[Boldartist]

I'd like your input in an exit letter to my primary care physician. I have a 3 strike policy when deciding if to change docs and this was her third.
In early July, we had an appointment in which we discussed, among several health complaints, a problem I had been experiencing lately of hyperactivity starting at about 8pm and lasting up to 2 or 3 am, at which point I would force myself to lay down and sleep. Fatigue then would take its turn (like kids on a see-saw, hyperactivity went down and fatigue was up) and come on so strongly that my body was in pain. This is all complicated by me having MS, a condition which requires sleep be regular, which is why it was important for me to mention. Of course in the morning, I'd be literally unable to move untilmid to late morning. My days had become totally unproductive. She did not respond he;pfully, only to validate that it wasn't normal.
Several days later, after reading about certain side affects in Cymbalta, a therapy I've been using for at least 5 years at 60mg, I saw that it was possible that this drug could be the culprit. I emailed her this information--email being her preferred communication in these instances--and asked her advice in either going to 30 mg or weaning off completely. I reinforced the point that I'd be doing something and needed her advice. There was no response for 3 weeks. During that time, I took matters in to my own hands and gradually, responsibly I hoped, weaned myself off by lengthening the days between doses. When I finally did receive a phone call 3 weeks, minus 1 day, later, it went like this:
Crystal, the medical assistant: HAS ANYONE CONTACTED YOU ABOUT YOUR EMAIL?
Me, the patient: NO
Crystal: SANDY[yes, we are to call the doc by her first name in this office] SAYS THAT YOU COULD TRY GOING DOWN TO 30 MILLIGRAMS
Me: [INTERRUPTING] COULD YOU TELL SANDY THAT I ALREADY TOOK MYSELF OFF THE CYMBALTA WHEN YOU DIDN'T CALL BACK FOR 3 WEEKS, I JUST DECIDED TO DO IT MYSELF, SO I VERY GRADUALLY TOOK MYSELF OFF.
CrystalL OH.(PAUSE) SO HOW'S THAT GOING/
Me: VERY NICELY, THANK YOU. AS I SAID, WHEN I DIDN'T HEAR BACK I CAREFULLY TOOK MYSELF OFF.
Crystal: WELL. GOOD. GLAD IT WORKED OUT FOR YOU.

And that was that. I never heard back from anybody in the office until they called to say they received my request for release of medical records to a new doc I'll be seeing soon. So here's my question to you--and I apologize that this ran so long: Any thoughts about how the doc should have responded? I'm trying to be as objective with my expectations and evaluation of this doctor as I feel it is only this way that she will take me seriously. So I reach out to get your perspective.

[Houdi]

Boldartist:

In my opinion, you sent a message to your doctor by changing MD's. Pretty loud and clear that you won't accept being 'put off' when it comes to your health. Maybe your MD doesn't really read the e-mails and someone in the office is supposed to do this. Yours fell through the cracks; someone quit, someone didn't do their job, doesn't matter. Your MD is ultimately responsible. Your health care was at risk. If you don't think your MD actually knows what happened, which is possible, I would hand deliver a short letter addressed to her at her office and explain your reason for departure. The letter would be more effective to her if it were short and sweet; just the facts. Like, I needed medical assistance and state why. I contacted you via email, your preferential communication vehicle. I received no response. This is unacceptable to me. I have found a new MD. Leave contact information if she wants to discuss this with you further. And wish her the best.

Something similar happened to me about 5 years ago. My MD had patients leave messages with her nurse. I had an medical issue that needed immediate response. The nurse called in prescriptions. I filled and had even further issues. I called and the nurse continued to call in prescriptions; stating I really didn't need to see my MD. I had horrible health issues, and low and behold, my MD didn't even know any of this. She was livid, left the practice and started on her own. The nurse did all of this on her own and her license was revoked. Ugh.

How was the Cymbalta weaning and ultimate withdrawal for you? Hope all is well now....Houdi

[Boldartist]

Thanks for your reasoned reply. I do tend to run long when writing and will look carefully at your suggested language for the exit letter.
Let me add here, though, that there was a context to this ignored email incident, as the appointment I had with her was a response to a first delayed-answered (another 3-weeker) email. This was written by the doc's assistant and was contrary to what, subsequently, I found out was the doc's answer. After this was mentioned to her, the doc insisted I had misremembered the email response. (Sadly I had not brought hard copy with me.) My experience with the office staff mess up and the doc's reactive defense has happened to other patients,as I came to find out. Yes, it's time to leave. If it wasn't for the potency of risks involved with this drug, I wouldn't be writing a letter to her at all. But I think she ought to reconsider her part in this. Thanks for helping me help her to this.

[Houdi]

Sounds quite reasonable on your part! You realize the MD may not 'get it' after you put so much effort into this departure You know she already is defensive and in the past not accepted responsibility for her inadequacies. I think it is great you are taking the time and effort to do this. There is always that chance it'll make the difference.

Let us know how things progress. I hope you find a really great doc to replace her. That will be wonderful.
Houdi