Tuesday, November 8, 2011

Medical Bait and Switch

Just a few weeks ago, I used my medical group's walk-in service because of a nasty bout of bronchitis.

Little did I know the appointment would feel like a rollercoaster derailing, thanks to medical staff's unwillingness inability to communicate to their patients effectively.

As I was checking in, a receptionist said coldly and matter-of-factly, "Oh, and here's a sheet to read while you're waiting."

I simply couldn't believe my eyes.

The letter started off, "We are sorry to inform you that XYZ Partners has decided to terminate its contract with our physicians...You will end up being assigned to a new (different) [primary care] physician." The letter went on to say all I had to do was to contact my HMO and change my group number, and I would continue to have my primary care physician lickety split.

Oh, and I would also be assigned to a new hospital. Which means -- with the exception of my primary care physician -- all new doctors. All new specialists.

Now if I were a run-of-the-mill person with excellent health, I might not have had too much of a problem with this. But all I could think of was this: I would have to make a horrible choice: Get a new primary care physician and keep my gazillion terrific specialists, including my oncologist, or keep my wonderful PCP and venture out to a new hospital and all new specialists.

So I did the only thing I could do at that moment.

I panicked.

When I questioned an unhappy-looking staffmember -- who was not at all concerned about my interests, of course -- she raised her shrill unpleasant voice to me, telling me that it was not the office's fault that my hospital was dropping my medical group as a provider.

And then I raised my voice, blaming the medical office's staff for breaking the news this impersonal way. 

In a shaky voice, I then poured out my heart. I told them that I have had breast cancer and I couldn't just go pick another medical group, thereby ditching my specialists and interrupting my continuation of care. And the meanie plus her medical cronies looked at each other, then at me, and the unhappy staffmember had the nerve to say:

"We understand this is an inconvenience and continuation of care is important, but if you select the new group 123, you will have the same primary care physician."

An inconvenience?

And I continued, "What about my oncologist, my breast surgeon, my gynecologist? Do I get to keep them!?"

The staffmembers all said, no, but if I selected the new group 123, I would be so lucky to keep the same primary care physician and get a new hospital to boot. 

I could see the writing on the wall: I would have to make a choice between my primary care physician, who took great care of me for 14 years, or my terrific oncologist, gynecologist, et al.

So while I sat in the examination room stunned as a fly who had just been swatted, in comes a physician I didn't know. The first thing he said to me was, "Looks like you're sick of being sick." Yes, I was sick, alright -- but my bronchitis was the furthest thing from my mind.

He started examining me and -- I've never had this happen to me before -- he said, "Ooops, I am not sure if I am supposed to be examining you because we are changing hospitals. You might have to pay a lot of money for this exam. Let me check."

And with that, he exited the examining room and then came back saying the office manager was allowing me to just pay the co-payment due to my unique circumstances. He could proceed with the examination.

Oh lucky me.

That exam being done and prescriptions being filled, I sobbed on the way to my car. I already made the tough decision: I will have to say goodbye to my primary care physician and keep my wide array of specialists and my hospital. I cried with anger that nobody told me about this change in person or via phone. Instead, I felt as if I were regarded as an afterthought with that impersonal letter.

A few days later....

To add insult to injury, I received the same "Dear John" letter in the mail.

A few days later....

I got a letter now saying that my primary care physician "resigned" from the medical group.

A week later....

I made an appointment to see my primary care physician just to achieve closure. I wanted to tell her -- without crying -- how much she meant to me. I wanted to tell her -- without crying -- how I didn't want another primary care physician and start over with a general doctor who didn't know me. I wanted to see her one last time -- without crying.

Well, I didn't cry, but I told her all those things and how very upset I was with the situation. She said she was upset about it, too. She said, "You know, I consider myself a pretty good physician. But you have many specialists, such as your oncologist, and it is easier to replace a primary care physician than it is an oncologist. You have specialized needs, so if I were you, I would search for a new PCP."

I didn't have the heart to tell her that was what I decided to do -- even before our appointment. In fact, I felt better because I was able to lie to convince myself that she made the decision for me.

Now that I'm no longer reeling from the shock of it all, I will call my oncologist and ask for a recommendation for a stellar PCP. It is difficult to start over with any doctor, but that's life. Change is inevitable. Doctors retire, move to other parts of the country, are also victims of changing healthcare policies, and they pass away.

