As some of you know, a cat bite to my left index finger required me to have surgery on that finger just before the holidays. The saga continues, unfortunately.  You’ll need this one bit of vocabulary: Each finger has three joints — the MP or MCP joint (MetaCarpal-Phalangeal), which is the big “knuckle” joint, the PIP (Proximal Intra-Phalangeal) which is the next joint outward, and the DIP (Distal Intra-Phalangeal) which is the joint at the fingertip. (The three bones are called the proximal phalanx, the middle phalanx, and the distal phalanx, if you were wondering.)

My bite was over the MP joint and caused an infection inside the flexor tendon sheath, which runs along the volar surface of the finger (the “palm” side). The incisions are all healed now, but my finger, frustratingly, still doesn’t work properly. It won’t bend more than 90 degrees at the PIP joint unless I help it along, it’s still badly swollen, and it hurts. None of this seems normal more than a month post-op.

January 5, 2011

[REDACTED], MD
[REDACTED] Orthopedics & Sports Medicine
[ADDRESS REDACTED]

Dr. [REDACTED],

When one schedules a medical appointment, particularly a routine followup, at 8:15 AM, one generally expects that the chance of the doctor being 45 minutes behind schedule will be very small indeed. Nonetheless, that is the result of this morning’s adventure at your office.

At 9:00 AM, in order to avoid losing control of my own schedule, I was forced to ask that the appointment be rescheduled. The earliest that your office staff could accomplish this was 19 January, two weeks hence. This is acceptable, I suppose, but adds insult to injury since the rescheduling is a result of your office’s difficulties, not mine.

None of this is necessarily a reflection on you. I have been most impressed with your handling of my case. You are without a doubt an accomplished, throrough physician and a most skilled surgeon, and I would readily recommend you.

It’s your front office staff that needs a bit of work. Most medical offices ask for 24 hours’ notice when an appointment will be missed; this is to avoid unnecessarily wasting a professional’s time. Your staff should realize that many patients are professionals also, and that their time is equally valuable.

I have not heard from you regarding the results of the C-Reactive Protein test you recently ordered, so I must assume that you’re satisfied with the results. Measurements were taken on Monday, 3 January, by my occupational therapist and forwarded to you; I am rather anxious to know your assessment of those results, as I am currently very disappointed in the lack of progress. I still cannot reach 90 degrees of active flexion in the PIP joint, and there is still a great deal of swelling in the digit. I would welcome any word from you on these issues.

Cordially,

Me.

January 17, 2011

[REDACTED], Executive Director
[REDACTED] Orthopedics & Sports Medicine
[ADDRESS REDACTED]

Dear Ms. [Redacted],

On 5 January 2010, I wrote a letter to Dr. [REDACTED] of your medical staff regarding the handling of my case, with particular respect to your office’s demonstrated inability to control appointment schedules. The letter was mailed on that date, and when I received no reply, a second copy was hand-delivered to your office the week of 10 January. I now enclose a third copy for your reference.

I am still in receipt of no reply whatsoever to my letter. Dr. [REDACTED], who impresses me as conscientious, professional, and thorough, would not be someone I would expect to ignore such correspondence. Therefore, as reluctant as I am to reach this conclusion, it seems clear that your office staff has misplaced both copies of my letter.

Whether this was by accident or design is a matter of no concern to me, but the importance of trust should be patently obvious and of grave concern to you.

What does concern me is that on at least one previous occasion related to the original injury, “the system failed me,” by the admission of at least two medical professionals. I will not sit idly by and allow “the system,” of which your office is a part, to fail me again.

By pursuing this matter rather than simply letting it slide as many patients would, it is my hope that I will help to bring about improvement in areas where it is needed. This will benefit us both, since it ensures that your future communications with patients will be of a more pleasant and cordial nature than this exchange.

Regards,

Me.

Enclosure
Cc: [REDACTED], Operations Manager
Dr. [REDACTED]