Your writing, as always, is insightful and lovely. I love your clarity of purpose and vulnerability in sharing. Your patients are so lucky to have you! Because your poll reveals a real truth about our healthcare system--the fragmentation hurts everyone, including the doctors who likely got into the field to HELP sick people. (I choose to believe this, perhaps naively.) I wish you could simultaneously teach other doctors and write and see patients, but my wand is in my other jacket. Thank you for being who you are and for sharing your gifts with us.
You are the shining example of how all doctors could make patient care better! Primary care is such a great responsibility and I don’t understand (well, I do) why it is looked down upon. The depth of knowledge and experience needed to care for people is impressive.
I wish you lived near me. Medicine is too fragmented. We are no longer seen as human.
I'm dealing with a GI doctor, who probably did not look at the barium swallow video in motion because he/she didn't order it. It showed I had a stricture. Other tests must be be ordered by the GI doctor to make that diagnosis. And so I wait....
You were trained to care for the Whole Person and notice details above and beyond the current complaint. May your patients continue to benefit from o\all your learning and sharing!
I totally agree. I’ve been misdiagnosed several times in regard to serious diseases and have been told to go home and meditate when I was in severe pain that turned out to be a serious condition. Sometimes you can’t get a straight answer. If holistic medicine was covered by Medicare, I would definitely try it.
I live in L.A., too. I think that women’s pain is often not taken seriously by male doctors in general, and the doctors are dismissive, not just in L.A. The practice of medicine these days isn’t easy for doctors, with many burning out and some taking their lives. Still, we patients are at their mercy, sometimes receiving inadequate care or too much testing, and office visits are too short to be worth much.
I just looked at your profile, and I’m going to get one of your books.
I was driving home yesterday and thought to myself, I love being a patient advocate, but I wanted to advocate for people against invisible things like THE SYSTEM and BIG PHARMA and MISOGYNY et, not against colleagues or other doctors. But then I realized we are all part of these invisible things. It's almost impossible to not be. It's easy to slip. How sad!
And thank you for getting my children's book! My medical rape culture book is not going to come out until 2026 lol!
I live in LA, so that's often the answer. Well, that or antidepressants. I put too much stock in the differential diagnosis.
My friends who are doctors (and two who are PCPs) have told me they really just want to give a prescription and move on to the next patient. It's a little disheartening.
(To my (women) friends' credit, they want to get home to their kids and see medicine as a job rather than a calling. Without comprehensive childcare and lack of active father involvement, I do understand at least in part).
I agree, without a system and suppprt in place to empower PCPs, we can't ask them to keep going out of their ways to help -- that's taking advantage of their sense of mission....which sometimes I feel happens to me........
Having problem getting anyone to direct me in what medications should go with what (taking some major meds). I’ve gone as far as I can go (no medical training) digging through good sites trying to balance things out. I’m frustrated and angry.
I just posted on fb the other day this thought process (to follow). I am a retired emergency room medical clerk - girl Friday. “To the medical health insurance companies of USA: I will no longer be calling in for useless lists of telephone numbers for primary care physicians no longer accepting new patients. This is your requirement. You provide me with an appointment and I will take my patient to it. Solved!!” And now, they tell me I gotta go to Walnut Creek (I live in Vallejo) to call member services and tell them them the home health officer has found my friend a primary care physician who has appointments available in the next 2 weeks. I have to go because he has to tell them, it’s ok to talk to me about his life. We have finally received the forms the insurance company requires be filled out - it’s only taken 10 months of asking to receive said forms. Today is the day, they get their wish!
Thank you for explaining why the primary care doctors I’ve seen never have any insight and just shuffle me off to the next doctor. My primary does all these tests and has zero answers about literally anything. He’s great for paperwork though for my disability so I stay for that, but it’s frustrated me for such a long time that specialists don’t collaborate, especially on “strange” cases like mine that require a 360 view.
A family physician (not an OB-GYN) delivered both of my children and then took care of them from birth (not a pediatrician). Now I see a DO family physician who specializes in integrative medicine. I don’t see the value in seeing specialists unless there’s a good reason — and I do have good reasons (I see a hematologist/oncologist and a neurologist, but they are both on a first-name basis with my primary doctor).
I have had great frustrations with my insurance company and I have had great frustrations with doctors (my children are 22 and 27, and there are many bad experiences that have come between their early years and today), but a good doctor makes all the difference. I enjoy reading your stories — you certainly sound like one of the good ones.
