The Medical Maze

By staff June 1, 2005

This "Top Doctors" issue, which includes medical researchers Castle Connolly's listing of the best local specialists, always generates inquiries from readers; and after trying to help my mother navigate a recent medical crisis, I know why.

We all realize that finding the right doctor can mean the difference-literally-between life and death; and most of us know exactly the kind of doctor we want to find-a brilliant diagnostician who has the kindly twinkle of Robert Young in Marcus Welby, M.D. But what do you do when you find out you need a specialist-and fast?

David Higgins asked experts that question for our "Top Doctors" story, and they had good advice: Check credentials, ask other patients, then meet with the doctor to see if you click. But as Mom and I found out, a real-world search isn't necessarily like that. The problem, as Sarasota Memorial Hospital's Lynn Cassan told David, is that Southwest Florida physicians are so busy that many aren't even taking new patients. And I can now testify that even those who are may be booked solid for months, and it can take weeks to score an appointment-and then you end up with the physician's assistant.

Except for severe osteoporosis, my mother, who lives in Fort Myers, has been remarkably healthy, although recently she's started to feel tired every afternoon. And she's such a positive thinker that my brother, David, says she's the only 84-year-old he knows who's interested in long-term real estate investments. But when she recently needed minor surgery, the anesthesiologist said her EKG was abnormal and might indicate she'd had a heart attack. I remembered an article we did about the silent signals of heart disease in women, and suddenly, her recent fatigue seemed like a warning sign.

"You have to call your doctor today," I told her; and she did, making her way through the phone system and leaving her message at the proper extension. After waiting at home for the next few days for a call back, she wrote a note and delivered it in person to the doctor's office. Still no call back-and now, whether it was heightened self-awareness or something more serious, she thought she was feeling little "pulls," as she called it, to her heart. When she phoned again, the nurse told her, "I was making calls back last night but I didn't want to bother you during dinner."

The nurse told Mom to call a cardiologist whom she'd seen for a routine check in 2001; but the cardiologist's nurse said enough time had elapsed that she was considered a new patient, and they'd get back to her if the doctors would agree to see her. I finally called myself and reached a helpful nurse, who spent half an hour trying to work us in and finally managed to book an appointment-with the physician's assistant-in three weeks. I wondered aloud if I should just take Mom to the emergency room, and the nurse said, "If it were my mother, I would."

I told Mother I was on my way down to take her to the hospital, and she decided to call her primary care doctor one more time; miraculously, a nurse answered and agreed to fit her in that afternoon. We waited in the icy, vast office for hours, surrounded by other patient seniors, until the physician's assistant finally appeared-a pretty young woman, chirpy but distracted, who kept calling my mother "dear" and snapped into total focus only when she began recounting the plot of a made-for-TV movie she'd seen the night before.

But she did order an immediate EKG, and after disappearing for another hour, returned to say there was a problem: The physician had compared it to one they'd done several years ago, and it looked completely different. She ordered a stress test, and we asked for copies of both EKGs in case they didn't get them to the test site in time. That night, Mother looked over the EKGs and discovered why they looked so different: One belonged to a 41-year-old woman with the same last name as hers.

We finally did manage to get an appointment with the cardiologist, and when the big day arrived, we waited eagerly until the door opened and the great man himself walked in. At this point, the experts say, you should interview the doctor about his experience and office practices, listening carefully to decide if you're the perfect fit. But after struggling for weeks to get this meeting, would anyone with an urgent condition really dismiss the doctor and start the search all over again?

The doctor sat down at a desk, his back to us, and announced that her primary care physician had not sent over her records (despite Mother's calling to remind them) and he could not interpret the stress test, since another doctor had ordered it. Besides, it didn't even have Mom's name on it, so how did he know it was hers? When I pointed out that it did have her exact date of birth, he reluctantly consented to take a look. He told her that although her EKG was "funny" and she had a "left bundle block," the stress test looked normal, so it didn't make sense to do more invasive tests. Confused, we pressed for more details. Did this mean she wasn't at risk for a heart attack? He couldn't promise that, he said: "After all, she is 84."

To be fair, the conversation improved after that, and he did change her blood pressure medicine and prescribe an additional test. But it was not until I looked up "left bundle block" on the Internet that I understood what I wished the doctor had explained: Her condition, though not dangerous in itself, can indicate underlying heart problems, especially in older people. And though my mother may be 84, she intends to do everything she possibly can to get older. So after doing some research, including reviewing Castle Connolly's regional list, we now have an appointment for a second opinion, at a hospital rated one of the best in the region for cardiac conditions.

I know doctors and their staffs are often overwhelmed, and they did manage to see my mother and may even have done everything that should or can be done for her. But the process was baffling and frustrating, and could even, I suspect, be fatal to those with critical problems. If I've learned anything from our saga, it's that it takes determination and research to get the care you need. Our "Top Doctors" story can't cure patients or the system, but we hope it will help you with your search to maintain and enjoy good health.

Filed under
Show Comments