Wellness

[Kathy19078]

I am very angry at the way my primary care doctor has handled my care. I may now be facing a serious illness because of this. I would like to change doctors but am not sure if now is the time to do it. Maybe I should wait until I have the exact diagnosis. Just so you understand my insurance I have Keystone Health Plan East and need a referral from my primary care doctor to see all specialists. His name is on my insurance card as my primary care doctor.

In June of 2013 I fell at work and fractured my left hip, and then the next day I had a partial hip replacement. I was taken to the ER directly from work. When they did the chest x-ray because of the surgery, they told me I had a nodule on the upper part of my right lung. They told me to follow up with my doctor when I got home. After the surgery, I spent several weeks in a rehab facility and went home in mid-July. My primary care doctor was not involved in my care regarding my hip. I went to my primary care doctor the beginning of August and told him about the x-ray. He was able to access a copy of the x-ray report, and he ordered a CT scan of the chest. After he got the results of the CT scan, someone from his office called me and told me it was very small and to follow up with another CT scan in about 12 months. I was never given a copy of the report.

The end of February I had an abnormal mammogram. I had gone to my primary care doctor I think it was in January for a check up regarding blood pressure and told him that I found a lump in my right breast. He never did an examination. So he ordered a diagnostic mammogram because I do not currently have a gynecologist. I had to reschedule the mammogram several times due to the snow. After I had the mammogram, the radiologist talked with me and told me that I should see a breast surgeon for a biopsy and that she was going to call my primary care doctor and talk with him. Then my primary care doctor called me and left a detailed message in my voice mail regarding the breast surgeon he wants me to see. I think he should have talked with me directly instead of leaving just the message or at least told me to call him to discuss this. I did schedule the appointment with the breast surgeon for Thursday. I also think that when he ordered the mammogram he should have also told me to go to see a gynecologist so I could have an examination since he did not examine me.

I called my primary care doctor and set up an appointment to see him next week because I want to talk to him face to face about all of this. I also went to his office today to get a copy of CT scan of the chest from August and the Mammogram and also the ultrasound (they did the ultrasound right after the mammogram. He did not order that. I think maybe the radiologist ordered that). From the research I have done, I know that they put a BI-RAD score on the mammogram. When I picked up the reports, I asked the girl at the desk where the BI-RAD score was and she went and asked the doctor and he said "they don't put that on the report and to ask the breast surgeon." When I came home and thoroughly read the report, it clearly said the BI-RADS category 5. From my research, I found out that means I have a 95% chance of having breast cancer. Obviously, he never read these reports. When I read the CT report it clearly states Tiny 3 mm nodule superior segment right LOWER lobe. There is no nodule in the right UPPER lobe seen which is the area of interest (they are referring to the area of interest on the x-ray, which was the right UPPER). It also said this does not correspond to the questionable abnormality seen at the right apex on the chest x-ray which most likely represented summation of bony shadows. Since there were two different areas referred to on the CT scan, I think he should have investigated more what was going on here and maybe referred me to a lung doctor back in August. By the way when I saw him in January, I specifically asked him if the lump had anything to do with or if it was seen on the CT scan that was previously done and he said no. On the CT scan it also said to have another CT scan in 6-12 months. I have also decided to see a gynecologist and that appointment is the end of March. Needless to say I am very upset.

Please advise how to handle my visit to my primary care doctor next week and also what your thoughts are about switching doctors and when I should switch. Thank you.

[Kathy19078]

I forgot to mention above that I am 64 years old.

[KittenShopper]

Sounds like you are on the right path. Get copies of every single doctor visit notes, reports, lab reports, x-rays, hospital/rehab info...you name it. Keep your own notes at each visit. Document everything. Start a file. Check every DX (diagnosis code).Make a worry list, and every question you can think of. Take to appts. as a checklist. Trust your instincts. Don't let fear push you into irrevocable decisions. Use your computer w/o scaring yourself. Check every RX given at drugs.com for eg. You are into the allopathic maze. Don't be bulldozed into the now ubiquitous 7 mins. appts....Look at ratemds.com. Immediately start building your health with sites like mercola.com, naturalnews.com, your Whole Foods type stores, stress reduction.. Make your focus optimal health on what you can do yourself.Healthcare system a mess now w/i Obamacare-Drs and RX's leading cause of death. I say: murders w/i impugnity and purveyors of poison. Trust yourself, stay steady. Good for you in questioning!So many of us have been, are, or will be in the same boat. It's very tough to find good doctors now.You are not alone. Ask God to guide you. YOU are the CEO of your healthcare. KrisCarr.com has lots of info on building a team. Use your insurance to the best benefits. Take advice from people you know carefully-not everyone can navigate and make good decisions. Off the cuff, hope this helped.