Thank you, thank you, THANK YOU for addressing this! I have been caught up in this obnoxious system for the past 8 years, since being diagnosed with Addison's Disease, which took 3 years of declining health to diagnose. I'm still struggling to get the proper care I need. I have been in what I call the "specialty shuffle" which is when Primary care responds like that cardiologist "I only deal with....." Fill in the blank. Very frustrating.
Do you have any words of wisdom for me, in terms of how to change this?
I'm so sorry! I hardly have any word of wisdom except YOU'VE DONE ENOUGH to advocate for yourself and you are allowed to feel mad by a system that works against you, sometimes (if not most of the time). I hope you find the right team for you. <3
I wish the US had thousands more PCPs like you, Dr. Zha! The healthcare system we use in my community (which is pervasive to the point of being a near monopoly) is totally fragmented. What I wouldn't give for a "country doctor" like you.
This was just what I needed to hear as it reinforces what I believe. I fortunately have an excellent primary care physician and I like the concept of treating the whole person and I think of him as a specialist.
What a great attitude! We need doctors like you in Canada. I was at my gynaecologist and when done with that check up asked him - apologetically because it takes 12 weeks to get in to see my family doctor - if my cough sounded like a chest infection. He replied, that it wasn't his department and added 'this system is broken and I won't be a part of it.'
Thank you so much for the hope you provide. I have gone chest to chest with those "stay-in-your-lane" docs to try and get my patients what they truly need - which you define every day in your posts and which is Right.
May you live a long long life and may you teach as long, may many many people become inspired by you to practice Family Medicine and Whole Person Medicine. 🙏🏻
Deanna can I ask your role in (the dreaded) healthcare (machinery lol)? Can you tell me more about how you went chest to chest with someone tho told you to stay in your lane??? I'd love to know an example!
Ok So that was way too long a post. 🙂 Thanks for your patience. The thought stimulated
my memory of at least 5 other incidents in which my opinion was dismissed, to the detriment of the patient in an acute care (read: high stakes) setting. My personal reflections remind me to double down, work harder to make allies and be heard in my work. I've also worked at a community clinic with 6 interpreters on staff, and with that whole dedicated crew of NPs MDs PAs RNs interpreters and office staff, everyone's opinion was equally heard. Best clinic/team I ever knew.🙏🏻
I am a RN (BSN) and have worked primarily in inpatient cardiology. In 15 years, I have also worked in other areas but, obviously, have brought my cardiology assessment skills with me. I'm no longer at this hospital but not long ago I was working at a very large institution, one spread through the state where I live, and on a surgical oncology floor. The majority of MDs (surgeons and residents) I worked with are GI specialists. Assessing a patient in the morning I heard an irregular heart rhythm, the radial pulse was irregular and hard to detect with palpation. Pt also said he felt like crap (he didn't feel that bad the previous day). He'd had a surgery more than a week earlier. I asked him about his history (knowing he's been through several surgeries in the past few years) and I asked whether he had "ever heard of 'AFib'" and "has anyone in the past ever told you you had AFib?" He said yes, after a surgery a few years ago, and he'd been on PO metoprolol for a while after that. I had taken care of him before and I knew he had had a regular heart rhythm prior to that day. I texted the resident requesting a stat 12-lead to capture the rhythm. Normal protocol and timely. (problem 1. we need an order from a doc to get a non-invasive 12-lead ekg that many RNs and Techs are trained to do, and which the machine itself walks a user through. That is, we couldn't just get one without an order). I texted a few times and did not get an answer (problem 2. the poor resident had to get approval from the GI surgeon who was in surgery before she could OK a 12-lead) Finally after two hours she put an order in for a 12-lead (problem 3. after talking with me over the phone, and my explaining all the above and more, despite that my original text explained my assessment). The 12-lead showed rapid AFib. Patient was stable this entire time, just felt bad. I had no reason yet to call a rapid response. Then the resident had to see the 12-lead herself, and by now we should be starting treatment..... she still had to check with the surgeon, and another two hours later they ordered a PO dose of metoprolol. (cumulative effect is delayed treatment: to reverse new AFib, early and quick treatment is best. Standards have not changed) No IV metoprolol was ordered and by this time I was getting increasingly frustrated, requesting as politely as I could in my texts to get a cardiac consult for the purpose of getting the best treatment as quickly as possible (by this time I felt no confidence in our GI surgeon handling the cardiac issue) also, we texted instead of spoke in person because this is too big a hospital with too few staff for anyone to speak face-to-face for more than a few minutes. The resident had left after reviewing the printout and confer with the surgeon). .....Ultimately, they refused a cardiac consult despite the patients complex history and he was on PO Metoprolol for two days until I got the house supervisor involved and he was transferred to the cardiology floor for care) Other points: I was criticized for my "tone" in text messages - I was always respectful and direct. In medical comms I was trained to get to the point (SBAR). After this criticism it was recommended to me that I "use more emojis" (I wish I was joking.) I was also criticised for asking for a cardiac consult, as if that request from someone so powerless as a bedside nurse could have bad consequences.
