Help writing a scathing letter?

[Spiky Bugger]

AND I need it to be shorter than this! LOL

Right now, I’m cranky. THIS is all on background:
1–I have three broken ribs.
2–I have three veterbral compression fractures.
3–I’m anemic (infusions pending.)
4–I have arthritis...knees, ankles, hips.
5–I have SIBO/IBS-D.
6–I might as well add in that I need “big toe surgery,” cuz that hurts, too.
7–There’s probably other stuff, but I AM cute.

Current issue: UTI-type symptoms.
But with my urinary tract history, it COULD BE Interstitial Cystitis or even a kidney stone.
Also with my c diff history, we don’t just throw a Bactrim or Cipro Rx in my direction, because we could kill me.

It’s my PCP’s day off. (BTW, her specialty is infectious diseases, so she knows c diff.) I called and wanted a urinalysis and they said I could have a Nurse Appointment.

I go...and meet Melissa, an M.A. I ask her if she has ever heard the term “interstitial cystitis.” She has not. I politely demand an actual nurse. I meet Irene, an LVN. She hasn’t heard it either, but appears to understand when I explain it.

I say, “I need to pee in a bottle and I need to know how to get the culture and sensitivity results on Monday and a prescription if necessary. I ABSOLUTELY DO NOT need a prescription now, because with my history, we don’t guess which antibiotics might work. We just wait and know for sure. And with me...it might not even be an infection.” (And yes, I know that Macrodantin/Macrobid stay in the urinary tract, but I don’t know about other drugs...and the Macrobid is time release, so poo on that.)

Irene tells me that she will give my message to Cynthia, the nurse practitioner who will also read my file and order the UA. She leaves. She returns and tells me that Cynthia says I can choose either of two antibiotics.

I stare at her. I ask Irene if she reminded Cynthia that I have interstitial cystitis, a history of kidney stones and a history of c diff. “Yes,” she said and looked at her notes and repeated the important words.

I said, “I want her to order the UA.” Irene says that has been done...but wants to know which drug she should tell Cynthia I want.

I said that I would be an idiot to take antibiotics before I know if I have an infection and that it is IRRESPONSIBLE of Cynthia to offer those drugs. I used tbe word “irresponsible” three times. I just want a urinalysis and to know whom I contact for the results.

I think I want CYNTHIA to know how little I think of her professional skills.

Is that reasonable of me? What should I say?

 

[Sheanie]

Irene sounds like she is in over her head. My guess is she is young, inexperienced, or both.

And relaying info like they are, no wonder nothing is right.

Why is your file not notated that you should only be seen by the doctor or PA? (Someone with an understanding of your needs?)

I feel your frustration.

Its a good thing you're cute. Did you at least get a sucker?

 

[DianaCox]

I would write out pretty much what you wrote. Or:

Dear PCP,

As you know, my medical records with your office are replete with information regarding my history of IC, kidney stones and UTIs, as well as C. diff.

Yesterday, suffering again with urinary symptoms, I tried to make an appointment with you, but you were unavailable. I was instead offered an appointment with Cynthia. Since all I needed was a referral for a UA, because as we have discussed in the past, it would be IRRESPONSIBLE to prescribe an antibiotic to me without a C&S, I thought that was fine.

When I arrived at your office, I did not see Cynthia - I was foisted off on Melissa. After determining that she did not know what interstitial cystitis is, and demanding to at least see a nurse, Irene came in. After carefully explaining my medical history to her (she too was unfamiliar with the term interstitial cystitis), as well as why all I was there for was the UA, she relayed my message to Cynthia - and then Irene came back and asked me which antibiotic I wanted.

Needless to say, I am extremely disturbed by this medical encounter. As you know, I am quite fluent and informed about my own medical history, and I could not have been clearer about the limited purpose of my visit and the inappropriateness of prescribing an antibiotic without the results of the C&S. And yet with my medical records in her hands, and with my clear explanation to Irene, Cynthia tried to prescribe antibiotics anyway. A less knowledgeable patient would have taken that inappropriate prescription.

Please review this situation with the people involved.

 

[hilary1617]

Sue, I recently was researching a doctor and came across the following case - fortunately, I was looking at a different Dr. Senno! Perhaps some language in it may be of use: https://caselaw.findlaw.com/il-court-of-appeals/1716337.html

"...Dr. Fatoki testified the proper standard of care for prescribing antibiotics includes documenting enough information to justify a presumptive or definitive diagnosis of a bacterial infection, or documenting enough circumstances to call for the drug's prophylactic use against the development of a bacterial infection or other serious condition. He explained a presumptive diagnosis is based on the patient's medical history, patient complaints, and on the physician's objective findings from a physical exam and a definitive diagnosis is based on diagnostic test results. Dr. Fatoki explained the standard of care for prescribing antibiotics includes documentation in the medical record of the patient's medical history, complaints, physical exam findings, any test results, the diagnosis, and the treatment plan. Dr. Fatoki testified the physician must document enough information in the medical record to justify diagnosing the patient with a bacterial infection or using an antibiotic for a prophylactic purpose."

"Based on the lack of documentation in the medical records, Dr. Fatoki testified Dr. Senno provided grossly inferior care to these patients. Grossly inferior care, he explained, was care that was below the minimum standard of care necessary to treat a patient's medical problem. Dr. Fatoki also testified these antibiotic prescriptions were in excess of needs and created a risk of harm to these patients. A risk of harm presents itself when the potential adverse effect of the treatment outweighs the benefit of the treatment. Unnecessary antibiotic use puts patients at risk of developing a resistance to bacteria, explained Dr. Fatoki, and exposes patients to possible allergic reaction to the antibiotic. Dr. Fatoki did testify that an antibiotic has to be unnecessarily overused many times before resistance in a patient could develop. Care in excess of needs is care that is not necessary for the treatment of the patient, he explained, and Dr. Senno exceeded necessary treatment by prescribing antibiotics without any documentation in the medical records to justify a bacterial infection or prophylactic purpose for such treatment."

