..what are the ethics involved?
Let me recap my situation for newbies. Pardon my redundancy but I don't want to make people chase links, although I will include them.
Here's the story:
You might be shocked to know I had breast cancer. No, really, I did! Sometimes even I find it hard to believe.
I chose the only reconstruction option a skinny chick like me can have - reconstruction with a tissue expander. After seeing the first plastic surgeon I was referred to, and not liking what I saw of his work, I got a second opinion from Dr. S, who agreed to treat me.
Or so I thought.
At the time of my mastectomy, October 21, 2009, this physician put in expander and did all my subsequent saline fills. I had numerous appointments with him, all of which he canceled and rescheduled. I got my last fill in February, and I was done.
Surgery to exchange the expander for an implant wasn't scheduled until June 8th. I prepared myself mentally for my final results, and was eager to at least be comfortable, as the expander, to say the least, is not.
The evening of June 7th, excited yet nervous for my upcoming surgery, I put a scopolamine patch behind my ear as I was instructed, and went to bed. My husband, who had taken the day off work, got up with me at 5:30 a.m. I was dizzy and light-headed from the drug, and of course, didn't eat. We arrived at the hospital by 6:30 a.m. My husband left to go home and take our son to school, and then came back.
I undressed. An IV was started. My blood pressure was taken. I was placed in a hospital bed.
And there I sat, dozing and dopey from the drug, for four hours.
At 10:00 a.m., hours after my surgery was to take place, Dr. S came in and told me that my implants had never arrived and surgery was off. Ominously (in retrospect), he said that was the reason he preferred to do operations in his own surgical center, to prevent these kinds of problems. (I couldn't go to his surgical center for insurance reasons.)
A couple of days and another canceled appointment later, he told me over the phone that he was not going to be my doctor anymore. He said it was nothing I had done, but he had decided not to do reconstructions any longer, which I took to mean he didn't want to deal with insurance companies anymore.
I was upset, naturally, but I wished him good health and accepted the decision. After the hospital fiasco, I felt it might even be for the best.
He verbally referred me to another plastic surgeon, Combat Doctor, and said he had spoken to her that weekend and she agreed to take me, and he had cleared it with my insurance. I was told to call immediately - which I did - and she'd get me right in.
When I called, I discovered that she had broken her pelvis, which, amazingly, she had failed to mention to Dr. S. Her office gave me an appointment for six weeks down the road, July 27th, when she was expected to have healed. They told me surgeries were backed up past October, which sent me into a funk.
I was clearly not getting this expander out of me any time soon.
Two weeks ago, her office canceled our appointment. She is not better.
And, of course, I feel bad for her. She has a terrible injury and I know that it's no fun.
Her office offered me an appointment with her partner. They said he was a "wonderful doctor." Googling, I see he graduated med school just a few years ago and does not have her breadth of experience. But, I am ready to get this expander out of me, and maybe he knows some new tricks. I like young people. I set up an appointment to at least meet him on July 30th.
In the mail today, I received a letter from my insurance company, which said, and I paraphrase, that they have not received enough information for me to see this new doctor. They don't have my full clinical history. My old plastic surgeon has 45 days to comply with their request or I will be denied care.
I might remind you, they said they had taken care of this right after June 8th.
Now, I don't think a doctor should be forced to treat a patient if he doesn't want to. However, I wasn't an abusive patient. I complied with all instructions. He canceled many appointments with me - I never canceled one with him. I never complained - in fact, his office staff liked me well enough to get me some free Latisse.
I was so understanding that in the hospital, on that fateful day, that when he apologized my response was, "Don't apologize, it's not your fault, things happen." At the time, I assumed it was the hospital's mistake.
But, honestly, is it the truth that it's not his fault? He is the physician. Shouldn't he have been the one responsible for making sure that my implants had arrived before surgery that day? Should surgery even have been scheduled until they arrived?
The physician/patient one is not equal. We are not at a cocktail party where he can notice my breath is bad, decide not to talk to me anymore, and just walk away. He has an obligation - has even taken an oath - to see that I am taken care of once he accepts me as a patient, doesn't he? Even if he decides he only wants to take cash patients in his own surgical center - shouldn't he have seen to it that he referred me to a doctor who was functional?
I depended on his knowledge, and I foolishly trusted him. I was going to allow him to cut me open, flay my muscles, restore my appearance. I believed him when he said I would not be perfectly happy with my appearance but that he would do the best he could. I undressed in front of him, allowed him to take photos, touch my breasts. I gave him intimate information and had faith he would care for it all.
And, for me.
And, he abandoned me for money, and has left me without care. It has been 38 days since I was supposed to have surgery and 6 months since my body was ready to have it - and the insurance company still doesn't have the information they need. If I have a problem; if the expander becomes infected, if it becomes damaged - I have no doctor to treat me. The expander has been in for ten months already and my last fill was in February. The valve is pushing through the skin, and is causing me discomfort, and I have permanent bruising. I cannot have MRIs, or fly without setting off an alarm, or have any other medical tests on my formerly cancerous side, and I should be doing that every six months.
I looked up the term patient abandonment. Patient abandonment is described as the unilateral withdrawal by a physician from a patient's care without first formally transferring that care to another qualified physician who is acceptable to the patient. I have been without medical care now since June 8th. Combat Doctor is certainly qualified - but she isn't functional. I believe the doctor thought he transferred my care to another doctor, but like with the missing implants, he didn't have any kind of follow-up. (Yes, I did call his office staff and tell them.)
I've never received any kind of letter or medical records or anything from this doctor. All I got was a phone call firing me - a call which I initiated.
Most women who had mastectomies the same time that I did have completed their reconstructive surgeries and have been able to get on with their lives by now.
And, I'm still waiting. In limbo. And, in discomfort.
My plan is not to do anything legally so no suggestions about that. I am not medically harmed, but I am living in discomfort much longer than I should have.
I am just curious as to whether this situation violates any medical ethics, or is normal.
Doctors, what do you think?