They are human like everyone else.

Achieving closure with my PCP was one of the best things I could've done. I had an excellent doctor, and speaking with her in person about my concerns and fears was a great move.

I can go forward. I am still scared of the prospects of a new doctor, but I am going forward.

I'm writing a book titled Calling the Shots: Coaching Your Way Through the Medical System. Please feel free to subscribe to this blog by clicking the orange subscribe button. I am a professional writer and have published numerous academic and magazine articles, as well as an essay on my breast cancer experience in the anthology Voices of Breast Cancer by LaChance Publishing. I can be contacted at bethlgainer@gmail.com and gainercallingtheshots@gmail.com.


  1. Wow, Beth.

    What an exasperating - and in so many ways - unnecessary experience. Everything you wrote about, especially the banal and grating, "SorryForTheInconvenience,"is something all of us have encountered in one way or another. That your needs and very real issues about continuity of care were an "inconvenience" for this staff, is an example of what is wrong with healthcare.

    Person to person, patient to patient - changing PCP is difficult and anxiety provoking. This partnership is essential for all, but especially for cancer survivors.

    And as a group of survivors, we need to continue to make our voices known and take back healthcare.

    And I hope you're cold is better. Thanks for writing. This is a really good piece.


    We need to take control back.

  2. Beth!!!!! This is utterly wretched!!! I'm so shocked & appalled, I don't even know what to say! Oh, sending you enormous hugs, my friend. This is just completely unforgivable all the way around. This is NOT good healthcare!

  3. Beth,

    I absolutely love your writing style! Your ability to pepper humor into a not-so-humorous situation is a gift.

    I'm so glad that you were able to get closure with your PCP. As you have said in the past, excellent doctors know other excellent doctors, and your oncologist has proved to be a fantastic gateway doctor for you. I'm sure he'll give you a referral to a stellar PCP.

    The medical system is so impersonal and I've had experience with horrific administrators as well, so I can totally relate to your situation.

    Keep on writing and sharing your experiences with us, and I look forward to reading your book one day. A publisher would be fortunate to take you on!

    All the best,


  4. Wow. I can't believe it. I went through almost the same situation yesterday. I had a moment where I lost control and let my frustration out of the girl that was setting up my appointment. I'm extremely upset that I'm basically being cornered to change my PCP. It is what it is. I hate that I have to start over with a new PCP. It means more shots, exams, questions, instability, and pain. I don't know how to feel about this anymore. Thank you for writing about this.

  5. Beth, what a frustrating and downright terrifying thing to have happen — the beautifully woven rug of specialists you so carefully cobbled together pulled right out from underneath you. OY!

    IMHO you made the right decision. Better to replace one "unknown" and keep many "knowns" than vice versa! ;-)


  6. Beth,
    With so many changes still to come with our nation's healthcare system, I fear the "Sorry for the Inconvenience" letters will become all the more prevalent.

    My mother has dementia. Even though she sees the same physician every time, she doesn't remember them, so it's like she's been abandoned all over again. To make matters worse, she openly criticizes them, turning to me with barbed comments as though they aren't standing in front of her. "I suppose this one thinks I like his clammy hands all over me," or "He doesn't look old enough to be out of med school. I want a real doctor!"

    After mother's visits to the doctor, I try and remind myself that the irritation works both ways: Doctors must be just as perturbed with some of us as we are with some of them. I do think you did a compassionate thing by going to see your PCP and not letting on. That was sweet.


  7. Jody,

    You are so right about cancer survivors being especially anxious regarding changes in healthcare. The attitude of the staff that day was really unacceptable and disrespectful to me. Yes, this "sorry for the inconvenience" excuse is not quite convenient for us patients.

  8. Kathi,

    Thank you so much for your empathy! You are so right about what happened to me as being wretched. It caused me so much anguish.

    Thanks, as always, for your support.

  9. Judy,

    You are so nice! Thank you for the compliments, and I hope my book gets out there. I'm working very hard on it.

  10. Mireya,

    You are welcome. I'm sorry you have to be going through all this, as well. It's easy to lose control, isn't it? I wanted to scream at everyone in my path that day, but I had to keep it under wraps.

    Hang in there. We have no choice, right? I hope you land a really good new doctor.

