17 December 2020

Response to Note to File from Doctor M, Respirology

 - Response to Note to File May 29/19     from Doctor SM, Respirology 

First, let me say, I do not wish Dr M or any other doctor including specialists, to begin by doing a bronchoscopy nor to do one at all. Nor do I want it done directly or indirectly - as last doctor available - to have it done under guidance and direction by Dr D. I would protocols to be followed, which indicate doing a sputum test, and preferably a 3-part sputum test, for the best chance. I was inserted into the middle of traditional TB protocols by not being offered a skin test, or sputum test first. And I was manipulated into having an ultrasound-guided endoscopy once I got into the patient area of the Procedure area that day.

Dr M suggests, in his first paragraph, page 2, in his version of my Medical Record, that I refused to follow up with further imaging. But that is not the case. I refused to follow up with him in having further imaging.  I have since had imaging, including a PET Scan organized by a different doctor, done on my lungs.  But I do object to radiologists like Dr G receiving too much direction as to what to write in the CT scan report. In his report dated Jan 23, 2019, he concludes, “Alteration in morphology of dominant lesion in the right upper lobe favours the possibility that it is related to the patient’s known history of atypical mycobacterial infection rather than malignancy.”  I objected formally, but organizations that support the LHSC, as well as THE LHSC, presume that all doctors speak from a position of professional integrity and good faith.

Furthermore, is Dr M inadvertently admitting to sending my lung culture to Toronto Public Health genome lab to be cultured and tested, in promoting his viewpoint on the state of my lung health in his Note to File. Or is he trying to undo a wrong which may be a little too late. In this offical Note, posted to my Medical Record in May, 2020, he claims the proper diagnosis of my condition is that I “have” non-TB mycobacterium. If he did not follow protocols (and he didn’t) when he submitted the sample/culture (deciding to go on no other basis than my not having TB after all), how can his word be trusted (ie, how can I, or we, have faith in his diagnosis?  How valuable is a professional opinion when it has not been confirmed, and even then, can that be trusted at this point, if the Dr’s colleagues are the ones confirming it?

Views of Radiologists

I have had just a few x-ray images as well as a CT scan taken  in the last 3 months, between taking various antibiotics, to determine how my lungs are, and what it looks like I have going on there. Some of the findings are repeated, but not the interpretation Dr M’s radiologist gave in his x-ray report made earlier, that served to uphold a questionably- acquired test result (called by Dr M a diagnosis). The results from different radiologists on those images in the last three months include aspiration pneumonia, pleural effusion, a primary nodule, bronchiectasis, an indication of hilum or hilar pneumonia, persistent left basilar opacities and interstitial pneumonia.

I implore readers of the Note to File, now on my medical record, not to blindly follow Dr M’s suggestions. He was not my Dr when he posted the Note to File and he had no right presenting his opinion in that manner. It was a test result, not a diagnosis. He is not my respirologist,  I will be sending this to FIPPA or the Privacy Office, and/or the President of LHSC Paul Woods, to have this Response placed alongside the Note to File.

Mycobacterium and TB

What Mr P (Dr Woods’ spokesperson, in his last letter) stated about mycobacterium, that it is a reportable disease, was factually incorrect. Tuberculosis is a mycobacterium, officially, but is reportable. But when the use of language comes into play, the way it is used is important. Language was created by humans, and can be changed by them, more likely if they have authority, to signify something else. Mr P doesn’t say where he gets his information, that all mycobacterium is reportable. If someone told him that mycobacterium is reportable, I would like to know who. If he discovered that incorrect fact himself, he made a grave error and should correct his misunderstanding.  I have implied before, if not stated outright, that someone sent my presumed sample/culture of mycobacterium (non-TB mycobacterium) up to Toronto without discussing the implications of it with me! And here Mr P is saying all mycobacterium, not just TB, was reportable and the testing needed to be done, for the sake of the community. And that my sample/culture, was sent up to Toronto to test further the TB aspect of it, I think he might have been saying, which was not true. The test for TB at the local lab came back clear. I did not have either active nor latent TB. That was decided and so someone sent it to Toronto. That would have been Dr M.  It was sent up to Toronto to investigate as a  a non-TB form of mycobacterium, which is non-reportable.