[Feline Fine]

Get this book (cheapest at Amazon.com), read it thoroughly & take notes/highlight points, and keep it on hand for reference. It will help a great deal. Good luck!

[docsgirl]

Dear Kathy,

I cannot address the breast issue as all of my mammo's and physical exams have been normal thus far. I am 68 years of age. I can, however, address the lung issue. Several years ago, I had a routine chest x-ray which showed a small mass. I was immediately referred to a pulmonologist who ordered a PET scan, which was normal. I was given CAT scans every 6 months for 2 years to check for any changes in the mass. After the 2 years, I was given a CAT after one year. Fortunately, all was normal and he said that although there should be nothing in the lung, there are some people who have benign things in the lungs. He said that as long as it showed no change over this period of time, it was not malignant and would just be there. Of course, I think I glow in the dark from all the radiation from the CAT scans. My doctors have always been beyond thorough and compassionate and I feel blessed. They sit down with me and explain everything. I wish you the very best. Please post and let us know what is happening. I will be keeping you in my thoughts and prayers. docsgirl

[Kathy19078]

KittenShooper, thank you for the encouragement. I have learned a very harsh lesson. I have to be own advocate regarding my health and really look at all the reports. If I don't understand something, I need to ask questions and do research.

FelineFine, thank you. I will definitely get that book.

docsgirl, thank you for the info regarding your lung issue and thank you for the prayers. I will update my post when I know more about my health issues.

[gailcoco]

I don't see where your primary did anything wrong. The CT results were given to you and what they told you was correct regarding the size and that they would recommend a follow-up CT in 12 months. Here is an article from the Mayo Clinic website:

<h2>Can lung nodules be cancerous?</h2> Answers from Edward C. Rosenow III, M.D.

Most lung nodules are noncancerous (benign). However, some lung nodules may be cancerous — either early-stage lung cancer or metastatic cancer that has spread to the lungs from another site in the body.

Lung nodules — small masses of tissue in the lung — are quite common. They appear as round, white shadows on a chest X-ray or computerized tomography (CT) scan. They're usually about .2 inch (5 millimeters) to 1 inch (25 mm) in size. A larger lung nodule, such as one that's 25 mm or larger, is more likely to be cancerous than is a smaller lung nodule.

The most helpful thing your doctor can do is compare your current chest X-ray or CT scan with a previous one. If the nodule on earlier images hasn't changed in size, shape or appearance, it's probably noncancerous. Causes of noncancerous lung nodules include infections, such as histoplasmosis or tuberculosis, a small collection of normal cells (hamartoma), lung cysts, and vascular abnormalities. Noncancerous lung nodules usually require no treatment. However, your doctor will probably monitor the nodule for changes using periodic imaging tests.

If a lung nodule is new or has changed in size, shape or appearance, your doctor may recommend further testing — such as a CT scan, positron emission tomography (PET) scan, bronchoscopy or tissue biopsy — to determine if it is cancerous.

A CT scan is usually the first test if it's suspected that a nodule is malignant. If there is no evidence that the possible cancer has spread, then surgical removal may be recommended. If results of the CT scan are indeterminate, then the decision may be made to observe with follow-up imaging or a biopsy. If you have multiple lung nodules (two or more), especially if not in just one lung, your doctor will work with you to develop a treatment plan that's specific to your case.

Edward C. Rosenow III, M.D.

I had a rare lung cancer that was surgically removed in 1993. It was discovered on a chest xray and the CT showed a 1.5 cm nodule. I had radiation therapy after the surgery and so far my lungs look good.

The only thing your primary had wrong was the BI-RAD's score and he probably told his staff that answer while he was in-between seeing patients and not looking at your chart. Plus, I also think he should have brought you into the office to discuss your mammogram instead of leaving you a message.

Granted, he should have had you come in to review the results but a lot of patients want to know as soon as we get them in the office and do not want to come in for an appointment. Our office will call the patient with the results and let them know the doctor will discuss at their next appointment.

