Health

I Got Fired by My Doctor

Exams that backfire

I wasn’t crazy about this internist who helped my husband through a kidney failure crisis in the hospital. I was grateful, but not particularly fond of his bedside manner, and this became more apparent when I too became his patient.

This resulted because I needed someone to monitor my hypothyroid condition and prescribe medication. And he was conveniently located near my house. Unfortunately he had a poorly run front office staff, and patients ended up waiting more than an hour before seeing him.

I went only two or three times to his office, and on this particular morning a medical student took my blood pressure, asked me a few personal questions, and basically left me alone to stare at the four walls.

While grasping for anything to grab my interest, I noticed that there were educational charts and brochures galore on topics ranging from heart disease to osteoporosis to digestive disorders. As an internist, this physician ministered to every organ and system in the body. Wherever I looked, I saw information: getting your flu shot, ways to lower your blood pressure, how to avoid diabetes, a skeleton exhibiting the bones in the body, a model of a chest cavity, etc.

The longer I sat reviewing these materials, the more I realized this Arizona physician had omitted key information pertinent to the Southwest — important data on both the CDC and Arizona Department of Health Services (ADHS) web sites.

Since I had all this time on my hands waiting to see the doctor, I wandered around the public area, making certain that I hadn’t overlooked a brochure on the only life-threatening infectious disease endemic to Arizona, especially virulent in what was known as the “corridor” area between Phoenix and Tucson.

If you haven’t guessed already, that fungal disease born in the Southwest and now migrating to Northwestern states like Oregon is known as Valley Fever. Classified by the Merck Index as coccidioidomycosis, this respiratory illness, which is caused by inhaled spores, has been spreading among Arizona residents, visitors, military, prisoners, and tourists for more than 50 years. And currently this disease is expanding to states other than southern California, New Mexico, and Texas due to climate change. The illness affects more than 200,000 people a year (70 percent of the cases in Arizona) with a great percentage of patients suffering neurological and organ damage and some of them dying.

Unfortunately doctors — even in Arizona — have been deficient in diagnosing cocci despite educational measures from the ADHS, the Valley Fever Center for Excellence at the University of Arizona (VFCE) in Tucson and the nonprofit Arizona Victims of Valley Fever (AVVF). That last 501c3 is an organization that I have helped direct for the past 10 years or so. The all-volunteer group holds fundraisers to help raise money for a vaccine or curative antifungal pharmaceutical agent, and we answer questions at health fairs and at our online site. Presently the disease has no cure or preventive vaccine.

At this time the only headway we’ve made is to help accelerate the development of a Valley Fever vaccine for dogs. Yes, dogs. Valley Fever infects all mammals, and dogs have been particularly affected, including my own. So I have a personal stake in getting out awareness of Valley Fever. AVVF provides help to people and pets. I’ve thoroughly indoctrinated my veterinarian on the subject and given him pamphlets.

Most Valley Fever patients, including canines, are misdiagnosed for at least six months-to-a-year before they receive a correct diagnosis since the symptoms (which include fatigue, headache, coughing, loss of weight, and rash) are similar to many other diseases in both people and pets. Even COVID.

To my way of thinking the doctor to whom I was paying a twice-yearly visit for bloodwork had omitted an educational function I deemed important. There was nary a brochure, a banner, or a handout on Valley Fever visible. It’s crucial that awareness of Valley Fever be carried out because it’s often misdiagnosed as pneumonia, cancer, or bronchitis, and treatment sometimes is delayed until the condition becomes severe. Seated in that exam room, I fumed over the absence of literature on the subject of Valley Fever. And the more I waited, the more frustrated I became.

So when this middle-aged Asian male doctor finally walked into the exam room, I politely inquired why he didn’t have any materials on Valley Fever since he had handouts on every other disease. He stopped in his tracks and looked at me as if he wondered what planet I came from. He said nothing, but his body language told me he was affronted by my question and did not deem it important enough to answer.