I'm so sorry for all of your suffering and hope you have rapid relief. Best wishes! Hil

 

[Spiky Bugger]

Sue, I recently was researching a doctor and came across the following case - fortunately, I was looking at a different Dr. Senno! Perhaps some language in it may be of use: https://caselaw.findlaw.com/il-court-of-appeals/1716337.html

"...Dr. Fatoki testified the proper standard of care for prescribing antibiotics includes documenting enough information to justify a presumptive or definitive diagnosis of a bacterial infection, or documenting enough circumstances to call for the drug's prophylactic use against the development of a bacterial infection or other serious condition. He explained a presumptive diagnosis is based on the patient's medical history, patient complaints, and on the physician's objective findings from a physical exam and a definitive diagnosis is based on diagnostic test results. Dr. Fatoki explained the standard of care for prescribing antibiotics includes documentation in the medical record of the patient's medical history, complaints, physical exam findings, any test results, the diagnosis, and the treatment plan. Dr. Fatoki testified the physician must document enough information in the medical record to justify diagnosing the patient with a bacterial infection or using an antibiotic for a prophylactic purpose."

"Based on the lack of documentation in the medical records, Dr. Fatoki testified Dr. Senno provided grossly inferior care to these patients. Grossly inferior care, he explained, was care that was below the minimum standard of care necessary to treat a patient's medical problem. Dr. Fatoki also testified these antibiotic prescriptions were in excess of needs and created a risk of harm to these patients. A risk of harm presents itself when the potential adverse effect of the treatment outweighs the benefit of the treatment. Unnecessary antibiotic use puts patients at risk of developing a resistance to bacteria, explained Dr. Fatoki, and exposes patients to possible allergic reaction to the antibiotic. Dr. Fatoki did testify that an antibiotic has to be unnecessarily overused many times before resistance in a patient could develop. Care in excess of needs is care that is not necessary for the treatment of the patient, he explained, and Dr. Senno exceeded necessary treatment by prescribing antibiotics without any documentation in the medical records to justify a bacterial infection or prophylactic purpose for such treatment."

I'm so sorry for all of your suffering and hope you have rapid relief. Best wishes! Hil

Oh, Hil!!!

I thnk I need to carry this with me at all times. Thanks so much.

 

[Spiky Bugger]

I would write out pretty much what you wrote. Or:

Dear PCP,

As you know, my medical records with your office are replete with information regarding my history of IC, kidney stones and UTIs, as well as C. diff.

Yesterday, suffering again with urinary symptoms, I tried to make an appointment with you, but you were unavailable. I was instead offered an appointment with Cynthia. Since all I needed was a referral for a UA, because as we have discussed in the past, it would be IRRESPONSIBLE to prescribe an antibiotic to me without a C&S, I thought that was fine.

When I arrived at your office, I did not see Cynthia - I was foisted off on Melissa. After determining that she did not know what interstitial cystitis is, and demanding to at least see a nurse, Irene came in. After carefully explaining my medical history to her (she too was unfamiliar with the term interstitial cystitis), as well as why all I was there for was the UA, she relayed my message to Cynthia - and then Irene came back and asked me which antibiotic I wanted.

Needless to say, I am extremely disturbed by this medical encounter. As you know, I am quite fluent and informed about my own medical history, and I could not have been clearer about the limited purpose of my visit and the inappropriateness of prescribing an antibiotic without the results of the C&S. And yet with my medical records in her hands, and with my clear explanation to Irene, Cynthia tried to prescribe antibiotics anyway. A less knowledgeable patient would have taken that inappropriate prescription.

Please review this situation with the people involved.

Plagiarized, with minor adjustments. It's always better when you write it for me. Thank you!

 

[Larra]

I was hoping DianaCox would get to this before me when I read your post. Knew she would get it right. My only concern is that the problem really isn't poor Melissa, or even Irene. You were foisted upon them just as they were foisted upon you. The problem was Cynthia, who should have either spoken with you herself or done a better review of your medical records. It's possible that she was overloaded with work in the absence of your pcp, and just hurrying through, but in that case she should have had you wait a little longer to get the right care.

 

[Spiky Bugger]

I was hoping DianaCox would get to this before me when I read your post. Knew she would get it right. My only concern is that the problem really isn't poor Melissa, or even Irene. You were foisted upon them just as they were foisted upon you. The problem was Cynthia, who should have either spoken with you herself or done a better review of your medical records. It's possible that she was overloaded with work in the absence of your pcp, and just hurrying through, but in that case she should have had you wait a little longer to get the right care.

Yes, I agree and I was as un-rude as possible to them. I figured that my combo of diseases was above their pay grades. But I always sound smart when DianaCox does the writing. (And my kid sounds smart when hilary1617 rewrites her stuff.)

I just got a response, but it was non-committal in terms of her throwing Cynthia over the hood of her car in the parking lot and slapping her silly...which would have been ideal. She hoped I was feeling better and reassured me that HAD SHE BEEN THERE, none of this would have happened because she DOES know my history.

I thanked her.

 

[k9ophile]

Talk about anti-climatic. I guess it's OK that she took the high and professional route, but seeing someone splayed over the roof of a car and getting slapped silly would be oh so more entertaining. I hope you fell better soon.

 

[JackieOnLine]

sadly, the reply could have been so much worse. so I am happy for you.

I always sound smart when DianaCox does the writing. (And my kid sounds smart when hilary1617 rewrites her stuff.)