Plus, a CT will not show a breast mass. I don't know if you were implying that the CT should have shown the breast mass or not.

I hope everything goes well with your biopsy and I will pray that the mass is benign. I wish you all the best. Good Luck. Gail

[hckynut]

""Please advise how to handle my visit to my primary care doctor next week and also what your thoughts are about switching doctors and when I should switch. Thank you.""

Not sure what you mean by ""handle"" in this instance. I personally would tell any doctor exactly what is bothering me and if they don't give me answers I understand and also agree with(after doing my own research)I would tell him/her they are no longer my doctor.

Now I am one that has never minced words with anyone and tell them in words that leave no doubt in their minds what I have told them. Maybe you are not like me.

[aoc2005]

On 3/5/2014 gailchap said:

I don't see where your primary did anything wrong. The CT results were given to you and what they told you was correct regarding the size and that they would recommend a follow-up CT in 12 months. Here is an article from the Mayo Clinic website:

<h2>Can lung nodules be cancerous?</h2> Answers from Edward C. Rosenow III, M.D.

Most lung nodules are noncancerous (benign). However, some lung nodules may be cancerous — either early-stage lung cancer or metastatic cancer that has spread to the lungs from another site in the body.

Lung nodules — small masses of tissue in the lung — are quite common. They appear as round, white shadows on a chest X-ray or computerized tomography (CT) scan. They're usually about .2 inch (5 millimeters) to 1 inch (25 mm) in size. A larger lung nodule, such as one that's 25 mm or larger, is more likely to be cancerous than is a smaller lung nodule.

The most helpful thing your doctor can do is compare your current chest X-ray or CT scan with a previous one. If the nodule on earlier images hasn't changed in size, shape or appearance, it's probably noncancerous. Causes of noncancerous lung nodules include infections, such as histoplasmosis or tuberculosis, a small collection of normal cells (hamartoma), lung cysts, and vascular abnormalities. Noncancerous lung nodules usually require no treatment. However, your doctor will probably monitor the nodule for changes using periodic imaging tests.

If a lung nodule is new or has changed in size, shape or appearance, your doctor may recommend further testing — such as a CT scan, positron emission tomography (PET) scan, bronchoscopy or tissue biopsy — to determine if it is cancerous.

A CT scan is usually the first test if it's suspected that a nodule is malignant. If there is no evidence that the possible cancer has spread, then surgical removal may be recommended. If results of the CT scan are indeterminate, then the decision may be made to observe with follow-up imaging or a biopsy. If you have multiple lung nodules (two or more), especially if not in just one lung, your doctor will work with you to develop a treatment plan that's specific to your case.

Edward C. Rosenow III, M.D.

I had a rare lung cancer that was surgically removed in 1993. It was discovered on a chest xray and the CT showed a 1.5 cm nodule. I had radiation therapy after the surgery and so far my lungs look good.

The only thing your primary had wrong was the BI-RAD's score and he probably told his staff that answer while he was in-between seeing patients and not looking at your chart. Plus, I also think he should have brought you into the office to discuss your mammogram instead of leaving you a message.

Granted, he should have had you come in to review the results but a lot of patients want to know as soon as we get them in the office and do not want to come in for an appointment. Our office will call the patient with the results and let them know the doctor will discuss at their next appointment.

Plus, a CT will not show a breast mass. I don't know if you were implying that the CT should have shown the breast mass or not.

I hope everything goes well with your biopsy and I will pray that the mass is benign. I wish you all the best. Good Luck. Gail

I am also confused as to what the PCP did wrong. He referred her to the proper specialists in a timely manner. I have been in healthcare 20+ years and from the post it appears proper procedure was followed. I believe she also is implying the CT scan should have shown the breast mass. Unfortunately that is not the case. Everything stated above is true.

I am truly sorry to the OP that she is dealing with this and hope that it all turns out well. Dealing with a health issue is stressful, especially when you don't yet know what you may be facing. I realize you are very scared and worried. I hope you have a good support system.

It is important to have a physician you feel comfortable with and can communicate with. However, do not let your stress cause you to blame the physician for any health issues you may have. If you truly feel you received sub-standard care you definitely need to change physicians. This in and of itself can be a stressful and time consuming process.

Wishing you the best of luck.

[depglass]

Aren't you supposed to see a breast surgeon? Get that taken care of before you spend your effort switching from your PCP. Priorities.