The Requisition

Furthermore, what they sent up to Toronto – what they – he – was looking for – was not done through a proper requisition.  Shouldn’t Dr M have known that? If not him, who authorized the requisition for further investigating of my culture in Toronto Public Health Lab.  The only requisition I have managed to gain access to was not signed and the title of the test or culture to be performed was altered.

The Consent Form - informed consent

The idea of informed consent is essential to hospital policy. But I was denied that when Dr D, who did the bronchoscopy, said I could not see the consent form until I got into the Procedure room, for the bronchoscopy. Now that so much time has elapsed, since 2018, no one will be able to remember anyway. But you can guarantee that if he did it once, he has, or will, try it again unless stopped!

I did not get to see the form until I had removed my glasses and had them put away, and was lying on my back on the stretcher. Then I got to see the form, while everyone bustled around with tubing and all that was required. I didn’t know what it meant that my sample/culture could be tested for research or whatever else it says, by the hospital.

“Clinical Symptoms”

Dr M didn’t seem to realize that up to this point, starting with the bronchoscopy, the symptoms written down as “clinical symptoms”  - cough and shortness of breath – were symptoms of me having emphysema. The mistake was passed to Dr P to Dr D, the morning of the bronchoscopy. Afterwards, somehow, the employee at LHSC managed to insert the same clinical symptoms into her SUSPECT form, indicating she thought I had new symptoms of coughing and a problem breathing, not symptoms attributable to emphysema but which had to be investigated as symptoms of Tuberculosis.  

SUSPECT of having TB

Dr M knew, or should have known, that the symptoms I had which were used to declare me SUSPECT of TB by LHSC Department of Infection and Control were taken from my Medical File, but were symptoms of COPD (Emphysema) not current symptoms of a recent respiratory illness.  We both knew – or I thought we did – that this was a routine bronchoscopy and that I didn’t have symptoms to investigate. The procedure was to investigate infection, but any respirologist would have known that this patient was also being investigated for a possible malignant nodule. After all, it’s in my Medical Record.

Reportable vs Nonreportable

Presumably, Dr M did not know that, unlike Tuberculosis, which is a reportable disease, non-TB mycobacterium is non-reportable – not required to be reported to Public Health.  Yet he went ahead and presumably sent a requisition up to Toronto with the sample/culture, gained without my informed consent. Too many guesses and assumptions led to this situation happening and no one taking responsibility. Regardless of whether it turns out I had non-TB mycobacterium, Dr M has behaved abominably.

If by chance I have the condition, how can we know that it happened by chance. If someone can ignore the protocols at will, for any reason, what’s to stop them from ignoring other protocols. When a Dr speaks and sees himself  as having the right to make mistakes on his Note to File, or on my medical record when used as a guide for others involved in my care, just because he is a professional and apparently his opinions matter while mine don’t, it doesn’t mean that what he speaks is always the truth.

Finding a Doctor

I have difficulty finding and keeping a doctor, through having spoken out before when things went badly. Being single and older and living alone isn’t the way our own culture works, and it may be worse for those with more traditional views about older women, especially if they do so without having had a career. The education can be so easily discounted if one didn’t have a career, as can anything the patient says. So at this time I would value any input into this situation, especially coming  during the pandemic, as it is. I am seeking better health than I sometimes have received, as I still have research I would like to do.

Comments can be made on this blog entry, directly below. Several doctors already have access to relevant documents. I may add more later. I am asking here that Dr W, President, LHSC, and the Privacy Office, take steps to place my response alongside the Note to File by Dr M. 

The names here have been altered to protect the privacy of all. Contact me privately for more information.


Thank you

Susan McPherson

 London, ON.

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