Connections: Dr. Who?

The urgency of having an ongoing relationship with a doctor

Jay I. Meltzer, a revered nephrologist and retired professor at the Columbia University College of Physicians and Surgeons, used to warn his patients, and I dare say still does warn anyone who will listen, about the urgency of having an ongoing relationship with a doctor. You need to know your doctor well, he always says, and your doctor needs to know you, especially when you become ill. 

I was reminded of this advice when my stepson Bob was stuck in an UpIsland hospital for four days, beginning last week, during which neither he nor his family could figure out who was in charge of his case: the emergency room doctor who admitted him, a surgeon, or a consulting gastroenterologist. 

Bob had wound up in this hospital not far from his home after symptoms of an undiagnosed complaint became hard to bear. It never is good to be sick, but it is absolutely awful to be stricken unexpectedly and wind up in a hospital you never heard of without a doctor you rely on. 

I don’t need to describe his condition, but standard tests — a C.T. or CAT scan, X-rays, blood tests — did not seem to provide good answers. It’s hard to be objective when someone you care about is suffering. In this case, the possible causes and potential treatments were described incompletely, and that added to the anxiety and unease. 

Worrywart that I am, I headed straight to the internet to see what the hospital’s ratings were. What I found out was scary. The hospital, and I quote, “reported 13 MRSA infections in 73,752 days its patients spent in the hospital between 01/01/2015 and 12/31/2015. This is 364 percent worse than national rates.” The hospital also reported 83 C. difficile infections during the same period, and the report said, “This is 57 percent worse than national rates.” This information came from Consumer Reports, which I have to assume is reliable. 

Checking further, I found that the Centers for Disease Control and Prevention has called C. difficile “an urgent threat to patient safety,” while MRSA infections, despite not always being serious, can be life-threatening. C. diff and MRSA? I really started to get anxious.

Despite the lack of any definite diagnosis, by Monday morning, the fourth day Bob was there, he was scheduled for surgery. The next thing we knew, however, that decision had been overruled by the consulting gastroenterolo­gist. The about-face and confusion were enough for Bob, his wife, and other members of the family to agree he should be moved to Stony Brook University Hospital. I had held off telling anyone about the Consumer Reports statistics until that morning, after hearing that the doctors couldn’t agree on surgery. On the fifth morning (actually it was the middle of the night), Bob was transferred, and as of this writing is being treated at Stony Brook, with reassuring results. 

All of this got me wondering what Dr. Meltzer might have to say about the Affordable Care Act and its imminent repeal. Not being able to select and keep the doctor of your personal choice has been one of the main bones critics have picked with Obamacare. Of course, with the new administration and the anti-Affordable Care factions in Congress still totally mum about what their alternative plans might be and how they could do better, we have no idea what the future of health care in America will be. 

One thing seems certain, though, and that is that the insurance companies, released from some of the Affordable Care Act’s rules and safeguards, will have more power to control our choices. I’m not sure this bodes well for maintaining long-term relationships with our physicians, but I’m pretty sure it is going to stir up a fair amount of anxiety and unease among the millions of Americans who might be left out of the bargain.