...you get the picture. I remained firm the entire time; the surgeon and I never got to reconcile the offense. And I was talked to repeatedly by my nurse manager (anyone want to join me under the bus?) for my "tone." Now, y'all don't know me so why believe me when I say I was still respectful. Even though I was direct requesting what I thought the patient needed, I never cursed or insulted anyone I was speaking to, nor did I insult them behind their backs. All my time with the patient, I was calm, and educated him about my observations and reassured him I wasn't worried, and spoke highly of his team to give him confidence that he would be ok.
I thank you for asking. I really enjoy working with every one of the members on our teams, when it's a good and respectful team; I was originally trained with MDs as our equals- inclusive rounding, direct communication, feedback always 100% accepted. After 15 years a RN, in retrospect I can see that my original training was excellent and has saved my license as well as at least a couple patient's lives, because I am not afraid to ask a doc for something I think the patient needs. If I understand why they think my request is unnecessary, and I get to learn something I didn't know before, I'm equally happy!
Your writing, as always, is insightful and lovely. I love your clarity of purpose and vulnerability in sharing. Your patients are so lucky to have you! Because your poll reveals a real truth about our healthcare system--the fragmentation hurts everyone, including the doctors who likely got into the field to HELP sick people. (I choose to believe this, perhaps naively.) I wish you could simultaneously teach other doctors and write and see patients, but my wand is in my other jacket. Thank you for being who you are and for sharing your gifts with us.
Thank you for reading and being so generous about my writing! (LOL also, your wand is in your other jacket lol)
Thank you for sharing your thoughts and stories with us! I wish more doctors thought like you. But...what happened with Jimmy?
Jimmy got worked up and had the thing I worried he had </3
You are the shining example of how all doctors could make patient care better! Primary care is such a great responsibility and I don’t understand (well, I do) why it is looked down upon. The depth of knowledge and experience needed to care for people is impressive.
🥹🥹🥹🩵🩵🩵
All hail primary care physicians! I will restack, because everyone should read this.
I’m a new subscriber to this wonderful substack because you did that, Susan; thanks!
🥰🥰🩵🩵🩵🩵
I wish you lived near me. Medicine is too fragmented. We are no longer seen as human.
I'm dealing with a GI doctor, who probably did not look at the barium swallow video in motion because he/she didn't order it. It showed I had a stricture. Other tests must be be ordered by the GI doctor to make that diagnosis. And so I wait....
I was thinking the same, Colleen
You were trained to care for the Whole Person and notice details above and beyond the current complaint. May your patients continue to benefit from o\all your learning and sharing!
Mary??????
I had good teachers you know 🥹🥹🥹🥹
I totally agree. I’ve been misdiagnosed several times in regard to serious diseases and have been told to go home and meditate when I was in severe pain that turned out to be a serious condition. Sometimes you can’t get a straight answer. If holistic medicine was covered by Medicare, I would definitely try it.
I live in L.A., too. I think that women’s pain is often not taken seriously by male doctors in general, and the doctors are dismissive, not just in L.A. The practice of medicine these days isn’t easy for doctors, with many burning out and some taking their lives. Still, we patients are at their mercy, sometimes receiving inadequate care or too much testing, and office visits are too short to be worth much.
I just looked at your profile, and I’m going to get one of your books.
I was driving home yesterday and thought to myself, I love being a patient advocate, but I wanted to advocate for people against invisible things like THE SYSTEM and BIG PHARMA and MISOGYNY et, not against colleagues or other doctors. But then I realized we are all part of these invisible things. It's almost impossible to not be. It's easy to slip. How sad!
And thank you for getting my children's book! My medical rape culture book is not going to come out until 2026 lol!
