Report inappropriate billing, care

Dear Dr. Gott: I am a white female, 65 years of age. One morning in early November, six months before my 65th birthday, I suddenly felt strange. My symptoms were, in rapid succession: a feeling of anxiety, chill, vertigo, violent vomiting and weakness. The weakness and almost total lack of control of my limbs made it difficult for my husband to get me into the car for the trip to the emergency room. I thought I was having a stroke. During the trip, my husband says I collapsed into a bundle beside him, clutching a “barf” bucket, alternately vomiting and praying aloud.

At the emergency room, staff were waiting at the curb with a wheelchair, and I had to be all but lifted into the chair. I remained lucid the entire time and could answer questions, with some thickness of tongue, it seemed to me. A drip was started (Phenobarbital) and an EKG administered. My blood pressure was highly elevated, I had rapid nystagmus (eye fluttering), etc. One doctor quickly told me they thought I had a “virus in my brain,” not unlike Bell’s Palsy, which affects the face, and that it would probably last “about two weeks.” I saw numerous staff doctors. Tests included several EKGs, lung X-rays, cross-section lung X-rays, a CAT scan and blood work. For three days, I was in a semi-darkened ICU room on an intravenous drip, nothing by mouth, with constant monitoring of my blood pressure, before I was released.

I was referred to and have seen a neurologist, a heart specialist because of my blood pressure and “something” that showed up on my EKG – “which may only have been caused by a breathing pattern,” per the cardiologist – an ENT to rule out Meniere’s. I had a heart sonogram, a stress test with another sonogram that showed my heart pumping “excellent” (sic), but some thickening of the heart muscle. An MRI of my head and spine were normal. When I saw the neurologist, after sophisticated testing that included a computer, goggles, rapid rotation, and warm and cold water in my ears, he diagnosed vestibular neuritis (inflammation of the hearing nerves). Recovery has been slow and difficult at best. The neurologist said symptoms shouldn’t last longer than six months. It’s now almost eight months, and while I’m much better, my gait is still off-balance – sometimes worse than others – my head still often feels as if there’s a heavy weight in it, and I’m very tired. My life is truly restricted. It’s as if my center of gravity has moved. I sometimes wander to one side or the other or even rock forward on my toes or back onto my heels. I try to walk one mile every day. My double vision comes and goes, but this is not as frequent, and my eyesight in general is worse. I’ve seen my doctor several times, and he ordered more tests each time, as well as prescribed meclizine.

Our medical care and the medical facility are questionable at best, frightening at the worst. For instance, our beautiful, well-equipped hospital employs what I refer to privately as “rent-a-docs,” doctors who come into our hospital and are called hospitalists. They are on duty for 36 hours and then fly back to wherever they came from. One hospitalist gave me a medical workup and wrote prescriptions. I saw him perhaps for 15 minutes. He left to “fly away,” and his replacement hospitalist came in. He gave me a medical workup and wrote prescriptions. (I had six prescriptions, some of them duplicates.) How scary is that?! I do not mean to be irreverent or disrespectful, but it is very confusing. I got one bill for over $300 from a doctor in the emergency room who stepped into my cubicle for perhaps five minutes, did not touch me, made no diagnosis and offered no opinion. Shortly thereafter, a second emergency room doctor (this one sporting a ponytail and inflated ego) came into my cubicle, made no diagnosis and did not touch me, but stood for perhaps 15 minutes regaling my husband, son, daughter-in-law, and me with stories about himself – and his bill was $649. What are we to do?

Before the onset of this illness, I was retired, an active wife, mother, and grandma, playing ball and riding bikes with my three young grandsons, cooking/baking, planning family dinners, and always reacted on a moment’s notice to meet any/all family members at local restaurants for dinner, etc. I climbed up and down to clean, worked in the yard, etc.

Please forgive me. I realize this letter is long and rambling, but any advice you can give me that might improve the outcome of my illness would be so very greatly appreciated. Your comments about the state of medical service in areas such as ours would also be welcome.

Dear Reader: I am printing your letter in its entirety because it is an articulate summation of what was obviously an alarming experience, made worse by a lack of medical consistency. Vestibular neuritis is a disabling affliction because it affects the inner ear, which controls balance and other sensations.

It appears that you have had thorough and appropriate medical examinations and attention from suitable specialists. Therefore, I’m afraid that you will need to take your medicine and be patient. The symptoms of vestibular neuritis often take several months to clear up. No one knows the cause of this disorder, so treatment is, unfortunately, largely nonspecific. For example, it is not universally accepted as effective, in contrast to antibiotic therapy for a strep throat.

I’m truly sorry you had a bad experience; that must have been frightening. Perhaps you should address the issue of hospitalists with your private physician. In my experience, hospitalists are a welcome addition to aid in the care of seriously ill patients. If yours failed the test – as they appear to have done – personnel changes are certainly in order. Your hospital should not hire doctors who behave badly and grossly overcharge. Aside from being inappropriate in billing, such doctors could well attract lawsuits against the hospital. Your hospital appear to need hospitalists who feel comfortable becoming valuable members of the medical community, rather than catch-as-catch-can cowboy hospitalists, as you characterized them.

Medical follow-up after an experience with a serious illness is vital. Your primary care physician – or someone in his stead, not a 36-hour doc – is necessary because someone has to monitor the situation, adjust the medications, supervise further testing and simply be there for you.