Apr 28, 2014 appointment with the Dr/Respondent

                                                                                                                               Sue McPherson

long transcript – of 21 minute recording, mentioned in 

Human Rights Tribunals: privacy and transparency
Sue's views on the News
Sept 20, 2015

Dr   Hello

Sue McPherson Hello.  

Dr   Okay

Sue McPherson  Well I’ve brought my prescriptions to be renewed. But I also wanted to ask you about iron pills. And whether I’m still supposed to be taking them. I never take a full tablet anyway, so, I take a partial tablet, but I was looking it up, because it  ? was from over a year ago. And the current level is 41, it looks like it was circled and I didn’t what that meant, but I didn’t know whether I was still supposed to be taking it. Cause that’s the blood test from last April. I started taking the ferritin before then, right, when it was reading 18.

Dr   It’s low, okay.

Sue McPherson  You say 18 is low.

Dr   Yes

Sue McPherson  What about 12. No one said anything when it was 12. And then I didn’t get tested again until . . . November, 2012. So am I supposed to be taking it, it’s at [level] 41?

Dr   Yes, that’s a normal reading, okay.

Sue McPherson  You don’t think that could be a sign that something else is wrong? 

Dr    No, ???   ?? 

Sue McPherson. . . . .It’s been a year, should I have that tested again now? And everything tested. I mean …… should we do the prescriptions first?  I mean the renewals of the prescriptions, and then see?  

Dr    [getting out Rx renewal information]  So this is where we are right now ???  What are you looking for?    ??   This paper is the renewal.

Dr      Yes, so, for the iron you know you can take iron supplements, we don’t have checking  - every year, so I’m going to recommend you take it for one year. . . .  Nothing will happen to you if you stop it [or take it] ??. It’s not dangerous, you know. You can take the iron for another 6 months and stop it. 

Sue McPherson I’ve been taking it off and on for a year and a half.

Dr   Okay

Sue McPherson  But it interferes with my digestion.

Dr    Yes, then stop it .

Sue McPherson  I didn’t know if I really needed to . . . . But regarding the renewal, I was wondering ?????  changing the amlopidine back to half a tablet, half a 5 mg tablet. 

Dr  – You take 5 mg – ½ tablet, right?

Sue McPherson   . . ???? It was affecting me . .. 

Dr  In general, we increased it to 10 mg?

Sue McPherson  Exactly ??? and now I’m wondering if I should – if we shouldn’t bring the valsartan - the diovan, it should be back to what it was originally, 160. That’s what I was taking when I came to you, and I was thinking maybe  - those are just drug pressures [explained about the ticket from the blood pressure machine that he was now holding] at Shoppers Drug Mart. 
Dr  Your pressures are good. I will check it again, yes. Would you sit down there?

Sue McPherson Yes, I thought they looked really okay. But a couple of them – I did start to take an increased dose of the diovan – two or three weeks ago, but then I ran out of the extra so I couldn’t actually keep it up, and  . .. but when you’re taking diovan it affects more than blood pressure, right? 

Dr  Yes. Right

Sue McPherson  And if he gave what – 2 mg

Dr   No, no I gave it to you the thing is going down, that’s why

Sue McPherson Pardon me?

Dr   The kidney function is too low - That’s why I  tell you to do it

Sue McPherson  But I . . . 

Dr   It protects the kidneys. But you know, diovan protects the kidneys but sometimes the kidney function is becoming low, and diovan affects the kidneys too.  Okay

Sue McPherson  But the other thing is that, if I’m not taking the proper medication for my blood pressure, it’s going to affect my heart.

Dr . We’ll check your blood pressure. Your blood pressure’s good . . . . . .???? change. 

Have you seen the kidney doctor?

Sue McPherson   No. I’m not sure that’s what I want to do right now, but I’ll think about it. 

Dr  That’s good. 140 over 80. But it should be okay at home, okay. About 130. So, I don’t want to change anything now.

Sue McPherson  Just the amlipidine?

Dr  Amlo - podine. 

