Re: Email to a 2nd-Class Citizen from Dr.

[Guest guest]

I think Dr. ought to get together with Dr.

Rutledge of MGB fame (his WLS procedure causes

cancer and has other horrible side effects) for

romantic reasons. They are spiritual bedfellows, to be

sure.

Who says being fat and needing WLS ain't fun?

Dear Dr. ,

Thank you so much for finally getting around to

answering my inquiry. It was very enlightening. My

worst fears were confirmed by it. It deserves brief

commentary, in that a number of misconceptions are

contained in it.

Re: BPD/DS: Impatient Patient With Attitude:

IPWI

" Mr Planz,

I treat all of my patients the same, celebrities or

not. No one, not even the highly educated, extremely

motivated DS patient, gets special treatment. "

Really? That's hard believe. So you would give the

president of the United States or one of your

colleagues the benefit of your expertise if he did not

wish to go through all the hoops? The

psychology tests, the retests, the follow-up tests,

the boring and expensive interview with the dietitian,

and so on. This sort of adamantine conviction on your

part deserves recognition. Still, it does sound a

trifle over-the-edge...

In my email below, I mentioned Procrustes. Perhaps he

was a relative of yours. Procrustes was a thief and a

murderer who would capture travelers and tie them in

an iron bed. If they were longer than the bed, he

would hack off their limbs until they fit. If too

short, he would stretch them. He, too, knew the

meaning of " sticking to one's guns. " As far as I can

uncover, however, he is not the model for surgical

care in today's land of the free.

It is asking a lot to be special, and I want you to

know that even if you do not consider me or my kind

special, just fat, I consider you so. indeed, I hope

all your colleagues around the land aren't like you.

" Each surgeon has the right to design his or her

program how they want and also has the right to accept

or refuse to take on a patient in an elective

situation. "

Yes. The patient in such a situation must never

accommodated in any way. This is known in

medicological circles as 'the modern surgeon's

imperative'. Still, it's good that I did not have a

surgeon like you when I had my heart surgery, for I

would never have passed the mental tests in spite of

being highly motivated and of above-average

intelligence. Moreover, you can and do refuse to do

laparoscopic surgeries for reasons that are outside of

ASBS guidelines, as you diddle with psychological

tests and waste your patient's time with dietitians

that are unfamiliar with the procedures you do (I

mention these things because other patients have

mentioned them). This kind of privacy-invading

medicine, it occurs to me, skirts very close to

malpractice, as you play goddess with your prospective

patients who are, in many instances, begging for your

help and approval.

This situation reminds me of that story about a new

arrival in Heaven who is talking to Saint as this

balding, middle-aged guy drives up in a brand new

dark-blue Mercedes. He is going too fast. He stops at

Heaven's gate, almost running into it, and repeatedly

honks and makes a big to-do about the gate not opening

promptly enough. Finally, the gate opens, and he guns

the Mercedes, and heads past it on into Heaven. " Who's

that?' " the new arrival queries. He must be somebody

really important. " Saint answers, " That's just

God. " Then he makes a sign indicating that the Creator

is not quite all there with his index finger pointed

toward his head. Then he explains, " He thinks he's a

surgeon this week! " Maybe God was thinking of you,

Dr. , and your perspective on your patients

when he took on that surgeon persona.

" I am not aware of any other type of surgery where the

patient comes into the office demanding surgery, or

worse yet, via email. "

Is your office being invaded by patients demanding

surgery? If so, I suggest that you hire a guard to

keep them out. I have no intent to invade your office.

This is unequivocal on my part.

Still, Dr. Pattersnon, you imply that I am " demanding

surgery " from you. I did not demand anything from you,

ma'am. You misread the tone: It is not strident or

angry. You see, in my world demanding is demanding and

asking is asking, and the two diverge and are based

upon different mental states. There is neither urgency

or peremptory in my asking in the email query below.

Therefore, it does not qualify as demanding. I laid

down a set of facts, and then ask you a few questions.

You said, no, in so many, many ways. I guess, from

your superior perspective, asking a few questions via

email is tantamount to demanding something. With your

attitude, it's hard for me to imagine a poor patient

demanding anything from you.

I think, in fact, that you have it backwards, surgeons

command and demand, patients ask and acquiesce. I am

sure that you don't have any truly demanding patients

for long.

This, in truth, is an instance of what psychologists

and psychiatrists call " projection, " for the demanding

is all on your side. Admit it: One has to be a little

on the mental side to resort to projection from a

droll and mildly entertaining email inquiry such as

below.

Why would someone want to contact you by email and ask

a few questions? Because all that one gets when one

calls your offices are answering machines and one has

to leave messages and then one gets forms and then one

fills out the forms. This, in case you don't know, is

not the way most medicine is carried out in this

country. Well, I was a possible consumer who may have

a question or two for a real human being before I walk

the uncertain plank of your lengthy and hidden program

which is four hours away by vehicle. In truth, you

manage the relationship only on your terms and those

terms are way out of the norm. Only those, Dr.

