Nuts & Bolts of Calling a Doctor’s Office

This subject seems to come up a lot, so I thought I would do a Tutorial on how to get in touch with a person and not a machine when you’re calling a doctor’s office.

My first and probably most important piece of information is:

CALL EARLY IN THE MORNING!

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I cannot stress this enough. Even if you have to wait on hold for awhile. I tend to call about 9:45am. By then the logjam has passed and the way is pretty clear.

Calling in the morning gives the doctor the entire day to get your chart, prescribe meds or answer your questions. Lunch time is the usual time they read your message, so if you call in the afternoon, unless you are in the ER, you will be waiting until the next day for an answer.

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If you are really in a crisis (psych, serious fever or infection), I would call back right after lunch. Be your nicest self! NO yelling about “Why hasn’t she called me back yet?!?” crap. Just kindly say, “I need help. I am so ill. Can I come in tomorrow morning? Or might I talk to the nurse or doctor this afternoon?”

“I need help” is a wonderful way of garnering sympathy for your situation.

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A Practice with a Receptionist

If your doctor is in a practice with a receptionist, it’s easier to get a hold of the doc you’re needing because someone should always be available during the 9-5 workday.

You often will be triaged by a nurse before getting a message to the doctor. Still, the earlier you call, the earlier your voice will be heard.

Most offices close for lunch… either between 12pm and 1pm or between 1pm and 2pm. Calling then, you will get a machine. Leaving a message on a machine is like talking into an abyss. Call back when lunch is over.

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Calling Mental Health Professionals

Therapists especially are meticulous with the timing of their appointments. They are 50 minutes long, beginning at the top of the hour, ending at 50 minutes after. I have great luck calling in that 10 minute window between clients. Some will listen to messages and call back during that time, but many pick up the phone, too.

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Know what you are going to say. They have moments to figure out what you need before the next appointment starts. Write it down if you need to before you call. Be ready!

Psychiatrists’ schedules are a bit more wonky, so leaving a message might be necessary. Just as if you were talking to a person, have what you want to say ready. The more info you can leave in the shortest amount of time… being concise… helps everyone get their needs met.

Playing Dumb

When I really need to get through to someone (and you pick your battles here), I feign accidentally hitting the button that says “If you are a care provider and need to speak to someone now, press 1.” Use that sparingly, especially in the same practice. Really, judicious use, please.

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Bypassing Automated  Menus

If you’ve read this far, I get to teach you a trick I learned from another operator. Not specifically for doctor’s offices, but really helpful for banks, phone companies, cable companies, DMVs… any of the bazillion places that have phone trees you seem to be forever lost in.

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Press 0 (zero) fast, over and over and over again. PressPressPressPressPress a dozen or more times. 8 out of 10 times, this gets me to a person.

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Patient Portals

If you doctors’ office has a Patient Portal, sign up for it asap!

In the portal, you can email your provider, ask for refills, make appointments without calling and see your chart and most lab results.

Patient Portals are the best.

Patient-Portal

If I didn’t answer something, ask me about it!

Fat Girl Whining

I’m fat. Really fat. Over 300 pounds fat.

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I also have Diabetes and have to see an Endocrinologist every few months. Endocrinologists take care of fat people. A lot of fat people. There has not been a time when I’ve sat in an Endo’s office that there were no less than 4 really fat people. I just left the Endo’s office (and I love the people there) and need to vent for a second.

Chairs

How can an office that caters to fat people not have chairs without arms on them? How?! The first time in there, I asked for a chair without arms and they brought out one of the bench chairs (that still had arms on it). Fine. They brought it in the exam room with me, too. Nice.

Today, the bench was there… with someone already in it. So I had to cram my fat butt into one of the tiny chairs… with the arms going INWARD instead of out! What the crap?

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I spoke with the office manager who said she’d already put a work order in for more benches and asked me to answer to survey I’ll get in my email with a comment about the chairs.

We’ll see how long that takes.

