A Patient’s Open Letter to Christie Clinic

A Patient’s Open Letter to Christie Clinic

To the Christie Clinic Board of Directors:

On Tuesday, February 10, 2015, I had an appointment with a doctor at your Windsor location. Having been diagnosed by this doctor with fibromyalgia late last year, I was due for a two-month check up, the purpose of which, I presume, was to make sure that the condition and the pain related to the condition were being managed adequately and that the benefits of the drug I had been prescribed outweighed any risks.

Instead of a helpful exchange with the doctor where I was able to voice my concerns, I endured a very frustrating three minutes in the exam room. I had planned to ask the doctor for his professional opinion about three things that concerned me, but was interrupted at almost every turn without even getting to questions two and three. That evening, I wrote an emotional blog post about the experience, which you can read here. I make no apologies for the language within that post.

My first concern was related to an irregular spike in weight gain. When I asked the doctor about this, he told me many times that there was nothing for me to do except exercise more and eat “food without calories.”

I tried explaining that the 12 pounds I had gained in the past two months was abnormal for me, that hunger signals weren’t suppressed even after meals, and that I constantly felt hungry. If that message got through to him, it was dismissed without discussion or explanation.

In my family, there is a history of high cholesterol, and my own blood work has shown that I already have high cholesterol. So my concern regarding my weight is not merely an issue of vanity. Putting on additional pounds can make my cholesterol even more difficult to control. I might have had an opportunity to explain this to the doctor as well if he had paused for a moment or two to stop admonishing me about diet and exercise.

When I could finally get a word in, I very frankly asked if there were any possibility the weight gain could be related to my thyroid. (After receiving radioactive iodine therapy for an overactive nodule about a decade ago, I, as expected, developed hypothyroidism. I take medication daily for an underactive thyroid, and the doctor was aware of this. Not only was it discussed during my initial visit with him, but it was also included in personal health records maintained by the Clinic.)

The doctor unequivocally told me that my thyroid condition could not be causing my abnormal weight gain. Maybe I am just gluttonous and lazy, but the fact that he never tested my thyroid levels since I started the fibromyalgia prescription gives me zero confidence in his assumption.

Underactive thyroid is listed as a rare but severe potential side effect of the medicine I was prescribed. And, of course, weight gain is a common symptom of an underactive thyroid. In addition, the following verbiage can be found on the personal prescription information leaflet that accompanies my fibromyalgia prescription:

“CONTACT YOUR DOCTOR IMMEDIATELY if you experience […] unusual weight changes.”

And then there’s this additional disclaimer at the end of the extensive list:

“This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your medical provider.”

As a patient seeking assistance from a medical professional, the best tool I have to advocate for my health is my voice. If I am cut off, if my concerns are dismissed, and if I am rushed out of the exam room, or if I have any doubt at all that my doctor is actually listening to my feedback, the doctor-patient relationship has deteriorated to the point that negative health consequences are a real concern.

Like many other patients for whom money is a significant problem, I understand that medical services are never going to be cheap. However, when your clinic receives a $50 co-pay before I even see the doctor, and then my insurance company pays hundreds more after my visit, I expect to be given more than three minutes with the doctor. I also expect that the doctor will not repeatedly cut me off during that time. So, you tell me: Does my doctor lack interpersonal skills? Does Christie Clinic incentivize doctors for rushing patients away? Is it some combination of both? Or does my doctor just want to make sure I continue taking the medicine he prescribed regardless of its effectiveness or consequences?

After reviewing information reported at openpaymentsdata.cms.gov, I learned that my doctor received over $3,000 in combined payments from pharmaceutical companies AbbVie and Pfizer in the last quarter of 2013. While neither of these companies manufactures the drug that has been prescribed for me, the fact that he takes payments at all from Big Pharma makes his decision not to investigate my concerns about the drug, his decision not to discuss alternative treatments, and his near-threat that if I reduced my dosage I would suffer more pain, seem even more dubious. I will be watching as drug company payments to this doctor are reported for 2014.

As a result of this experience, I have very little confidence in my diagnosis. In fact, some small part of me now wonders whether the diagnosis was merely a means to placate me as a result of some preconceived notion that I am an attention seeker. If fibromyalgia were indeed taken seriously by my doctor, I can’t believe he would flippantly tell me to keep pushing myself to exercise without, at the very least, inquiring about my current activity levels. And if he doesn’t take fibromyalgia seriously, why is he diagnosing it and prescribing for it?

