My life as a Malaysian doctor in the United States.
Tuesday, January 04, 2011
Sometimes, you just can't win.
I got a note from the front office today. One of my patients with Graves' disease was transferring care to a different endo. The reason was that "Dr. V insisted I had to take the medication (Methimazole) whereas this other endo suggested the radiation treatment..."
And so I looked back at my consult note. And saw that I had given her the options of I131, or antithyroids, or even surgery. And had reviewed each in detail with her, and suggested after she completes the confirmatory thyroid scan and uptake, to return so that we can pick a treatment option. I even printed out a patient handout for her outlining these options. Except she no-shows the appointment, and calls me wanting to discuss over the phone instead. And when I called her, she vehemently refused the radiation treatment, instead opting for a course of Methimazole. Except 2 months into it she stopped her meds because she 'felt better' but by her next follow up she was frankly thyrotoxic with a free T4 3 times above normal and I had to resume her meds. She then cancels the subsequent lab visit.
And so, here we are. Sometimes you just can't win. Whether it's because I didn't make myself clear, or she didn't understand, or just some other personality issues, I suppose I don't care to find out. Sometimes though, try as you might to explain things, and give patients the option of treatment choices, and things backfire, it does leave a bad taste in the mouth.
Good riddance, I say.