Blood Pressure Cuffs

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For fuck’s sake, I thought I had finished complaining about medical people taking my blood pressure incorrectly/painfully 2 decades ago.

  • Dealing with a stupid ER nurse using medical tape to try and keep the wrong size cuff on my arm, the tape splitting and the nurse huffing off to get his supervisor
  • Having too small cuffs bruising me dozens of times
  • Having large cuffs bruising me because I have really big upper arms with batwings

I thought I’d come up with a solution by insisting they use the cuff on my forearm. Techs and nurses balked at first, but for the last 5 years, it has been a matter-of-course to take my BP that way.

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Then today, the nurse came at me with a thigh cuff, easily twice as large as the large-sized cuff. I asked her to please take it on my lower arm and she said they had just had training saying it was required to take it on the upper arm because doing it on the forearm is “quite inaccurate.” I grudgingly said she could try, but if it hurt, I would cry.

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The cuff goes on and begins tightening. And tightening. And tightening even more. I said, “It hurts, take it off,” and it stopped pumping up so I said I’d sit still. Then it began tightening again and I nearly hollered, “GET IT OFF.” She did, charting, “Patient refuses BP.” I corrected her: I am more than glad to have my BP done, but on my forearm. She shrugged and left the room.

After my appointment with the Endo (which went really well), I asked how we were going to resolve this BP issue and she said it was “policy” and she would ask what to do. I said, “Patient requests forearm blood pressure,” please put that in my chart. She did.

Fat Anger

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We (our country) is fat… and getting fatter. What is wrong with healthcare providers that they do not make concessions for us? I’ve been writing about this since 1987!!! This is ridiculous.

Not accommodating fat people is yet another way to discriminate and intimidate fat folks. Healthcare providers not doing so prevents far too many people from obtaining care at all, care that can keep them healthier… and for you fat haters, even help fat folks lose some weight (if they want to or are able to).

Over the years, in the courts, this accommodating for “morbidly obese” people has been argued. The general consensus is now that fat falls under the American With Disabilities Act. One more thing on our side.

Please Speak Up!

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Many fat people in our society sit in these tiny chairs, put up with exam tables that do not go up and down and never ask for accomodations for their size. I speak up whenever I can, but I cannot do it alone.

Thinner/Smaller friends and family, please “see” things how we do. If you see people squished into chairs, quietly talk to the office manager, explaining how difficult the chairs are for fat people. Say you have a family member or friend (which I am!) or partner that won’t say anything, but that they get bruises every visit. If you work in an office, restaurant or anywhere people need to sit, please advocate for us to get the proper seating for fat folks.

Special mention to servers: PLEASE STOP SEATING FAT PEOPLE IN BOOTHS (unless they ask to be put in one specifically). It is humiliating to try and squish ourselves into the tight tight space at a booth.

And if anyone thinks the small chairs and small spaces are going to force us to lose weight, you are woefully incorrect. Fat-Haters, rue the day this issue is yours or someone’s you love.

Thanks for listening. Rant over.

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painter: Igor-Grabar

Bipolar Diary: Incremental Shift

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Loving Nudge

After my Bipolar Diary: Depression Deepens post, I had several people tell me to call my psychiatrist immediately. I thought I could white knuckle it for another week, but others saw what I couldn’t. I trust those closest to me and picked up the phone, getting pushed into a non-existent spot in his schedule the next day. Wednesday, August 2, 2017.

Office Visit

The crying had been keeping me from functioning and did not abate while in his office.

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I told him about the suicidal ideation increasing… then added the obligatory, “But I have no plans to hurt myself, am not stockpiling meds and promise to call 911 if I do find myself getting too close.” He replied, “I understand how frightening they (the thoughts) can be, even when you aren’t consciously creating them.” I breathed a sigh of relief that he seemed to understand.

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artist: Soren Dreier

I’ve had at least 8 different psychiatrists in 30 years and this one is one of the top 2. He listens to me, takes my preferences seriously like refusing the Risperdal increase and is infinitely patient with my continued distress.