I am sure you are annoyed that I’m putting all these questions to you, the Board of Directors of Christie Clinic, rather than taking them directly to the doctor in question. But I think I’ve already established he doesn’t listen to me. Perhaps you will. Perhaps you will look for ways to make Christie Clinic a more welcoming clinic for patients instead of just another pharma-friendly facility perpetuating the highest-cost, least-care-possible model of business that frustrates so many of us who require frequent access to health care services.

Sincerely,

Emily Suess
Champaign, IL

Does Cymbalta Cause Weight Gain?

Does Cymbalta Cause Weight Gain?

…The world may never know.

I’m not quite sure what it means for me to say that today I feel depressed, considering a couple months back I was diagnosed with “depressive disorder, not elsewhere classified.” But after an appointment with my rheumatologist today, depressed seems the best way to describe my state. As a rule, I typically feel pretty goddamn normal. That is, until some asshole reduces me to angry tears.

Today’s appointment was scheduled as a two-month checkup to make sure my Cymbalta was still working and my fibromyalgia pain was bearable. The nurse weighed me and took my BP, then asked how I was feeling before the rheumatologist came in.

“Well, I’ve been better. I don’t know if you noticed, but my weight shot up 12 pounds since the last time I was here.” He clicked a few keys on the laptop and pulled up my records.

“Oh, yeah. I do see that now.”

“Well, I’ve never been terribly skinny, and I’ve been known to put on a few pounds over the years. But that’s abnormal for me. You can see it on my chart. I’m not sure if it’s a side-effect or part of the fibro or what. I wanted to ask about it.”

The nurse recommended that I bring it up with the doctor. He hadn’t heard that Cymbalta could cause weight gain and thought maybe the rheumatologist would want to check my thyroid levels again just to make sure I was within range. Sounded like a plan to me; the rheumatologist came in a few minutes later to ask me how I felt.” He was scribbling shit on my chart already.

“I’m doing mostly…”

“You’re doing good?” he interrupted. “Mood OK? Pain OK?”

“I think so, yes, I replied. But I have a few questions for you.”

“Sure,” he said. So I brought up the weight thing, and told him about my recent, uncharacteristic gain.

“Oh well, I’ve heard two or three pounds maybe, but never 10 or 12 on Cymbalta. You need to exercise more.”

“I’ve been exercising more and I bought a pedal desk for working on the comp…”

“That’s good.” He scribbled something else. “Stop eating food with calories.”

“…”

I had no response for that. Stop eating food with calories? Really? Immediately I saw the old women from that hilarious Esurance commercial flash through my mind. “That’s not how this works,” the one says. “That’s not how any of this works.” Maybe it was just that he was a non-native English speaker.

I attempted to add some explanation. “You see, it’s not normal for me. That full signal I used to get after a meal? That doesn’t happen anymore. And I’m constantly hungry to the point that my brain is distracting me with…”

“Exercise more. I mean, I could put you back down to 30mg of Cymbalta, but then you would be in a lot of pain.” Whether he meant it to or not, his tone came off as threatening.

“But what about my thyroid? Are you saying there’s no way any of this could possibly be caused by a dosage that needs tweaking for my…”

“No. Absolutely not. Exercise more and start eating things without calories when you get a craving. You might need to enroll in a weight loss program and see a dietitian for counseling.”

At this point I was fighting back tears. It takes me some time to flip my thick skin switch, and I wasn’t expecting to need thick skin at my motherfucking rheumatologist’s office. So I was emotionally a little off-kilter.

“Stop eating so much,” he said one last time. But at this point my back was to him. I was getting my purse and putting on my coat while mouthing “cocksucking, motherfucking asswipe cunt whore.” Once my coat was buttoned, I grabbed the yellow paper from his hands. “See you in three months,” he said.

The fuck you will, I thought. I left  without even the chance to ask him about the pain in my big toes or the odd, tender bump high on my sternum between my boobs — and whether he thought it might simply be costochondritis (which seems to be prevalent among those diagnosed with fibro) or whether it might need to be investigated further.

I couldn’t get to my car fast enough. When I slammed the door and started the engine, I started sobbing.

A few days ago I got a letter in the mail that my primary care doctor, who works in the same clinic as my rheumatoglogist, was moving her practice. I was going to be looking for a new PCP anyway. This seems like the perfect time to switch health systems. Second opinions all the way around. I don’t expect doctors to be all-knowing gods, but they damn sure better let me finish a sentence.

I can’t believe I paid a $50 co-pay UPFRONT! for a lousy three minutes of interruption and judgment.

Pin It on Pinterest