the danes will not be winning any customer service awards

i have to share with you a letter that i wrote today to my local doctor's office. as those of you who are friends with me on facebook know, i've had a cough for more than two months now. today, i had an appointment for a "lung function" test (it's apparently the last straw when they can't figure out anything else), which i dutifully reported for at the appointed time, only to find that there was no appointment on the books. in frustration, i came home and wrote this letter to the doctor's office. i'm about to print it and deliver it by hand, but i had to share it here, capital letters and all. interestingly, my initial reaction is that this isn't even a question of socialized medicine, just an utter lack of customer service and perhaps empathy (and a little bit of being absent from medical school on latin day).  but i'll be interested in your take on it (and i warn you, it's long and it features two phlebotomists and a mean nurse).

here's a picture of a fluffy bunny to take your mind off how many words there are...

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Dear Lægehuset (House of Doctors),

I have to write in English because it’s easier to express myself and I trust that you’ll be able to make it out.  I have had a severe cough since the beginning of January. I’ve been in to your actual clinic 3 times (4 counting an aborted mission today, but we'll get to that).  I’ve called during the 8-9 a.m. calling hours at least 3-4 additional times. And here it is, March 5 and I’m now just really, really good at coughing and we’re no closer to knowing what on earth is causing a cough of such abnormal duration.

I’d like to walk you through what I’ve been through and ask you if think it sounds ok. The first doctor I saw was a young woman who was apparently taking part in a contest to see how many patients she could see in a day (or an hour?) - sadly, I never learned her name, nor was I invited to sit down or even remove my coat, so I cannot tell you who she was (tho’ I could identify her in a line-up if necessary). I was literally in and out in under a minute with nothing but a compliment for my excellent coughing ability.

A week later, after a couple of coughing fits that made me wonder if I should go to the ER, I called during telephone hours. A nice doctor with a very deep voice looked at my medical history and noted that I had had a similar cough in May 2010 and he suggested we try the steroid inhaler that worked at that time, so he called it in to the pharmacy for me and I went and picked it up and began using it as directed.

A couple of weeks later, ragged from the continued coughing, which wasn’t showing any signs of letting up and now getting quite sleep-deprived, I called again and got in to see another gentleman. He was apparently not in a competition that day and actually invited me to take off my coat and sit down, I’ll even grant that he might have told me his name, tho’ I didn’t take note of it and in the haze of my illness, I simply don’t remember. However, I felt that he took my cough seriously and he sent me in for some tests - a blood test and a throat swab, as well as an x-ray. Oddly, other than the x-ray, he didn’t bother to explain to me what he was testing for, nor what I should do next. I went out to the waiting area and was called in for a blood test. The phlebotomist taking my blood was nice, but didn’t explain what the test would be looking for or how long it would take to get results. She just sent me into another nurse’s room, where a nurse who NEVER SAID A SINGLE WORD TO ME (I can only presume because she and I had not met when we were in kindergarden together), not even hello, or “fuck you,” came at me with a long q-tip, not even asking me to open my mouth and say "aah," but leaving me to bewilderedly figure that out for myself while trying not gag on the stick she was wordlessly shoving down my throat. She also failed to explain what the test was for or what I was expected to do next. I made my way to the local hospital for my x-ray and dutifully waited for a call about the results as directed by the nameless doctor.

When no call came, I called in, but having no idea which doctor to ask for by name,  I took the first available doctor in your endless loop phone system. She (again, didn’t catch the name) was a bit short with me; telling me my results weren’t all in and behaving as if I should have known not to call so soon. Not being telepathic and having only dated a medical student during college and thereby only peripherally attended medical school, I had no way of knowing when to call for my test results, since I hadn’t been told. Nor had I been told what I was being tested for, which made it even more challenging to guess (google?) when I should call for the results. So, still coughing, and by this time a real expert, I waited ‘til early the next week and called again. This time, I was blithely told all the test results were negative (but still not told what I had been tested for). I asked if there wasn’t something we could do to get me some relief so I could get proper sleep, rather than waking with coughing fits several times per night. And the nice lady then called in a prescription cough syrup for me (giving me no warnings that I should be careful driving or operating heavy machinery, nor asking me if I had had previous issues with codeine products in the past (hmm, would have thought that was standard)).

I took a few doses of the cough syrup several evenings in a row, trying to get some sleep, but the presence of actual opium in it made me feel worse, so I stopped taking it and just continued coughing, which by now I was doing at Olympic-levels. In desperation, I came in for a third visit. This time, I saw Dr. M and I only got her name because I insisted on it and typed it into my phone as she spelled it to me.

What is up with not introducing yourselves? I realize that I’ve never seen the same doctor twice, so perhaps it’s unnecessary since you apparently have what I can only characterize as an endless supply or consider them disposable like one-time surgical gloves.

Dr. M tested me for allergies, as when I came in this time, I suggested that maybe the reason my cough didn’t go away was because it was a symptom of an allergic reaction. (See that, I came with the diagnosis idea and again, me = no medical school.) I learned to my relief that now allergies can be tested via a blood test, rather than the panel of pricks on your back that I had back in 1996 at an allergist in the US. So, I went in to the phlebotomist again and she took a rather alarming amount of rather alarmingly large vials of my blood. This time, probably because I knew her name, Dr. M told me the results would take a week and I should call again then, during the regular telephone hours.

And that brings us ALMOST to the end of our story. I dutifully called a week later and talked to a woman doctor (not Dr. M, as she wasn’t listed among those available on the numbers to press that morning) who said that I was very allergic to birch, but not to milk or wheat (which had been suspects, as I often have a coughing fit after eating dinner). I had to ask if there were any signs of allergy to molds and she looked again at the results and seemed unsure whether the last one was a mold or not (it being listed by the latin name - apparently not covered in medical school?), but yes, it showed that I was allergic to it, whatever it was. I asked what the next step was and she started advising me to have someone out to my house to check for skimmelsvamp. And while I appreciate homeowner’s advice, I was calling for MEDICAL advice. When I pressed her on that, she made me an appointment to come in for a lung function test today at 13:45. Someone along the way had suggested that I might need a lung function test, so I guess she was covering all bases. But, here’s where it gets ever better...I show up today for my appointment and the machine in the lobby tells me that I don’t have an appointment. I ring the bell and ask when my appointment is and the secretary tells me that I don’t have one at all. Now, I grant you that I am not a native speaker of Danish (hence the writing in English, which I assume you already got), but I did not misunderstand this. And I did not fail to note it down correctly. I repeated it back to her and she verbally confirmed on the phone and I noted it in my calendar.

And meanwhile, I continue to cough. My conservative American friends are having a fieldday with the story on Facebook as they think it has all the symptoms of all of the ills of socialized medicine written all over it. But, I don’t think it’s a question of that, it’s a question of customer service, or an astonishing lack thereof. And a symptom of a system where I have never been assigned a doctor that is MY doctor and knows me, but instead get bounced around and “practiced” on by an endless array of one-time doctors. But I can tell you, as limited as my attendance in medical school was, it is NOT NORMAL to cough - really, really cough - for two months straight. Oh, and by the way, tho’ not a single person asked me along the way, I am NOT a smoker.

I’m very interested to see what happens next.

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i'll keep you posted.

i guess there's a good reason why they call it "practicing" medicine. they're really just practicing.