The following is a letter of complaint I am sending to the branch manager of the local health office. Some words are transliterated from the Hebrew, but the gist of the letter should be clear.
December 20th 2010
To whom it may concern,
This is a short summary of a horrible experience I had at the — on — in —, culminating in one of the most painful and humiliating exams I have ever experienced. Although the first part of the complaint is mostly focused on some of the support staff who not once, but 3 times managed to book the incorrect appointment and, as well as the lack of local adequate medical staff over holidays, the primary complaint lies against Dr. — and the exam that took place on December 14th 2010.
As an overweight pregnant woman with gestational diabetes and a history of pre-term labour, I understand that my needs are more complicated than those of a comparative non-high risk maternity patient. I am currently seeing Dr. D, as well as dietitian L (both of whom, together with the nursing staff, I have found to be a pleasure to deal with, competent, and understanding), and together with them am doing everything possible to maintain a healthy pregnancy. To that end I am currently 22 weeks pregnant and losing 0.5-1kg most weeks even though the baby is growing and developing normally. My glucose numbers are well tracked and both my doctor and the dietitian are pleased with my results.
As a diabetic maternity patient there are certain exams that are standard procedure that takes place at certain points in the pregnancy. One such example is the fetal heart echo. When I was told I needed to have the echo done, I called the office, made an appointment at the Chativat Harel branch of Maccabi, and the exam was completed simply and with minimal complications and my dignity intact.
Unfortunately when it came to booking and completing the 20 week organ scan this was not the case. […]
I arrived for my appointment on December 14th to discover that only a 5 minute slot had been booked for what I was told would be a 20-30 minute appointment. Fortunately was seen on time and was told that there were 2 different types of organ scans- the normal one, and a separate one that was 200 shekel out of pocket. As I did not know about this in advance I decided to do the normal one, and if it is not what my doctor wanted I would return.
Dr. — than began to explain that the scan was not 100% accurate “especially in cases like mine”. Before he even began the exam he had decided that there would be problems and that obviously I would be more difficult but, he would see what he could do but would likely need to send me somewhere else.” Please know that I have had ultrasounds on this machine before, and had the heart echo 2 days earlier on a machine designed for infants with no pain or humiliation.
Within the first few minutes of the exam it became apparent that Dr. — was not interested in completing the exam properly. Although I continuously tried to tell him that every single ultrasound I have had indicated that the baby is sitting incredibly low, and that no less than 3 ultrasound technicians had suggested that I would be much better served to have the scan done flat on my back rather than in a semi-prone position, he continued to ignore me. He called out numbers to the assistant on the computer, and would not explain what he was seeing, nor would he translate anything we managed to hear. although I repeated asked him to speak louder as I could barely hear him, he ignored me entirely other than to tell me how difficult the exam was. He seemed to be actually pushing it under my pelvic bone with such pressure that he actually stretch and split the skin so that a week later it is still cut, irritated and painful.
After no more than 5-6 minutes he decided to switch to an internal ultrasound. I am no stranger to the procedure and understand that at times it is the better choice, however I have never had an internal ultrasound hurt or feel so violating in my life. He kept ordering me to move down further onto the transducer so that it was so far inset that it was incredibly painful. He was incredibly harsh with it for another 2-3 minutes before informing me that he gave up and it could not be done. At this point, no more than 10 minutes into my appointment time, the assistant left. He told me he could not complete the scan and I should go somewhere else where they had better equipment.
It was only at this point that I got angry. I raised my voice and again informed him that there were other ways to try to do the scan. He kept refusing to attempt it flat on my back saying “it would not make a difference. It was only when I said I was going to file a complaint that he agreed to even take the 2 minutes to try it, and even then it was with the attitude that he was only doing it to show me that it would not work.
Fortunately for me the change of position did make a large difference and he was able to complete the scan in a matter of minutes (while still causing a lot of pain by pushing much to hard on the transducer). I have no idea if he got everything he needed or not as he refused to answer questions. It was only as we were leaving he thrust a waiver of some sort at me, refused to explain anything more about it than that it said the scan might not be accurate (so then what’s the point? Is this a normal waiver or just one reserved for difficult patients?) and handed me the results while once again telling me how hard the exam was.
I will know later on this week what the results said and if they are complete as he refused to explain or elaborate on anything.
For the next 36 hours I was in incredible amounts of pain in my hips, my lower abdomen, and the skin where it had been stretched. The pain has tapered since then, but almost a week later is still lingering. Internally I felt as if I had been abused and was raw and sore for roughly 72 hours. Neither of those are standard for either internal or external ultrasounds.
I should add that based on an ultrasound from a week earlier the baby seems to have gotten smaller! After doing some research in the last week and speaking to other ultrasound technicians I have learned that this is often the case when someone conducts the exam using too much force leading to distorted images.
I am very disturbed by the treatment I received by Dr. — . His lack of care and attention to details, and horrific bedside manner on a standard and routine exam must be addressed and some skill upgrades needs to be provided. No patient should ever leave an exam feeling violated by her doctor, nor feeling as if the doctor was disgusted at having to do the exam in the first place. The fact that I am still in pain, and have torn and stretched skin a week later is entirely unacceptable.
I sincerely hope that Maccabi is open to improving both their staff as needed and the administrative issues I have addressed.