Sue McPherson Change that down to 

Dr   No, you take 10 

Sue McPherson  No. what?

Dr  Take 10 mg.

Sue McPherson  but we already cut it back to 5 mg.  And then we . .. 

Dr   And then we increased to 10

Sue McPherson  You increased it to 10 a couple of months ago.

Dr   Yes.

Sue McPherson  or maybe 3 months ago.

Dr  Yeah, yeah, yeah.

Sue McPherson  But that wasn’t good because I got sypmtoms from that – increased symptoms – of arrythmia, or whatever. And I recall having tightness across my chest. And I’m getting these symptoms of laboured breathing – after exercise. 

Dr  From the amlopidine?

Sue McPherson  I don’t know what the cause is, but that’s why I think it should all go back to what it was. And maybe I should see a cardiologist or something. 

Dr   Well you have to see the kidney specialist. And the cardiologist, okay.  Go see the kidney specialist, because your kidney function is going down. They are internists – they know about the heart, too, okay? And he will ?????? see about the medicine.  Alright? So for the time being, you continue take the same pills - 10 mg.

Sue McPherson  No I won’t take 10 mg. of amlopidine. It gives me palpitations – I get a lot of them . . .

Dr  Okay then I will write down this patient is asking for me – I’ll give you the medications, okay? You want me to increase your prescription to the previous dose? The Valsartan  - 160?  Diovan?

Sue McPherson   And amlopidine down to ½ tablet of 5 mg.

Dr       ????????????????         up to you.  ????? patient requesting ?????????    [writing]  So????????? 
I’m going to call you but I have previous patients. You wanted to go there [to see the nephrologist]. You have to go there, okay 

Sue McPherson  When I talked to the person there [at nephrologist’s ofice] they told me, they told me that on the referral was “at the patient’s request.”

Dr   Yes.

Sue McPherson  And I don’t want that on any referral because it comes across as the Dr doesn’t think I need to go see him, but that it’s only at my request. And I wonder, what’s the point in going, if thinks I am just a patient who is demanding to go to a nephrologist. I didn’t ask to see him. I wanted to . . .   

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.

End of short excerpt of the Apr 28, 2014 appt.

Sue McPherson   [I took the container and went to the washroom to get the sample of urine – for which I was required to pick up key at the Pharmacy, but then changed my mind.  3 minutes later I return to receptionist, who is behind the counter]

Sue McPherson [to the receptionist]. No I’m not going to do it right now. I’m going to take it to a lab and let them, and do it there.

Dr  ?????????????????? [ He is standing 12 feet away, across the waiting room, in his practice area]. 

Receptionist  He’s asked - you’re expected to - do it right now. Do you want some water?

Sue McPherson   No, I don’t.

Receptionist  Well he’s asking that you give it right now.

Sue McPherson  [to the receptionist]   No, I’m not going to do it right now. I don’t know who’s going to be checking it. I don’t know what I am getting into here.  ?????  ?????????? [I was also concerned because the container for the sample did not have my name on it.] 

Well if you want to cancel that [ the rx for Tylenol 2] then you have to. But I’m not going to do it.  I can go to a lab right now, and get it done. And they’ll do it there. You can do whatever you want [re the prescription for Tylenol 2].
[At that point I left the building, went to my car, then decided to return to ask them – the doctor or receptionist -  for a requisition form]

Sue McPherson     I need a form. I’m not going to be able to get the test done without a form.

Dr   ????? [He is still standing 12 feet away. I can’t hear what he is saying.]  

Sue McPherson   I’m just asking you for a form

Dr  ?????????????

Sue McPherson Pardon me?

Dr   [at other side of the waiting room] - ??????? 

Sue McPherson  If you give me a form for the lab, I’ll take it.   . . . . Who does it? Who looks at it.  [The container was blank, had no name on the label]. I would rather take it to a lab, thanks. I’ll get a form, and I’ll take it to a lab and give them a sample.  [Neither the doctor nor the receptionist responded to my request for a form to take to the 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, I discovered later]

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.

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