JULIA, M.D.

10 thoughts on “The Doorknob, Again”

  1. I am an NU grad myself and a physician. I just retired from Kaiser Permanente, an entity that is both insurer and provider (hospitals, clinics, surgery centers), here in California. I was a “partner” OB/GYN physician at Kaiser, for 25 years. One thing I added to my practice when they began the computerized EHR, was to sit, facing the patient, at the computer screen, for easy data entry during every patient visit. The computer pods were mobile, on wheels, with a wire connection to the wall, making it easy to face the computer and the patient at the same time. Once this was in place, I would always ask patients to go through every single complaint, from most important to minor, so that I could utilize the EHR and enter every single complaint and ultimately determine and document treatment plans for each complaint or finding, right on the spot. This way, the “doorknob complaints” were completely eliminated. Prior to that, I had always found that these particular types of last minute patient interactions would throw off my daily schedule in a terrible way. I always had extremely high patient satisfaction scores, since I kept asking about patient concerns throughout the entire visit, leaving them with nothing left to say at the very end, except “thank you”. It was also helpful to have worked with a system (system? – YES!!) like Kaiser, where referrals and tests were easy to order, and actually facilitated by the Epic based EHR, after a few years of physician input in design. Since retirement, I still do some hospital OB coverage now, but fortunately, office/clinic for me is a thing of the past. You’ve got a great web site. I hope that it facilitates your income or lifestyle.

    1. Thanks Joseph for your kind words and support. Sounds like you worked within a system that really helped you care for patients well. All the best!

  2. Dear Julia,
    After reading the first sentence of your essay (I’m an NU alum, so I got the hard copy), I knew you had cancer. “I feel like I’ve been gaining weight, but it’s just in my belly.”
    It was exactly the complaint my mother was expressing for several MONTHS to her doctor. Instead of immediately having her tested for cancer, the doc had tested for everything else under the sun. But not cancer. When she almost passed out walking half a block, she went to the hospital where NINE LITERS of fluid were removed from her belly — ascites – liquid filled with cancer cells; peritoneal cancer. It had already spread thanks to a doctor who should have instantly recognized this symptom — as your doctor should have. I know about it now. Why didn’t your doctor?
    I find it unbelievable that 23 years after my mom first made her complaints that this obvious warning sign is still not jumped on by doctors!

    ANY woman who feels she’s “getting fat only in her stomach,” should have an immediate cancer work up.

    1. Linda, I’m so sorry to hear about your mother and your family’s suffering as a result. Unfortunately, I think many doctors still assume a woman’s weight gain is related to diet or physical activity, which is often the case, but not always. A good physical exam and the right scans should sort the common from the unusual – I’m sorry it took too long for your mother to have them. ~Julia

  3. Like you Dr. Julia,I am an NU alum and I read with interest your article, “The Doorknob Complaint” in the fall issue of the Alumni magazine. As a non-physician I have heard those door knob stories. Seems like patients always wait until the last possible second before bringing up a complaint that can turn out to be serious.
    But in fact what especially caught my attention was your diagnosis of a liposacroma. That makes us about 2 in two million. I too was diagnosed with a liposacroma in March 2014.
    I first visited my PCP in November 2013 with a slight swelling in my left hip. He opined that it could be a muscular issue and suggested waiting one month to see if it grew larger or shrunk. One month later it was still there—not larger or smaller and I never had any pain associated with it.
    MRI a few weeks later revealed a possible liposarcoma. Because they are rare, he advised that no physicians in the area treated this condition and suggested the U of Miami, which is about 270 miles south of my home.
    Appt there in March, a needle biopsy by an orthopedic oncologist and results a week or so later confirmed the radiologist’s tentative finding.
    Another appt at U. of Miami with oncologist Dr. Breelyn Wilky who specializes in sarcomas (in fact there are several sarcoma specialists at the Sylvester Cancer Center) in April. Followed by a treatment regimen of three chemo sessions (May, June and July 2014), hospitalized at Sylvester for about a week for each session, with about three weeks between each session.
    Then 25 radiation treatments here in Melbourne, FL – five weeks with five treatments per week. The radiation treatments ended in early Sept followed by surgery to remove the tumor in early October by the orthopedic oncologist who had performed the initial biopsy. Again in Miami. Post-surgical pathology revealed that it was about 97% dead. I don’t recall the size of the tumor except one of the dimensions was about 12 cm. 42 staples to close the incision.
    Then three more chemo sessions—about a week each- at Sylvester in Nov Dec 2014 and the last one in Jan 2015.
    Aside from losing my hair twice and some kidney issues during round one, I tolerated the chemo relatively well, no gastro intestinal distress nor loss of appetite.
    I now have an appointment about ever four months with Dr. Wilky in Miami. So far all is well.
    I trust and pray that all continues to go well for you Julia.
    John DeAngelis

    1. Hi John –
      Thanks for sharing your story. It sounds like you’re doing well through treatment and the light is at the end of the tunnel. I’m glad you’ve found a care team you trust. You may already be aware of these organizations, but if you’re interested in getting more involved in the sarcoma survivor community, check out http://www.curesarcoma.org and http://sarcomaalliance.org
      All the best,
      Julia

  5. I just read your article in Discover, One More Thing. There a set of questions used in the therapy community which I borrow from and use regularly in my coaching sessions. I ask these questions with time left in the session to respond to them: “do you feel listened to and hear by me today?” and “Is there anything else you wanted to bring up today?”
    I have often been surprised by what I learn and I am able to serve my clients better.
    executive coach and life coach, Pat

    1. Thanks for reading, Pat! You ask wise questions – I’m sure they help make you an effective and thoughtful coach. All the best, Julia

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