July 25, 2012
Claire Pomeroy, M.D., M.B.A
Dean, School of Medicine
UC Davis Education Building
4610 X Street, Suite 3101
Sacramento, CA 95817
Re: Treatment at UC Davis Medical Center
Dean Pomeroy:
I am writing to bring to your attention evidence of the poor education your school is providing its doctors and the resulting impact on patients. The matters I refer to are endemic throughout the UC Davis Medical Group suggesting that the UC Davis Medical School’s curriculum is at fault.
The situation borders on malpractice on a systemic level.
Introduction
I have been a patient at UC Davis since July of 2008. The following statements apply to all the various practices I have been to, unless an exception is explicitly noted. Topic titles are in bold print for easier reference. The considerations here are isolated neither in time nor by individual. This letter is long overdue.
Refills
I would estimate that in 75% of the cases in which I have sent in a timely request for a medication refill – either by calling the office in question myself or by having my pharmacy send it – go unanswered until after I run out. I’m talking about long-term medications which I have been taking daily for several years. About 5% of the time, the first request is answered in a timely fashion. The remaining 20% of the time the first request is ignored, but I manage to get a response before I run out. This track record is even applicable to my Lamictal prescription, which could potentially kill me if stopped abruptly; it might still take three or four requests, but since I know the dangers of running out, I’m more careful and conscientious than my doctors or their office staff.
Phone calls in general
Most of the time I put in a call to one of my doctors, I hear nothing back and have to make subsequent phone calls. Usually the person I speak to doesn’t accurately pass on the message, which has resulted in all kinds of risks to my health, not to mention another merry-go-round of difficult phone calls. Which leads me to…
The My Chart Program
Only my family practice is any good at all in responding to this method of communication. I was very excited when it was initiated because I thought I would finally be able to pass my doctors the correct information they needed to respond to whatever my problem was. The other practices reply late or never, however, so it hasn’t been nearly as helpful as I thought it would be.
Interdepartmental Communication
It would take on the order of a thousand words to describe just one example of how the system has failed me badly in this area. In an attempt at brevity, I’ll just say this: after I got a blood clot during my cancer treatment, the hospital apparently told none of the interested parties, including the doctor who was heading the Cumadin Clinic.
Note: The above issues may be less a matter of the doctors’ education and more about poor policies or policy enforcement. Either way it falls under your purview, Dr. Pomeroy.
Pain Management – This topic makes me angry and disgusts me.
In every practice and every exam room at UC Davis there is a brochure describing the UC Davis policy on pain management. Primary among the things the brochure says which are not, in fact, practiced by the doctors in this medical group, is the accurate statement that a patient heals better and faster if they aren’t in pain while recovering. This is as true for a boo-boo as it is for major surgery. With the exception of Dr. Scott Christensen, this “policy” is disregarded by every single doctor I’ve dealt with in the four years I’ve been a UC Davis patient.
Not only is the so-called policy ignored, but so is my medical history. I’ve always metabolized medications faster than the “norm.” This information should be in my chart, as it has come up over and over. Also, during the course of my treatment for breast cancer, I completely wore out the ability for hydrocodone to help me. Dr. Christensen – the only doctor I’ve seen who seems to understand pain – told me not to bother taking it ever again. Thus I need stronger, different medications. Anyone taking a passing glance at my medication history would be able to see that I need a larger dose, at a shorter interval, than the average patient. I am not a drug seeker. I’m just a person whose needs aren’t being met. This has caused me, on several occasions, to need to contact the prescribing doctor again…. which leads to the above stated problems about communication, and is a waste of everyone’s time. It has also led to a great deal of suffering on my part.
Also easily found in my medical records is the fact that I have stated over and over until I’m blue in the face that NSAIDs have never worked for me and will never work for me. I’m forty-two years old: if they haven’t helped by now it’s simply not going to happen. I have given them a try – in an effort to be “compliant” – repeatedly during the course of being a patient at UC Davis. My final straw was when a doctor had me shot in the butt with one of these drugs. The shot resulted in about forty-two minutes of pain at the injection site and about five minutes of mild nausea which occurred approximately fifteen minutes after the shot was administered. There were no beneficial results. That’s it. I’m done trying. I don’t want any doctor ever again to even suggest NSAIDs. I wish this could be the first thing any doctor sees when looking at my chart, no matter why I’m there: I WILL NOT TAKE NSAIDs. THEY DON’T HELP. AT ALL. EVEN WITH SWELLING. DON’T EVEN THINK ABOUT SUGGESTING THEM. Big red letters would be appropriate, since apparently nobody can be bothered to read my chart.