Next he inquired as to why I was there. I said I was there to receive a blood test to evaluate my thyroid level. He perused my chart while I sat uncomfortably given his sullen expression. It was obvious he was still mulling my question about Valley Fever. His manner had gone from cordial to cold.

I realized at that point that he took my question as criticism, which it really was if I were being truly honest with myself. I couldn’t understand why an internist practicing in Arizona where Valley Fever was as common as the common cold wouldn’t try to pass along information about a disease that had been declared by the ADHS as “Arizona’s Disease.” Although there was no preventive treatment, people could minimize their contact with the fungus by staying out of dust storms, wearing masks if they were gardening or on an ATV, and knowing where and how to get a Valley Fever skin or blood test. That information was packaged in pamphlets easily available from the ADHS, VFCE, and ADHS.

All this floated quickly through my mind while the doctor asked a few cursory questions about a mammogram and colonoscopy to which I responded in the negative. After a brief pause he said abruptly, “I don’t think you should be a patient here.”

I was so astonished by his matter-of-fact statement that I immediately became defensive. I sensed intuitively that as an Asian physician, he may not have the same enlightened vision of women that I craved in a professional. Maybe he was a chauvinist, even in this day and age, who considered women inferior.

My background in multi-culturism told me that an assertive female may have annoyed him and as a patient, I probably had no status with him other than as a receptive vessel to fill with prescriptions, prohibitions, and advice. He did not invite questions or critiques — that was obvious.

In fact while he was repeating his wish to end my tenure as his patient, he became a bit too talkative and leaked information about my husband that was downright insulting. He reminded me that he had “saved my husband’s life,” a fact immensely exaggerated since other hospital personnel were present, including EMTs and a urologist, during my husband’s crisis. Then he told me how my husband regularly bombarded him with so many questions that he had to allocate more time for him than for usual patients. I was amazed that his vanity insisted that he get back at me for my innocent question. I could do nothing but stare, my mouth agape in astonishment.

Then I did something I’m ashamed to admit. I started crawling back into his good graces by telling him how I appreciated his services to my husband. In the past we had thanked him effusively, but I figured he needed another boost, and I really wanted that script for thyroid medication! I also apologized for inadvertently insulting him about the Valley Fever omissions.

But he was not to be appeased. His mind was made up. He agreed to allow the phlebotomist to take my blood and send it out, but other than that, he was dismissive. Rude. He would send whatever records I needed to a new doctor when I found one.

So that was that. He turned around and with his back to me and his head held high as if he had performed a miracle of healing, he headed toward the door. He did not wish me good luck or good health or anything I could conceivably consider a friendly gesture. As I watched him retreat into the next exam room, I wondered if his next patient would be better behaved and less critical than me. I certainly hoped so since his personality and temperament told me he was not to be crossed.

The “firing” happened so swiftly I hadn’t had the chance to get angry. I started to blame myself — my default behavior during confrontations — but I realized I was entitled to ask a question that he might have considered unusual, and, besides, I had apologized even though I now regretted it.

By the time I gathered my purse and walked to the car, my anger had surfaced to the extent that I was throwing things around the car — my purse, my cell phone, my AVVF cards on which were printed contact info. I briefly thought about returning to the office and plunking down those cards in the waiting room. If people needed help with Valley Fever, they could contact me. I tabled that idea figuring the cards would be wasted since I was sure they would be tossed. I then wondered that if I sent some Valley Fever educational materials to his office, would he display them? Nah!

I doubted if either of those two educational methods would work considering this physician’s obnoxious response to my suggestion and his overall defensiveness. I could do one thing in this new world of social media. Yup, I wrote him up on Yelp, pointing out his delinquency in Valley Fever awareness and cautioning prospective patients about his lack of compassion. The only thing I omitted from the review was that this highly educated man with all the requisite degrees and certifications of a physician acted like an ass.