I really am so blessed to have such a kind (and gifted) doctor. I know that is rare and how privileged I am to be able to receive quality medical and psychiatric care.

I OWE MY AWESOME CARE TO THE ACA/OBAMACARE INSURANCE I HAVE.

I would not be alive without it.

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Medication Change… Again

I continued crying while he pondered, looking at his computer, typing some, then thinking again.

He found a medication I had not tried before… Latuda… which I’ve since read is used specifically for bipolar depression. Yes, yes… it does come with a laundry list of side effects, but I’m ignoring them, listening to my body instead.

I know it takes at least 2 weeks (in my body) to 6 weeks to feel the full effect of psych meds, but when I got home from the appointment, I took my first pill. Then the next morning, I took the second. (It is taken once a day.)

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Whether placebo or really working that fast, I did not cry until late evening the next day. I didn’t cry the next night, either. And the ideation has slowed, the thoughts feeling more “transparent,” fewer hard imaginings. The images had been like mosquito bites, begging to be scratched. (Not sure I explained that clearly… I’m having a terrible time writing this, pardon spelling and grammar errors, please.)

August 6, 2017

I’m feeling better still. The doc told me that if I was feeling too sedated, to drop the Risperdal, which I did on day 3 after starting the Latuda. I’ve been on Risperdal since 1995, so it is a major thought process to not take it before bed. I do feel less sedated (I described it like someone spiked my drink), but there’s a lot more room for not dropping into a slumber at any given moment.

Let me get this out so those who are following along know how I am doing. Thanks for you care and attention, my dear friends. Thank you for your love.

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artist: Zenos Frudakis

My Wall-E-esque Life: Part 1

“Fat Acceptance” has been a catch-phrase for at least 40 of the years I have been alive. In 2 parts, I share my experiences and lessons learnt being a part of the…

Fat Acceptance Movement.

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I’ve been fat ever since I got my tonsils out when I was 7-years old.

Fat kid, teen, adult and now a “mature” adult.

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Trials (and Errors)

I’ve done dozens of diets, been prescribed Black Beauties & other speed (starting at age 8), belonged to many gyms, taken Phen-Fen (with success, but with heart valve damage), tried Topamax (fail), used Wellbutrin (fail), had a Roux en Y Gastric Bypass (with fabulous success, then epic failure), done hypnosis & acupuncture (fail & fail), become a daily Mindfulness Meditation fanatic (fail for weight loss/huge win for pain relief), have tried to have anorexia, then bulimia, hand-written hundreds of thousands of journal pages, letting them “hold” my pain, shame, revulsion, self-hate, wishes, fears, hopes &, eventually, resolution with my size.

I remain in resolution.

I will never diet or take diet drugs again. Ever.

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Time & Money

Thinking about the masses of time and money I’ve spent trying to lose weight makes my head spin.

Time

  • Going to the gym
  • Writing out menus
  • Researching rules and techniques for success
  • Real life or online support group meetings, including social networks talking about losing/gaining weight
  • Shopping slower to read labels and make sure food is “appropriate”
  • Learning new cooking methods
  • Fighting with family about the change in foods in the fridge and cupboards
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artist: Sapphire4723

Money

  • Gym membership
  • New cookbooks
  • Membership fees & apps
  • Tools for success (exercise equipment, pedometer, walking/running shoes, gym clothes, etc.)
  • Tossing all the “bad” food in the garbage
  • Buying all the “good” food
  • Probably eventually buying more “bad” food for my family because they whined so much about foisting my diet on them
  • $28,000 cash for RNY gastric bypass (GB)

Can I include the time and money (including the taxpayer’s) for the years of therapy discussing and crying about all of this?

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Positive?

I was a Fat Activist in the mid-late 80’s, mostly in the lesbian community. I’ve written about being fat-positive for almost 3 decades.

In the beginning, when I was in my 20’s and early 30’s, I was healthy… labs were fine, no diabetes, my joints or feet didn’t hurt. I crowed (bragged, was arrogant) about how it was the fat-hating that made fat people sick and die, not the fat itself.