It makes me very uncomfortable to have to explain my needs over and over and over. It makes me feel like I’m being judged, and harshly at that. At this point it also makes me feel tired. I shouldn’t have to do this. The doctors should take a look at my file and see what I need, and not waste my time and energy trying to make do with uninformed decisions.
It makes me sick to think of how many patients have been misled and poorly treated as a result of every doctor in your practices (again, except for Dr. Christensen) completely ignoring the policies that you have seen fit to distribute to every exam room.
“Addictive Drugs”
Most drugs, if taken over time, cannot be stopped abruptly. The doctors in your practices, students of your Medical School, seem to have some deranged idea that addiction to, say, a psychiatric medication is not a bad thing, but addiction to any controlled substance is to be avoided at all costs.
My husband ran into this when he sought treatment for debilitating anxiety. The doctor he saw prescribed Paxil, which you must “ramp” up and down to take. As someone who has had to stop taking a number of SSRIs, I can assure you that going off these drugs is an awful experience. The same doctor was extremely reluctant to prescribe Lorazepam – even though my husband was in an acute and (hopefully) temporary crisis – and when he did, he prescribed an amount that not only was less than my husband informed him was necessary for him to function, but he didn’t even prescribe enough to last until the follow-up visit assuming that he took the medication as prescribed. Let me stress this: The medication, as prescribed, was insufficient to last the two weeks the doctor put between visit and follow-up.
I’m going to paraphrase the above paragraph, because the facts bear repeating: The doctor cavalierly prescribed a drug that is well known to be time consuming and uncomfortable to discontinue, which he had no idea if would be effective at all, and which would take several weeks to reach beneficial and therapeutic results. Then he very reluctantly prescribed a medication that would immediately address the patient’s acute situation on the grounds that it might be habit forming.
I find that so preposterous that it takes my breath away. It literally strikes me as either insane or retarded (in the medical sense of the word, not as a derogatory term). Honestly it does. It makes less than no sense.
And it is very nearly malpractice. If this perspective is being taught at your medical school, it must stop. It’s wrong in that it’s inaccurate and dangerous, and it’s wrong in a moral sense. Any professor who teaches this point of view should be very very ashamed of his or herself.
Etc.
I’m not going to go in-depth into the “one example” instances in which I have been unquestionably horribly mistreated. They include but are not limited to the following:
- A random doctor puncturing my expander then leaving me in a room by myself. Leaving. Not coming back. Not answering frantic phone calls. Not accomplishing what he was supposed to be doing in the first place (which was collecting a sample of the seroma (from an unhealed interior wound subsequent to my mastectomy) that appeared to have a bacterial infection).
- An adhesive tape which I am extremely allergic to being put on me when I was admitted to the hospital for a blood clot, while I had the red allergy band on. That was just the start of the horrifically bad treatment I received for said blood clot.
- Showing up for a post-surgery check to find that the office thought I was there for a pre-op to get a chest port, when I was, in fact, there because my arm port had just been removed. Furthermore, the woman didn’t know what to look for – she specifically stated this – and finally dismissed me with “Well, I guess it looks okay.” In other words: wrong in every way.
Those are all long involved stories, but I recognize that it may not be appropriate to extrapolate these isolated incidents into some over-arching conclusion of endemic ineptitude. In this they are different from the categories already discussed, which apply, as I’ve said, to all practices and practitioners, unless specifically noted otherwise.
Conclusion
I don’t think I can take this much longer. As much as I hate “doctor shopping”. As much as I love Dr. Christensen, who is extremely knowledgeable about every aspect of his trade. (It genuinely shocked me when I looked up his education and found that he was a UC Davis graduate. The school must have been better in those days.) The treatment has been so bad on so many levels from so many providers that it is appalling. I used to think that it was worthwhile to stick with UC Davis because of the electronic chart, which all practitioners can access. I have finally had to accept that this technology isn’t being used in a way that is helpful to me.
For the benefit of the countless patients treated by UC Davis, I beg you to consider these things seriously. It can’t be just me, it’s too consistent and widespread. The doctors are being poorly educated and patients are the ones who suffer for it.
Please respond to this letter in writing. Phone calls will not be accepted at this time. Thank you.
Very sincerely,
Katherine Folland
Write to me at:
[redacted for the web]
or
[redacted for the web]
cc:
UC Davis Medical Group Patient Relations, 2315 Stockton Blvd, Sacramento, CA 95817
The internet