, who are willing to put up with anything

will subject themselves to your program.

" As I am sure you are aware, I do require

psychological evaluation. "

Yes, even when the patient has already had a psych

workup, you would not be satisfied. You have already

indicated that you make no exceptions. You reinvent

the wheel with every patient. There is only one way to

do things: Emma's Way. You can't be too careful---a

neurotic might slip through your clutches and get

skinny. In the old days, surgeons just did surgeries;

they did not have to act as gatekeeper and jury, there

to make sure the patient deserves to get the

operation. One wonders if you are not doing psych

research and having the patient's insurance company

pay for your data.

" If you are interested in our program, then please

call and leave your name and addresss

on the bariatric extension. "

I am now not interested in your program. I could never

pass the psychological evaluation. Nor am I that

stupid. You see, I consider myself a consumer of

surgical services, as well as a patient. I do not want

to be a pawn in your surgical chess game. I have a

right to ask to be treated like a human being and not

a pawn. A few prospective patients can say no with

their feet.

That you accommodate no one for any reason, including

scheduling, makes you someone that needs to see a

shrink to shrink one enormous EGO.

----lcp

" Sincerely,

Emma J. , MD "

BPD/DS: Impatient Patient With Attitude: IPWI

" Dear Dr. :

I have gone through a complete physical and psych

workup for the obesity surgery with my personal

physician and psychiatrist. This included chest X-ray,

EKG, and blood workup. My internist is enthusiastic

about the surgery and has had several patients with

open RNYs. I had an-hour-long interview with the

psychiatrist. He okayed me for the surgery.

I have done a lot of research on these surgeries and

believe that you are competent to do a lap BPD/DS,

which is the preferred surgery from my perspective,

though you are not as experienced as some. I figure

that by the time a surgeon has done about 10 of these

procedures, he or she ought to be pretty adept at it.

You have exceeded this number, I'm sure. I have not

heard anything really bad about you on yahoo in the DS

group. I also feel that your professional interest in

baryatrics is a good thing.

I weigh a little over 300lbs and have a BMI of about

42. My surgery will be covered by Medicare-Medicaid,

Oregon Version, so there is no problem with

preapproval because Medicare covers obesity surgery

and the OMAP program that I have covers all Medicare

approved surgeries, picking up what Medicare Parts A&B

doesn't completely cover. I am not a death's door. I

present no extraordinary problems, except a little

post-CABG scarring at the base of the sternum from 15

years ago. In short, I am a good candidate, physically

speaking.

I am, alas, of slightly above-average intelligence. My

analytic skills are superior. I am aware that I must

have tiny meals for the first six weeks after surgery,

go light on the fats, drink or eat lots of protein,

and eschew sweets. Four ounces is a half a cup of

water. This is not a very large amount. After that

period of time, the danger of blowing open my stomach

is less. My tiny stomach will inflate to some degree

in size over the next year. Hopefully, I will be back

to a decent weight by that time. Still, I will never

be able to eat like I do now. It is imperative that I

have this lap surgery for weight and health reasons.

Perhaps being a quick study is part of the reason that

I am not interested in being part of any 'program'. I

do not need to consult a dietitian and find psychology

tests to be irrelevant in the context of having gained

the approval of my internist and a psychiatrist.

Indeed, I am a student of the use of these written

indicators, and consider them overrated and unreliable

predictors of ultimate patient compliance. As a way to

sort out candidates for a procedure, the use of the

MMPI, for example, is highly questionable and probably

a violation of the ADA. I manifest no obvious

psychoses, so I qualify under both the NHI and ASBS

guidelines, mentally speaking.

Is it, first, possible to get this surgery from you

and your clinic in a timely manner? Or do you or they

insist, like Procrustes, that all of your

non-celebrity patients be program patients and go

through a rigmarole that the two SF physicians, who've

done over 200 such surgeries, that I have contacted

don't? Are you restrained by conviction or the system

to only drawn-out program business? Or do you, in

short, want my quick-and-lean business as the ASBS

guidelines okay? What's so wrong with quick-and-lean

when appropriate?

What I would like to know, secondly, Dr. ,

assuming a qualified yes to my first set of questions,

is this. Since I have to travel Portland from

sport, OR, which is quite a lengthy trip, is it

possible to have the office visit and the surgery in

close temporal proximity? Or will I have to make a

couple of trips to the area? I have relatives in the

McMinnville area, so I can stay overnight with them.

In short, how can I arrange a lap BPD/DS from you in a

most efficient way?

Thank you, Dr. , for your prompt and helpful

response to both concerns.

All my best, curmudgeonly yours,

lcp "

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