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Reality

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Now, at 56-years old, I see how delusional I was. I am well on the road to dying before most people in my family did, and they all had diabetes, too. My future resides in my memories of my Cuban relatives & the diabetes complications they endured before dying. Heart attacks, going blind, having toes, then feet cut off, eventually dying in a coma because the body just gave up.

I see it coming as if it was a roaring train heading right for me.

Litany of Pain

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Here are my fat-related illnesses and issues:

  • Type 2 Diabetes (diagnosed at 34 years old), now on 2 insulins and metformin
  • I heal terribly because of the diabetes, often needing antibiotics for residual infections
  • Stage 3 Kidney Disease from the diabetes
  • Pain with every step I take
  • Osteoporosis and arthritis in my feet, which have broken 3 times just from walking for exercise, and one foot breaking while swimming
  • Broke one foot falling off the Wii Fit Board trying to exercise… needed 3 surgeries to repair
  • Arthritis in my lower back, was on opioids for 8+ years for the back pain, becoming incredibly addicted, finally getting clean 3 years ago (yay me!) Now I use Mindfulness Meditation for pain relief, though many times I wish for some Norco.
  • It took me years to find surgeons I felt safe with to get my 4 hernias repaired (one surgery) and then my gallbladder out (a separate surgery, with 3 hospital visits afterwards because of infection)… several turning me away because of my enormous belly size (blessedly, I found the docs and those issues are resolved)
  • Bone loss from possibly 2 main sources: lack of exercise & the GB
  • Walking with a walker, but should be in an electric wheelchair, my feet hurting so badly
  • Using an electric wheelchair when I shop

Nautilus

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My world has gradually become smaller and smaller. After 32 years in birth work (where I hurt daily as well), I am now a sedentary Phone Sex Operator. I live in a small space and leave the house only for doctor appointments, physical therapy, shopping and seeing my doggies at mom’s house.

Writing that makes me sad.

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Part 2 On Its Way

In Part 2 of My Wall-E-esque Life, I will talk about the place the Fat Advocacy Movement does have in our lives. While it might not be health (despite the incessant refrain that it does), it is most assuredly have an enormous place in our physical and emotional world.

More soon!

A Side Effect of Goodbye

I wrote my Goodbye post for my Navelgazing Midwife Facebook followers and received something that I couldn’t have predicted: love.

I Am Loved

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Thanks

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The kind words of thanks and appreciation for my writings over the last decade+ made my heart so full.

“A million times thank you. Without your influence I would never have become my own navel gazer.”

“Barb, I understand closing this door in your life and moving on but just know your words have had a great positive impact and you will be missed.”

“I have always been awed and so inspired by your ability to open up and share so boldly who you are.”

Births

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But the comments from women about their births… my heart melted with those.

“so sorry to see you go! i found you during my surrogacy pregnancy, and you were a huge factor in my choice to birth med. free.”

“While pregnant with my first son I couldn’t get enough of your blog – it is what ultimately allowed me to find my voice and speak up that I wasn’t liking the care I was receiving from my OBGYN. I chose to leave that practice and seek out a midwife. Best decision I’ve ever made.”

“I love you Barb. You patiently waited for me to find my strength to say what really caused my baby to die. You held my hand and my heart as it took me years to realize how my daughter really died. You didn’t shame or blame or deflect from the truth.” This mom went on to become an NICU nurse instead of home birth midwife after her baby died due to the negligence of a home birth midwife.

Caring for Women
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photo by Barb Herrera

And then there were the women who shared their personal paths from doula to nurse or certified nurse midwife. Stunning.

“I have followed you for so long, yours was the first blog I found and fell in love with when I realized that I NEEDED birth in my life! I’ve since gone to nursing school and become a l&d nurse, chairing our NCB Committee, and trying so hard to help women be respected and truly cared for during their experiences.”

“You have been such a wealth of knowledge for me as I completed my journey from doula to labor nurse to nurse midwife.”