I live in LA, so that's often the answer. Well, that or antidepressants. I put too much stock in the differential diagnosis.
My friends who are doctors (and two who are PCPs) have told me they really just want to give a prescription and move on to the next patient. It's a little disheartening.
(To my (women) friends' credit, they want to get home to their kids and see medicine as a job rather than a calling. Without comprehensive childcare and lack of active father involvement, I do understand at least in part).
I agree, without a system and suppprt in place to empower PCPs, we can't ask them to keep going out of their ways to help -- that's taking advantage of their sense of mission....which sometimes I feel happens to me........
Having problem getting anyone to direct me in what medications should go with what (taking some major meds). I’ve gone as far as I can go (no medical training) digging through good sites trying to balance things out. I’m frustrated and angry.
I just posted on fb the other day this thought process (to follow). I am a retired emergency room medical clerk - girl Friday. “To the medical health insurance companies of USA: I will no longer be calling in for useless lists of telephone numbers for primary care physicians no longer accepting new patients. This is your requirement. You provide me with an appointment and I will take my patient to it. Solved!!” And now, they tell me I gotta go to Walnut Creek (I live in Vallejo) to call member services and tell them them the home health officer has found my friend a primary care physician who has appointments available in the next 2 weeks. I have to go because he has to tell them, it’s ok to talk to me about his life. We have finally received the forms the insurance company requires be filled out - it’s only taken 10 months of asking to receive said forms. Today is the day, they get their wish!
The runaround with malicious intent !!!!
Thank you for explaining why the primary care doctors I’ve seen never have any insight and just shuffle me off to the next doctor. My primary does all these tests and has zero answers about literally anything. He’s great for paperwork though for my disability so I stay for that, but it’s frustrated me for such a long time that specialists don’t collaborate, especially on “strange” cases like mine that require a 360 view.
there was a program for difficult diagnoses at Cedars in LA that was just closed....
That’s sad to hear! We need more places like that.
A family physician (not an OB-GYN) delivered both of my children and then took care of them from birth (not a pediatrician). Now I see a DO family physician who specializes in integrative medicine. I don’t see the value in seeing specialists unless there’s a good reason — and I do have good reasons (I see a hematologist/oncologist and a neurologist, but they are both on a first-name basis with my primary doctor).
I have had great frustrations with my insurance company and I have had great frustrations with doctors (my children are 22 and 27, and there are many bad experiences that have come between their early years and today), but a good doctor makes all the difference. I enjoy reading your stories — you certainly sound like one of the good ones.
🥰🩵
Thank you, thank you, THANK YOU for addressing this! I have been caught up in this obnoxious system for the past 8 years, since being diagnosed with Addison's Disease, which took 3 years of declining health to diagnose. I'm still struggling to get the proper care I need. I have been in what I call the "specialty shuffle" which is when Primary care responds like that cardiologist "I only deal with....." Fill in the blank. Very frustrating.
Do you have any words of wisdom for me, in terms of how to change this?
I'm so sorry! I hardly have any word of wisdom except YOU'VE DONE ENOUGH to advocate for yourself and you are allowed to feel mad by a system that works against you, sometimes (if not most of the time). I hope you find the right team for you. <3
Thank you so much for your response! I really needed that today! 😊
I wish the US had thousands more PCPs like you, Dr. Zha! The healthcare system we use in my community (which is pervasive to the point of being a near monopoly) is totally fragmented. What I wouldn't give for a "country doctor" like you.
<3333
This was just what I needed to hear as it reinforces what I believe. I fortunately have an excellent primary care physician and I like the concept of treating the whole person and I think of him as a specialist.
What a great attitude! We need doctors like you in Canada. I was at my gynaecologist and when done with that check up asked him - apologetically because it takes 12 weeks to get in to see my family doctor - if my cough sounded like a chest infection. He replied, that it wasn't his department and added 'this system is broken and I won't be a part of it.'
“ I won’t be part of it” meaning that “I won’t do more than what I need to do??”
Thank you so much for the hope you provide. I have gone chest to chest with those "stay-in-your-lane" docs to try and get my patients what they truly need - which you define every day in your posts and which is Right.
May you live a long long life and may you teach as long, may many many people become inspired by you to practice Family Medicine and Whole Person Medicine. 🙏🏻
Deanna can I ask your role in (the dreaded) healthcare (machinery lol)? Can you tell me more about how you went chest to chest with someone tho told you to stay in your lane??? I'd love to know an example!
