpha of the time-of-appointment restrictions I was under because of my severe sleep apnea, or that Thursday is my one day for a shower. They hadn't received any information to that effect from Dr Alpha. They said that I didn't need a Glaucometer, and the troubling notation on their mailout to me was for those particpants in their program who already had such a device. I woud be given one! Praise the Lord!

Trying to schedule with a doctor inaccessible, the phantom of 410

Then along came the end of the interim and the recurrence of my need for a 3-month renewal of prescriptions for my medications. As bad luck woud have it, Dr Alpha's Easter-Passover 2012 vacation woud play out for me like his Christmas-Chanuka 2011-12 vacation. As the end of my period of medications loomed, coming soon after Easter-Passover, I got on the phone to make an appointment for some time in the next week. I was incredulous to learn for the first time that Dr Alpha not only had a huge backlog of patients already anxious to see him due to his extended absence, but nevertheless that he wasn't available on Wednesdays at all. That floored me! My position is that if he insists on taking these long vacations, he coud at least be available on all five days of the workweek. But actually, his arbitrary arrangement and inaccessibility meant that I had only 3 days of the week in which to see him, as Thursdays are the days for my weekly shower day, when a home-care person comes to my apartment and helps me with my shower, during which all the ointment on my diabetes-dermotosic legs peels off into the drain due to the hot water, necessitating that I sit for several hours after the shower and let my legs dry out thoroly -- before I can effectively begin the application of a new layer of the ointment, and continue to build up Thursday's first layer daily during the following week until the next Thurday shower day; having the function of a “second skin” as diabetes-dermatosis on the legs means the tissue is very prone to ooze and bleed if it is scratched, nicked, bumped on furniture, etc. Fear of getting gangrene and having my legs cut off, as happened to my cousin Margaret, is a haunting factor of my diabetes. Other than the dermatosis, I have no apparent symptoms of diabetes – unless you count the unapparent scientifically-determined blood-tests as a symptom. I subjectively experience my diabetes only thru my dermatosic legs.

So, from my side, I have only Monday, Tuesday, Wednesday and Friday in the mid- to late-afternoons  to see the inaccessible doctor Alpha, while Alpha (I was being informed) is not present at all on Wednesdays – from his side, he condescends to be present only on Monday, Tuesday, Thursday, and Friday – because he likes long vacations and nevertheless takes Wednesdays off from his patients list, thus herding us hapless patients into lengthy queues, and forcing us to compete to see him, and forcing himself to operate fast and mean in one of the cruellest forms of Taylorism about which I know (I've done a lot of study of Taylorism; see especially Maarten J. Verkerk, Trust and Power on the Shop Floor: An Ethnographical, Ethical, and Philosophic Study on Responsible Behaviour in Industrial Relations, Eburon, Delft, 2004). Alpha has expressed his own exhaustion to me, treating so many patients in one workday, with few breaks when he is on the shop floor. And I can't penetrate this industrial-relations medical practice which wants to treat on a one-size-fits-all basis as we patients come down the assembly line. My overall health situation requires some small latitude on the four days in a year when I need to see the doctor for the timely renewal of my prescriptions. The first-come-first-served system works against my health and well-being – but I only need a small consideration four times a year. I woud dearly love to be seen promptly in the time just before my prescriptions run out, as I don't like to make appointments far in the future and then find myself not able to keep them. In Canada we accomodate everything, but Dr Alpha can't accomodate the exigencies of my medical situation and send/get notice to me when my pills are running out, quarterly. Or, receive me cheerfully, when I just show up, as he knows I'm willing to sit and wait for hours shoud my mood swings prevent me from another course of action in getting to see him. Further, I don't see any announcement or receive any phone call or email or letter in regular mail when Dr Alpha plans to leave a day early and then arrive days after the clinic re-opens – which all leads to no-dates-available, queuing and competion among patients for a suitable appointment time for each of us. Alpha and Nameless Clinic have options and can make exceptions in difficult cases, but they seem to manage creatively only on behalf of the staff, not the patients some of whom may have special needs. A few technical work-ins on the expensive computer system that they use (apparently only for their own needs), and can't deploy that system to notify patients when a doctor foresees being inaccessible. Technology is only for the scientists and staff it seems at Nameless. Somehow the patients' needs to know the upcoming schedule just don't factor in.  And I sense that doctors just don't want to be tranparent about their schedules.

So, Easter-Passover 2012, trying to get an appointment and failing to do so, floored by learning Alpha wasn't available at all on any Wednesday, while he goes early on vacation, and comes back late several days after the clinic has re-opened – which leaves me with only 3 afternoons in the weeks of needing my medications renewed 4 times a year (3-month prescription periods) – so, I phoned back the Clinic and scheduled another appointment, this time with Dr Beta. After I made my appointment with Beta, I receive a telephone call from a clerk saying Alpha will see me after all on Thursday. As tho he can dictate to me the precise date on which I can't come in, and at 1 o'clock instead of 2 or 3 or 4 or 5. He knows full well that my Thursdays are resevered for my bath, at least I told him so when I made the arrangement. He doesn't seem to know yet what dialogue and accomodation is all about with a patient with a complex illness like mine. So, the next unsatisfactory appointment was with Dr Beta, a resident under Dr Alpha's supervision.

— end of part III — conitnued on Part IV, "Appointment with a neophyte stand-in"

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