I DO want to tell a (brief) story to illustrate why it’s important to make records readily accessible to patients who’re willing to grapple with them…

A friend was undergoing echocardiogram prior to knee surgery (at the anaesthetist’s request). A “density” or “tumor” (language used by cardiologist reporting results) was spotted in a lower lobe of the lung.

My friend was told that it was necessary to rule out lung cancer with an X-ray.

After a 10-day wait for an appointment (despite the fact that my friend lives in Mexico and had to delay returning to his business there), the X-ray was “inconclusive.”

(I suspect it was the wrong “next test,” but…I didn’t research it. Why not a PET scan to look for metabolic and “tissue characterization” data? Who knows. I don’t without doing research).

It was a Friday. My friend was told he’d be given an appointment with an oncologist who would review these “inconclusive” results, but that he’d have to wait until Monday to establish the appointment.

No oncologist had ever seen these results when he called Monday. They were still sitting in the cardiology department in the secretary’s “inbox.”

After a day of waiting to hear back from someone in cardiology, my friend was told that he had to have surgery…but that no appointment was available for 2-3 weeks.

Three days later, he met with a surgeon. When he asked for further testing that might reveal “conclusive” results, he was told: “Most patients just want to ‘get it out’ of them, and fast.”

“But, what’s this ‘it’?” asked my friend.

“We don’t know. But why risk it?” replied the surgeon. (I was with him in the surgeon’s office to hear all of this.)

“I can’t stay here in the U.S. for a month to recover from lung surgery unless it’s really a malignant tumor,” answered my friend. “I need to know if it’s malignant or otherwise harmful before I can agree to surgery. Can you arrange further testing?”

“I’ll try,” said the surgeon, “but they’re very busy in imaging. I can’t guarantee an appointment in less than 10-14 days. I’ll have my secretary get back to you.”

No call came that day. The following day, my friend was told by this surgeon’s secretary that “imaging appointments” were a month out. No specific “imaging” was proposed.

The story goes on…. To get to my point, my friend got tired of the runaround, didn’t trust the surgeon, and called “Imaging” himself. He explained his situation with living (and owning a solar business) in Mexico, and pressed for a quick appointment.

In ONE DAY, he received what he said was a CAT scan (I didn’t verify) that proved the “growth” was “calcium,” or “calcification.” In ONE DAY.

By taking things into his own hands, my friend avoided expensive, potentially risky surgery. He avoided a month-long recuperation on the futon-on-the-floor in a friend’s apartment. He didn’t have to abandon his business for a month, and lose serious income.

Neither of us know why the surgeon insisted on surgery, and would not help arrange testing. We can speculate.

Although the surgeon was a salaried employee at Dartmouth-Hitchcock Medical Center, and supposedly had “no incentive” to push surgery, I imagine she had self-interested reasons, whether they were financial or academic, despite this claim.

How can I think otherwise when her actions were so clearly against the patient’s “wholistic” interests? The surgeon never heard, despite repeated protests, that my friend wasn’t “most patients” who “just wanted to ‘get it out’ quickly.” He didn’t have that luxury. On the day he demanded an “imaging” appointment, my friend had already waited 18 days to find out if he had fast-growing lung cancer…or not.

If this story had been my own, and not my friend’s, I would have insisted on seeing my x-ray and all related records, and hightailed it over to the Dartmouth Medical Library to identify various guidelines for diagnostic workups on “suspicious lumps found in the lung during an echocardiogram.”

Armed with specific information, I could have had more fruitful conversations with the cardiologist, imaging specialist, lung surgeon, etc. I could have asked targeted questions. I may have gotten better results.

At the very least, armed with my X-ray and records, I would have had an answer to “do I have lung cancer” in fewer than 19 days (which is how long my friend waited to be told he had calcification in his lung rather than a malignant tumor.

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(it’s pseudo-spondylo-listhesis)