  11. Thanks, Renn, for your support. Yes, I also think I made the right decision. Your comment was beautiful; I especially took the following to heart: "...the beautifully woven rug of specialists you so carefully cobbled together pulled right out from underneath you."

  12. Brenda,

    You bring up an excellent point. All too often patients can be brutal to medical personnel. I'm so sorry about your mom, and it must feel very awkward when she disparages doctors right in front of them.

    It is no easy feat to be a doctor; you are right.

    In terms of my seeing my PCP, I really needed the closure. I think it was a nice final meeting between us, and she hopefully added that maybe one day she will be my doctor again. It may never happen, but I can only dream!!

  13. I'm so sorry that happened to you Beth. A good PCP is worth their weight in gold. You did the right thing under those circumstances. Your doctor supported the decision, even if they didn't know you'd made one.

    You are right - the treatment you received was totally unacceptable. They have no idea what it is to find yourself in circumstances such as yours. The lack of empathy is upsetting, to put it mildly.

    I wish you all the best in finding a great PCP. Asking your oncologist is a great start for your search.

  14. Chrysalis,

    Thank you for your supportive comment. You are so right about the value of a good PCP. And the lack of empathy is what struck me, as well. I know the office had no control over being dropped by my hospital, but staff members did have control over how they would break the news to patients.

    I'm so glad I asserted myself to them and told them that I didn't like being mistreated.

  15. Beth,
    Oh my goodness, isn't it crazy you and I are going through a similar thing and also both have blogged about it this week? Great minds as they say...ha.

    Seriously though, I'm so sorry your "termination" was handled so poorly. Mine wasn't handled very well either. I think you made the right decision. Finding one new doctor should hopefully be easier. Good luck finding your new personal care doctor. I had to find a new one a few years ago when I moved, and I like my new one even better than my old one. Somebody said (I forgot who) try to re-frame this as an opportunity for meeting someone new who will also have a new (maybe better??) perspective. Who knows? It's possible. Anyway, good luck, Beth. Keep us posted.

    Hope you are feeling better and that your daughter didn't catch what you had.

  16. Thanks, Nancy! Great minds really do think alike. It is a coincidence that we are going through the doctor-seeking phase together and blogging about it at the same time.

    The same holds true for you in terms of finding an improvement in care: maybe you will have a better oncologist than the one you have had. Who knows, right?

    I've been making phone calls all day, from doctor to insurance to doctor. I am sweating from the stress, even though I was all cool and collected.

    I am feeling better, thank you. Ari was sick, too, but less so than me, so I'm happy about that.

  17. So sorry, Beth. Cancer certainly complicates any thoughts of changing doctors or insurance. I had to go through hell trying to find new insurance when I finally had to switch from Aetna (the evil empire). For many years they had been raising premiums astronomically for individual policies. When they raised it 37% I could no longer take it. (Their expenses for medical costs had only risen about 12%. Yes, I checked their filings with the SEC. But I guess their executive raises of 67% had to come from somewhere.) Finding insurance that would let me keep all of my specialists and was affordable took a HUGE amount of work.

    I think you made the right choice. Continuity with your specialists is so important. It's difficult to leave any doctor that you like & have a history with. But starting over with an new onc/surgeon for followup would be terrible. Good luck!

  18. Thank you, Julie, for your support. I also think I made the right decision, albeit a painful one.

    I appreciate your input, and yes, cancer does complicate everything related to medical care....including finding good replacement doctors.

  19. What an awful thing to deal with! I'm guessing you were not the only unhappy patient, hence the staff's poor response, brought on no doubt by their own frustration to be in the middle of it all! May you go forward in good health!!!

  20. Thank you for reading my posting. Yes, I imagine there were many unhappy patients, and the staff must've felt like a broken record.

    And thanks for the good wishes. Good health is such a wonderful thing to strive for!

  21. Shocking, it illustrates very sadly that money, transactions and contracts seem to be given greater priority than healthcare. I have also also just lost my GP (the equivalent of your PCP I believe) because she has been sent to a new posting, but my situation was nowhere as traumatic as yours, and I was kept fully informed. Thanks for sharing and I hope you find a wonderful new PCP.

  22. Philippa,

    Thank you for reading and commenting. It is shocking, indeed, but in the grand scheme of things what you say is true about transactions and contracts being the priority. I think I am finding a good new PCP (fingers crossed). I hope you find a great GP in your search. I'm glad you were kept apprised of the situation.