Saturday, December 14, 2013

The Email I Want To Send, But Probably Won't

Dear Dr. [X],

Thank you for your note. I will let my patient know as soon as possible that you aren't interested in seeing him in your clinic so that he won't trouble you with his medical issues.

It is true that we did have him admitted to expedite a biopsy while you were the attending on service for the [Q] team. However, as he had not yet seen a specialist in [Q] and that Dr. [Y] had provided help to me in phone consultation, we both thought that you would have been the most logical choice to see him in follow-up. The misunderstanding is all mine, as I thought you were this person called a "doctor" and that doctors do this thing called "taking care of patients". You appear to be a "biopsy chaperone". Please forgive my confusion on this point.

Part of my need for assistance from a [Q] perspective is my concern that his labs are unchanged since late November. You note that "his [R] labs are essentially improving". On November 20, his [R] was 350; on discharge this week, nearly a month later, it was 410. Since I was a bottom-feeding medical student with no ambition and thus went into Infectious Disease, I must have been asleep at the lecture where they explained how an increase from 350 to 410 over a one month period constitutes essential improvement. Also, I must confess that I have factored in the notoriously unreliable, non-validatable, un-billable parameter of the patient's symptoms into my thinking: he is still in a great deal of pain, which is evident on this item known as the "physical exam". As I was not so driven to pursue as competitive a subspecialty as [Q], I have concluded that, one month into a serious complication in this man's treatment, he's not getting better, which is why I sought input from [Q] given the complications are in his [Q] organ.

Yes, it is true that all the notes &c. can be found in the electronic chart. However after I dutifully read all such notes, I still had no real idea what you as a [Q] specialist thought. Your email replying to my inquiries indicates you think this is drug toxicity, which is somewhat helpful because there is nothing in the chart that actually says that. Unfortunately, Dr. [Y] shared with me during our initial talks that drug toxicity has a characteristic appearance on biopsy, and the pathologists made no comment in their analysis to that effect. This is, of course, why I was seeking to do this thing called "talking with a colleague", as my experience is that it is a superior method to this other thing called "communicating through the chart". But perhaps you have had more success with the latter, or at least it minimizes how many discussions you must have with non-[Q] physicians, and that may indeed be how you define success.

Hereinafter I will do my best not to interrupt your wildly busy schedule, coming to bother you with such trivial matters as a patient with a potentially life-threatening illness. Thank you again for your careful attention to facilitating a biopsy and billing for an inpatient admission, and forgive me for assuming that also included caring for my patient by making a reasoned assessment of his [Q] problems.

Yours in disgust,