Ok So that was way too long a post. 🙂 Thanks for your patience. The thought stimulated
my memory of at least 5 other incidents in which my opinion was dismissed, to the detriment of the patient in an acute care (read: high stakes) setting. My personal reflections remind me to double down, work harder to make allies and be heard in my work. I've also worked at a community clinic with 6 interpreters on staff, and with that whole dedicated crew of NPs MDs PAs RNs interpreters and office staff, everyone's opinion was equally heard. Best clinic/team I ever knew.🙏🏻
I am a RN (BSN) and have worked primarily in inpatient cardiology. In 15 years, I have also worked in other areas but, obviously, have brought my cardiology assessment skills with me. I'm no longer at this hospital but not long ago I was working at a very large institution, one spread through the state where I live, and on a surgical oncology floor. The majority of MDs (surgeons and residents) I worked with are GI specialists. Assessing a patient in the morning I heard an irregular heart rhythm, the radial pulse was irregular and hard to detect with palpation. Pt also said he felt like crap (he didn't feel that bad the previous day). He'd had a surgery more than a week earlier. I asked him about his history (knowing he's been through several surgeries in the past few years) and I asked whether he had "ever heard of 'AFib'" and "has anyone in the past ever told you you had AFib?" He said yes, after a surgery a few years ago, and he'd been on PO metoprolol for a while after that. I had taken care of him before and I knew he had had a regular heart rhythm prior to that day. I texted the resident requesting a stat 12-lead to capture the rhythm. Normal protocol and timely. (problem 1. we need an order from a doc to get a non-invasive 12-lead ekg that many RNs and Techs are trained to do, and which the machine itself walks a user through. That is, we couldn't just get one without an order). I texted a few times and did not get an answer (problem 2. the poor resident had to get approval from the GI surgeon who was in surgery before she could OK a 12-lead) Finally after two hours she put an order in for a 12-lead (problem 3. after talking with me over the phone, and my explaining all the above and more, despite that my original text explained my assessment). The 12-lead showed rapid AFib. Patient was stable this entire time, just felt bad. I had no reason yet to call a rapid response. Then the resident had to see the 12-lead herself, and by now we should be starting treatment..... she still had to check with the surgeon, and another two hours later they ordered a PO dose of metoprolol. (cumulative effect is delayed treatment: to reverse new AFib, early and quick treatment is best. Standards have not changed) No IV metoprolol was ordered and by this time I was getting increasingly frustrated, requesting as politely as I could in my texts to get a cardiac consult for the purpose of getting the best treatment as quickly as possible (by this time I felt no confidence in our GI surgeon handling the cardiac issue) also, we texted instead of spoke in person because this is too big a hospital with too few staff for anyone to speak face-to-face for more than a few minutes. The resident had left after reviewing the printout and confer with the surgeon). .....Ultimately, they refused a cardiac consult despite the patients complex history and he was on PO Metoprolol for two days until I got the house supervisor involved and he was transferred to the cardiology floor for care) Other points: I was criticized for my "tone" in text messages - I was always respectful and direct. In medical comms I was trained to get to the point (SBAR). After this criticism it was recommended to me that I "use more emojis" (I wish I was joking.) I was also criticised for asking for a cardiac consult, as if that request from someone so powerless as a bedside nurse could have bad consequences.
...you get the picture. I remained firm the entire time; the surgeon and I never got to reconcile the offense. And I was talked to repeatedly by my nurse manager (anyone want to join me under the bus?) for my "tone." Now, y'all don't know me so why believe me when I say I was still respectful. Even though I was direct requesting what I thought the patient needed, I never cursed or insulted anyone I was speaking to, nor did I insult them behind their backs. All my time with the patient, I was calm, and educated him about my observations and reassured him I wasn't worried, and spoke highly of his team to give him confidence that he would be ok.
I thank you for asking. I really enjoy working with every one of the members on our teams, when it's a good and respectful team; I was originally trained with MDs as our equals- inclusive rounding, direct communication, feedback always 100% accepted. After 15 years a RN, in retrospect I can see that my original training was excellent and has saved my license as well as at least a couple patient's lives, because I am not afraid to ask a doc for something I think the patient needs. If I understand why they think my request is unnecessary, and I get to learn something I didn't know before, I'm equally happy!