In my last column ("Do You Welcome New Patients?" October 18, 1999), I talked about the difficulties I encountered in finding my mother a chiropractor. I'd like to continue on through her first visit and report of findings. Although I got all the information second-hand, I did check it out with the chiropractor later, during an unexpected encounter. Let me set the stage for those of you who didn't read my last column or don't recall the details.
Late in the summer, my 80-year-old mom visited an old friend in New Hampshire. The days were blazing hot, the humidity high, and the exertion level, although mild, more than what she was normally accustomed to. Shortly before I arrived, she stepped onto a balcony for a cigarette (I know, you tell her!) and promptly passed out. She seemed mildly shaken, but fortunately, none the worse for wear. My sister insisted she see a doctor (MD), and I insisted she see a doctor (DC).
My last column covered the difficulties of screening want ads, calling with typical new patient questions, and eventually choosing a doctor for her. Remember: it was my idea that she see a chiropractor. Mom felt we were making entirely too much of the whole incident. When she made her first visit to her chiropractor, here's where she stood. Extensive medical testing had ruled out stroke, heart problems, diabetes, carotid artery disease, etc. A few days after her fall, her right leg began to hurt and quickly accelerated until she couldn't walk without holding on to something. That problem disappeared after a few days of heavy pain medication (borrowed and self-prescribed). She also has chronic gall bladder disease which has landed her in the hospital.
As far as I was concerned, she needed to get to a chiropractor now! She'd been a long-term check-up patient years ago in Miami, until both she and her chiropractor moved. I "prepped" her for her first visit, reminding her that she'd be examined, x-rayed, and would probably get a recommendation for a period of time. She mentioned that two ladies in her bridge club needed a chiropractor, too. My response was, "Let's get you started, and then you can tell them all about it."
I called after her first visit to see what the chiropractor had to say. I asked what he did, how often she'd be going into his office - all the things the family wants to know. I could barely keep myself from exploding when she announced that he'd examined and adjusted her and told her to come back in a month. With great difficulty, I asked what he thought about her fainting. She hadn't mentioned the fainting "Did he see any neck involvement on the x-rays?" I asked. X-rays? He didn't take any x-rays!
I continued casually asking questions about her visit. "What did he say about the problem with your leg (that had nearly landed her in a wheelchair)?
"He didn't say anything."
"Did you tell him about it?"
"He didn't ask; besides, it's not bothering me now."
"Well, did you mention your gall bladder?"
"What for? It doesn't bother me unless I eat something real greasy." Apparently she indicated to him that she was "only there at my insistence" and "was really in fairly good shape as substantiated by her battery of medical tests." As Mom puts it, "I smoke, I drink a few margaritas, and I carouse!"
After giving myself time for my blood pressure to return to normal and my incipient aneurysm to deflate, I continued probing. She had decided "he was a nice young man." I congratulated her on actually going to the chiropractor, then hung up. I needed time to think. The next day, I called my son (and chiropractor) and asked him whether he thought I should talk with the chiropractor in question.
My son was as upset as I was. Our concerns? "She fell," "hidden fractures," "unexplained leg pain and temporary decrease in function," "Medicare law," "her gall bladder" and "unexplained faint" bounced back and forth in our conversation. He volunteered to call and have a "doctor-to-doctor" chat. I suggested we both cool off.
As luck would have it, enough time passed that her chiropractor saw my column and e-mailed me. As I feared, my mom had sucked him right in with her "smoke, drink, carouse" routine. He hadn't done a thorough case history - you know, the kind with him asking questions because he's suspicious when an 80 year old has no problems. Because of staff changes and an unexpected number of new patients, he hadn't bothered to take x-rays. He didn't understand it was not only dangerously bad patient care, but also a violation of Medicare regulations.
I hope that he and you consider yourselves lucky this time. Next time, it could be a fracture (and a lawsuit) that arrive with that nice little old lady. I told my mom that she had deceived the doctor by not volunteering all of the above information. She still doesn't see it that way. To make sure that she comes clean, I told the chiropractor everything I've told you today. I also told mom and the chiropractor that if she wasn't completely examined and x-rayed where necessary, there was going to be hell to pay when I got there at Christmas.
Do I have a lot of nerve interfering with my mom's care? I don't think so. I care about the standard of care she receives. I would demand the same for myself. I flew to Florida, just for one day, to be there when her MD gave her a report on all her tests. I asked lots of questions, and it wasn't a problem. As for all of you? Look out for the little old ladies! I won't be there to run interference for you.
Please! Don't tell me my mom should change DCs. I think things are all straightened out, and I don't think I can take the strain! Don't ask who the DC is: that's not the point. Don't tell me about the change in Medicare law regarding x-rays: it wasn't in force last summer. Besides, I can't believe anyone in their right mind would adjust an 80 year old, knowing all of the above, without taking an x-ray.
As always, thanks for your calls, letters and e-mails. If the doctor from Louisiana (Dr. H something) will call again, my machine cut you off, probably because you were very soft-spoken and paused frequently.
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