“I was accepted back into nursing school today – 4 semesters stand between me and a BSN. L&D is the goal and upon graduation, my MSN to become a CNM. Thanks Barb, I owe a lot of my drive and self discovery to you.”

Thoughts

I am incredibly humbled by the comments I received on that Goodbye post. That I had an affect on so many is so amazing to me. As I write this, I am wiping tears of gratitude for all the blessings I’ve had as the Navelgazing Midwife. As is usual, the love and indebtedness people have for each other is symbiotic, flowing back and forth… a Möbius strip of love.

Thank you to all.

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Who Is “45”?

“45” is what I call POTUS, the 45th president of the United States, that horrid man who squats in the White House tweeting (LYING) about random topics to divert our attention from the fucked up bullshit he does that will, PLEASE GODDESS, get him impeached.

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Immigrant Birthing in El Paso

I wrote about my introduction to working with immigrants in ICE Burns: My Early Doula Clients. In 1990-1991, I volunteered as a doula at a Planned Parenthood Prenatal Program in San Diego, California.

El Paso, Texas

When I moved back to Orlando in 1993, I stopped for 3 months at Casa de Nacimiento, a birth center (now closed) in El Paso, Texas. 99.9% of the clients coming through Casa were immigrant women from Mexico, usually Ciudad Juárez. My Spanish, school-acquired, then practiced with the doula clients in San Diego, became second-nature in El Paso.

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While Casa gave me an amazing education and taught me many skills, there are lingering worries about being a White person using the immigrant women as practice specimens… a reverse voluntourism experience. I will write about these feelings separately; they are deep and complicated.

I was not as woke about the White Savior Complex as I am now, so merely tried to be the best student midwife I could be. I loved these women and their families. I loved talking to them, learning about their Mexican lives (which were slightly different than the Mexicans’ experiences in San Diego). I purposefully kept my heart open, wanting to be a positive birth worker for the women coming and going through the center’s doors. Those 3 months in El Paso remain some of my most wondrous life memories. While most people despise the city, I found it alive with culture and magic.

Rio Grande

Getting from Ciudad Juárez to El Paso for prenatal appointments was often a hit or miss experience for the birth center’s clients depending on which officer was patrolling the border bridge that day.

It had not been easy: The visa that allowed her to cross back and forth between Mexico and the U.S. is expensive, and she had had to prove she had money in the bank and a reason to return to Mexico to be granted it. The lines at the border between Juarez and El Paso can take hours, and border agents are said to sometimes tear up the visas of women who are noticeably pregnant. Some women end up giving birth on the bridge between Juarez and El Paso because of delays….”

When the border was closed to even those with visas, the pregnant and laboring women, with their families, trudged through the Rio Grande River… day and night… to cross into the United States. They often walked miles to reach the birth center.

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Crossing the Rio Grande was bad enough, but the water was/is disgustingly polluted. American maquiladoras rose on Mexican soil years ago as a way to bypass manufacturing regulations implemented in the United States. With so little oversight, the maquiladoras also freely dump their waste, including poisonous chemicals, directly into the river… the same one laboring women were walking through. On several occasions, we would give a river-soaked woman a shower before she felt clean enough to have her midwifery appointment or birth her baby.

I remember one visit down to the edge of the river to help a nursing mom up the slope, the surface of the water had an oil (or gasoline) slick on it as well as scum like this:

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All because Border Patrol would feel holier-than-thou and not let people over the bridge even with valid visas.

Disgusting.

Borders

I’ve not been to El Paso or Ciudad Juárez since 2002, but the border topic, with #45 in power, has a new focus.

Just this week, on February 22, 2017, the Washington Post wrote “Anxiety over Trump stems flood of Mexican shoppers to El Paso,” ending the piece with:

A U.S. border agent checking documents remarked at the lack of cars.

“People are scared,” he said, as he took this reporter’s and a photographer’s passports.

Of what?

“Of our president,” he said, before sending us on our way.

Yes, those of us who have a positive history with immigrants in border towns are, most assuredly, very, very scared.

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Photo by Ivan Pierre Aguirre for The Washington Post