Tuesday, June 22, 2010

the stone age

So I had my appointment with Dr. L/C (as I explained previously) and she told me (among other things) that femara is only prescribed for PCOS patients. Then I heard from several bloggers who have been prescribed it but do not have PCOS. Then I found an article explaining its ovulation-stimulating effects, having nothing to do with PCOS. It also sounds like it would have fewer endo-aggravating side effects than tamoxifen or clomid, just based on the mechanism by which it works.

So I sent an email, with a link to the article and questions about femara, as well as another question or two, to the info@ address for Tepeyac (the only address that Tepeyac will publicly admit that it has. But since this isn't the actual stone age and I'm an educated adult, I know that if you have any address that's "@mybusiness.com," you own the domain and an email server, and you probably have email addresses for all of your employees - though they may not be enabled, perhaps. But you could enable them).

I get that doctors don't get paid for time they spend on the phone with you; just time you spend in appointments with them. But, I have two important points to make about that. (1) That means that phone and/or email time is an overhead cost of the time they spend in appointments, and in any non-bankrupt business, overhead costs are built into prices. They can't bill my insurance company for the salary of their receptionist, either - and somehow they manage to work this out within the framework of their billing practices. LIKE EVERY OTHER BUSINESS. (2) If they cannot communicate thoroughly and accurately during appointments - or if, God forbid, they treat people in medical circumstances that require questions be answered sooner than two weeks (or whenever their next appointment opening falls), such as, I don't know, pregnancy or infertility - they need to suck it up and learn another form(s) of communication. I answer my Blackberry at midnight. While I'm not requesting the opportunity to call my doctor at home at midnight, I'd like the option of writing out my concerns in a nice email to which she can respond at her leisure.

But by "at her leisure," I don't mean "before I enter full-blown menopause." I sent that email last Tuesday, with an express request for the records gal (who answers the info@ address, as I have been told by a Tepeyac employee) to let me know if she could forward the email to Dr. L/C, or to let me know if this was not possible, in which case I would work on another form of communication. She has not responded. Not even a snotty "sorry we don't forward emails" response - nothing.

So last Friday I called the nurse's line and left a message inquiring about what had happened to the email and letting them know it contained fairly detailed questions about my medication. And...no response. I just called again. I think I'll also send another email, pointlessly inquiring after the first one...I'm debating whether the email should state that I know of other Tepeyac patients who have switched practices because of the communication issues alone.

I cannot believe a whole group of people can obtain medical degrees and residencies in their specialties and never learn how to use email along the way. Most five-year-olds can use email. What is the problem?


  1. Have you thought about going to see Dr. Steg.man? It's farther of course, I think it's like two hours from your area, but they definitely email! I've received emails not only from nurses but from Dr. S himself. You might even be able to ask to work with them by phone and email after a couple initial appointments if they know you're long distance.

    I had a hard time working with Dr. L/C. It seemed like she did the same treatment for all of us no matter how different our cases were (and, incidentally, I have PCOS and yet all she ever gave me was tamoxifan, month after month. It's definitely her drug of choice!!). So I understand your frustration.

  2. Sounds frustrating! I've never tried emailing a dr nor has any dr recommended doing that. I usually call...leave msg's and wait for an answer. I like your approach and I think emailing should be used for things that don't require immediate feedback (but feedback nontheless). Keep us posted on how this goes. If the dr isn't open to email...then they should inform you of that and you do it the old fashioned way.

  3. This is interesting that they cannot reply to you in any manner of timeliness. Yikes.

    I actually sent an email to the Haagen-Daz company a couple of weeks ago to comment how much I liked their new commercials, just thinking that it might be nice for the people who make the commercials to know someone out there likes them. I totally did not expect a response, or if I got one, for it to be a formulaic email. But I got a really nice email from someone in their media department thanking me for taking time to email them about the commercial. It made my day.

    I know it doesn't compare to really needing an answer from your doctor, but if HD can email me back, your doctor can certainly email you about something as important as your health.

  4. Update: they called back and said that the email is on Dr. L/C's desk waiting for her to get to it. I assume that this was true as of 10 seconds before they called me, rather than last week when I sent it, but they didn't specify, and I decided to leave well enough alone for now.

    And, AYWH - I've made the decision not to go to Dr. S, or Dr. H, or anyone else out of state, based on my blanket policy that IF will not be my second career - I do not spend out of pocket for out-of-network IF treatment when I have good insurance, I do not travel outside my commuting area for doctors' appointments, and I do not take off work for treatment unless it is necessary to my global health (rather than to get me knocked up). I bitterly resent the substantial encroachments IF has already made on my life and my peace of mind, and I won't cede any more territory. If that means I lose opportunities for treatments that may be more successful statistically, then I am willing to forego them. Standard disclaimer: this is not meant to disparage the efforts of those who have made considerable sacrifices to pursue treatment. I am just not interested in doing so myself.

  5. I'm glad your email is at least on Dr. L/C's desk. I can understand your thoughts on IF treatment, but at least you know that there are other options available if you change your policy. I hope Dr. L/C gives you a reply soon.

  6. That's one of the reasons I love Dr. Jen so much! She is available by phone or email anytime of day (although, obviously I wouldn't call her after hours unless it was an emergency, but it's nice to know I have the option) and responds promptly to any emails. In fact, I just got an email from her about an hour ago letting me know there was an appt. cancellation next week so I can move up my appt.
    Not trying to gloat here, but just point out that it is possible for a dr. to communicate with their patients! Of course, she has her own practice and does not accept insurance (she'll provide you the paperwork to get reimbursed though) - I imagine it saves her a lot of time on paperwork or bureaucratic stuff that she instead spends on her patients.
    In this day and age, a doctor should be available by email...end of story. At least a simple response like "please make an appt to discuss this" would at least be polite.
    Ugh. Hopefully dr. l/c gets back to you soon!

  7. Sometimes if you call the appointment line you can get some poor receptionist to feel sorry for you and transfer you to someone who is actually helpful. Hope your Dr gets back to you soon. That situation is sooo frustrating. Good thing you aren't a heart patient or something. It's ridiculous for RE's and OBGYN's to be too lazy or busy to answer a phone call or email.

  8. I'm actually amazed at how many people in positions of authority can't figure out a computer's basic functions on their own. Our Director is forever calling me into her office for help. I have no more IT education than she does (meaning none). What I know, I figured out myself. It's not that difficult. It appears, though, that they consider their time too valuable to waste a little of it figuring out something or other.

    Customer service also seems to be lacking in many doctors' offices. I hate being a pest by calling, and calling, and calling again until I get a response, but when they don't call you back, what else can you do?

  9. Of course you know my latest grief about not being able to talk to the doc on the PHONE, and I don't even have any delusions that they'd give me his (or his nurse's) email address! It's so frustrating. I applaud you for not making infertility your second career and establishing boundaries for yourself (and your sanity!)

  10. Yes, a frustrating situation! I guess I never connected it with the not being able to bill situation they find themselves in if you are not in their office. But still...they are moving to electronic records for patient files, you think this would be the next logical extension. I just read the update and I am glad that it got narrowed down to the Dr. as being the source of the delay. Even though, I don't think that makes the situation any better! :)