Short transcript of Dr's office appointment April 28, 2014

Attachment to ‘Health care among single, older women – a case of discrimination for OHRT’ Apr 12, 2015)

Page attached to blog post April 23, 2013

Apr 28, 2014.  Transcript of 6 minute - short - excerpt of audio recording of office visit at which my prescriptions were being renewed by my family doctor. The transcript opens with a brief discussion and misunderstanding about a separate issue but soon gets into the issues of concern in my CPSO complaint and/or the Human Rights application, that of the way the doctor ended the physician patient relationship and his demand that I provide a urine sample for “street drugs.”  

My notes are in italics

Dr    But you wanted to go there .

Sue McPherson  No, I wanted to the ---    [information centre for patients' kidney health] . I thought that’s what they did.

Dr    Yeh. That’s why I sent you there, so . . . But were you requesting to going there?

Sue McPherson  I requested to the one at -------- .

Dr  That’s the same as the one at --------------.

Sue McPherson  No it’s different. It’s   ----- Hospital [the appointment had been made for me with a nephrologist at ------- Hospital, and I didn’t know why, when I had simply been seeking information. Dr    ---- had previously told me I didn’t need to see a nephrologist.  My blood test had routinely showed an eGFR stage 3 kidney disfunction].

Dr  Oh ????.

Sue McPherson ?????  Well here’s the

Dr   I’ll have to call and check it.

Did you find another doctor. I asked you to find a different doctor right?

Sue McPherson  Pardon me?

Dr   I asked you to find another doctor. A family doctor.

Sue McPherson  Well I’m still waiting for your form to sign. I don’t think it’s up to me to just go and find a doctor. . .

Dr  It’s up to you

Sue McPherson  If you want to get rid of me then you have to have a reason for it, and you have to tell the College of Physicians.  Because I  - I’m just kinda stuck?????  right here.  For one thing  I want to have my prescriptions the way they should be, which is the way they were before you altered them.  And I can’t do anything till that’s done. But still, you have no right to tell me to tell me to leave like that.

Dr   I tell you I’m giving you a 3 month prescription, okay. So and then, in the meantime, in 3 months, according to the College of Physicians guidelines, I give you a 3-month prescription and then the patient is supposed to find a doctor.

Sue McPherson Well then, you put in in writing and sign it. Because ????????????  back yet. You can’t just give it verbally. You just . ..

Dr  Yes. It’s difficult for me to manage you as a patient.

Sue McPherson Well it’s difficult for me as a patient. Because things are not getting looked at, and you know, so many things have got in a muddle.

Dr  Yeah that’s what I mean, we don‘t match each other. So, that’s why I am not a good doctor for you.

Sue McPherson  And your patients don’t mind if it’s in a muddle?/ If there are issues, and consultations that are in a muddle?

Dr   Do you take Tylenol #2?  [filling out prescription renewal]

Sue McPherson  Yes.

Dr    How many?

Sue McPherson   180. It’s for 3 months, which is 2 times a day.

Dr    Two tablets?

Sue McPherson Two tablets a day.

Dr   Two tablets once a day [writing out Rx renewal].  I’ll give it for 3 months, okay, after ????????? that I will give it once a month, okay. ???????????? Each time. Now I’m prescribing only for a month period.  But for you I’ll give you for 3 months. I’ve changed my practice, okay. From now on I’ll only issue for one month - a one month period. Each time you are to give urine, when I issue it, in the office.

Sue McPherson  [ reacting with disbelief] Yes, but, but . .

Dr   Okay?

Sue McPherson Oh!  For what reason? What do you do with it?

Dr   Oh just   ??????????

Sue McPherson  You want me to do that today?

Dr   No I’ll do it for 3 months, okay. That will give you 3 months to find a different doctor. So,  . .
Sue McPherson  So

Dr   So I’m not giving you any other referrals. . .

Sue McPherson  This lab test is due. Do you want to – because it was last done by you in April 2013, did you want to actually send me for this now?  April 28? So, that’s just a year.

Dr   Okay, I’ll send you a letter, okay. I’ll send you all these things – why you are discontinued as a patient, and hope you find a doctor. So after that ?????????????? I’m not seeing you again. ??????????– 3 month period

Sue McPherson  What about the lab test, then, that is due this month. ?????????????

Dr  The lab test has to be done by your new Dr, whoever you appoint. Okay? So, 2 tablets a day. Gabapentin you take 2 tablets a day, okay? [still doing Rx renewals]  Gabapentin?

Sue McPherson Yes.

Dr  Two tablets once a day. Okay, I’ll check your blood pressure. I checked it already. It’s 145 over 80. . . . . . I’ll give you a urine bottle and you can give me some urine.

Sue McPherson I do?

Dr  Yes

Sue McPherson I thought you said I didn’t have to.

Dr    No.

Sue McPherson What are you checking?

Dr    Any other drugs. Street drugs.

Sue McPherson  Do you do this for everyone? Do you make all your patients do this?.

Dr  Yes. It’s our policy.

Sue McPherson   Well, it was never compulsory before I started seeing you. I’ve never taken  - I’ve never taken any illegal drugs.

Dr    If you’re not doing it I cannot give you the Tylenol

Sue McPherson  But don’t you do this for everybody? Do you make everybody do it?

Dr   . . . . . . . . . . .. .  . ..  Are you doing it or not?

Sue McPherson  Yes, I can give it to you. I don’t take drugs.

Dr  But if you don’t do that you don’t . . . .

Sue McPherson  But the thing is, do you make everybody take this urine test?

Dr    Everyone. . . . . . . . .  Everyone.

[I took the container and went to get the sample but then changed my mind. I told the receptionist (and the doctor, across the room) I would like a requisition to take to a lab, to get it done there, as I did not trust them with it. They ignored my request for a requisition to take to a lab, so I left. I went immediately to the ---------- where I saw a Dr -----, and gave them a urine sample to test for “street drugs” but they apparently lost it]. 

As an aside, the misunderstanding about the nephrology problem was resolved, finally, on discovering that I would need to see a nephrologist before being able to have get information from the kidney care information centre. The label, kidney disfunction, due to eGFR level, can appear on a blood test report for several years before the medical system does anything about it, as long as it remains stable. 

The disconnected style of the communication was due, in all probability, to the usual brevity of the appointment and the necessity of abruptly raising issues and switching topics, so that all would be covered in the time slot available. To me, part of the overall problem was that the doctor had no assistant or practice nurse. Whenever I asked the receptionist about an admin-related problem, I was told to ask the doctor.

Sue McPherson,  Sue’s Views on the News. 2015

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