Wednesday, January 28, 2009

A Tale of Two Doctors

All doctors are not created equal.

That sounds so obvious, but it really hit home for me in the past couple weeks. I saw two expensive specialists, a neurologist and a cardiologist. They're both well reputed and came recommended.

The neurologist, Dr. P., is the one who sent me for the sleep study and then blamed my pain meds for my fatigue and sleepiness. Last week's visit was a check-back after being off narcotics for more than a month (actually, two months). My time with Dr. P couldn't have been more than about 5 minutes, during which time she went over an outdated list of meds I've taken over the past two years, asking me about five or six different narcotic pain medications I've tried. I'm not sure why my saying I'm off pain meds wasn't enough, but we went through the checklist, which included some meds I haven't been on since Fall 2007.

She asked if I was still sleeping a lot. I am. So she said I have idiopathic hypersomnia, which I thought we already knew. The whole appointment just left me shaking my head on why I bothered.

Then I saw Dr. John McAnulty, a cardiologist, last Friday. Wow. What a difference! His office fit me in fairly quickly after my internist got nervous about my recent fainting. I was in the office for over two hours, most of it with Dr. McAnulty and/or the fourth-year medical student who did the initial intake. And when they weren't in the exam room with me, they were brainstorming and consulting each other about my case.

I guess what blew me away was how warm and friendly Dr. McAnulty was. He radiated sincerity and sympathy, and was one of the few doctors I've seen other than my internist who really grasps how much this mystery illness has impacted my life. He actually apologized (!) to me that I've seen so many doctors and no one has been able to fully diagnose me yet. And he apologized that he, too, didn't think he had the answer for me.

[Side note: He is ordering an echocardiogram for me just to rule out that the inflammation I clearly have has not enlarged my heart and/or affected the lining of my heart. Both of those are risks for people with connective tissue autoimmune diseases. It's not that he thinks it's likely in my case, but he says it's been long enough since my last echo that it's worth looking since my symptoms have persisted. He's mildly concerned about my ongoing tachycardia, but says he strongly believes that any heart issues I'm having are secondary to my overall health issue. He ruled out POTS, but confirmed that my heart rate does go up even farther when I change from reclining to standing. He said that normally he would consider a low dose of beta blockers -- and he might anyway depending on what he sees at the echo -- but he says both my asthma and my low blood pressure are concerns with beta blockers. Oh, and totally off-topic, but he thinks I look like Jodi Picoult, one of my favorite authors. Since I think she's pretty, I did not complain about that comparison! Although I think it's mostly just a similar reddish tone to our curly hair that he saw.]

Dr. McAnulty is the first doctor I've seen that I left feeling almost a little sorry that my mystery illness didn't fall into his field. He just has the best bedside manner I've ever witnessed, and while I hope I don't ever need to see him regularly, I definitely know who I want to see if I ever develop cardiac problems.

The difference between him and Dr. P, who gave me a prescription for headache meds without explaining it to me at all, even that it would be a daily medication instead of something I took only when I felt a headache on the way, was just stunning.

Dr. McAnulty took the time to explain everything to me. He examined me closely, without rushing, and he took the time to really listen to my concerns and reassure me. I could see what a wonderful mentor he must be as he talked to his resident and medical student like they were, if not equals, people with opinions and insights he respected.

Dr. P, on the other hand, couldn't be bothered to look up the interactions of a stimulant she wanted me to try with my other medications. And I'm still a little flabbergasted that a neurologist wouldn't know that Ritilin, which has been on the market for decades, is a controlled substance and needed a paper prescription rather than being sent electronically. (There was voicemail waiting for me when I got home from that appointment telling me I needed to come back and pick up the paper prescription. Gee, thanks.)

If anyone needs a recommendation for a cardiologist in Portland, I've got one for you. Can't say the same about neurologists. If I need to see one again, I'm definitely not going back to Dr. P.

Meanwhile, the mystery continues.


Anonymous said...

Ay-yi-yi, this should not be happening to you. I've had similar experiences myself over the last 40 years although with somewhat different set of symptoms. The common thread though is the differences between doctors and how the best ones are usually not the ones who treat the diseases you/I have!

I'd really urge you to leave a review(s) at It won't necessarily change your life but it's been a good (albeit controlled) vent for me as well as supporting those docs who have done good things for me. You're also helping out other patients who might wonder where to go for care. Recently I had to change primary care physicians (insurance required) and I checked RateMD to decide which one to pick. So far I'm glad I did.

drewandkatie said...

Glad you had at least one positive doctor interaction! Sounds like a great visit even if you are still searching. Also glad he ruled out POTS for you. I'm about to start looking for cardiologists in Charlotte... your doc sounds good, but don't think I'll be commuting cross country for any appointments..despite the ringing endorsement.