Healthcare is a hot button issue across the country. Politicians and civilians alike have been in a constant debate as to whether or not federally socialized healthcare is right for the United States. In this seemingly never-ending parade of ideology, however, an important issue has gone overlooked: Regardless of how or how much they get paid, many medical professionals aren’t doing the job they promised to do.
A 36 year old resident of Tennessee, “Frederick Smith” is a kidney transplant patient who, for the last thirteen years, has been dependent on anti-rejection medications he takes every twelve hours. Also throughout these years, Smith has regularly been in and out of lab testing to make sure his new kidney is functioning well enough. As a very intelligent and self-motivated man, Smith has learned, to some extent, how to be his own doctor—he analyzes the results of his own bloodwork and urinalysis, asking questions when something seems amiss. All transplanted kidneys will only last so long in a new body (ten to thirteen years on average from a living donor), and he is determined to avoid spending more of his life in dialysis clinics.
Smith arrived in Tennessee in September of 2021 and immediately sought out a general practitioner in his new hometown, providing a detailed oral report of his medical history and requesting a referral for a nephrologist. A few months later, he returned to his doctor for blood work, reiterating again that it was very important that he had a specialized kidney doctor. “He seemed to want to do everything himself,” says Smith. “At first I didn’t think that was a problem because I could read my lab results and they were fine — until they weren’t fine.”
The everything his GP wanted to take care of apparently didn’t include delegation of basic administrative work. Smith was told to collect his own (then eleven years of) medical records and bring them to the office in order to get the referral he needed. Without the option of sitting on his hands, Smith did collect all of his medical records and put them on a USB stick. When he brought that USB stick into the office, however, his doctor wasn’t there. A person in the front room said they would put the USB stick on his doctor’s desk, and that was the last Smith ever heard of it. “I have no idea if they have [my medical records],” he states.
These first two appointments turned out to only be the beginning of Smith’s troubles. In September of 2022, he took his own blood pressure and found it running at 170 over 110. Immediately concerned that this was his early sign of kidney failure, he went into the doctor’s office. There, they took an EKG reading, gave him some clonidine, told him he was about to have a heart attack, and told him to drive himself to the emergency room—an hour away.
Smith spent five hours in the ER that day, repeatedly begging for answers and eventually just begging to go home. They told him he was “fine.” The day after, his blood pressure had bounced right back up to 170 over 110 because of clonodine’s rebound effect. “Every time I had gone to the doctor’s office a nurse had manually taken my blood pressure and very quickly deflated the cuff, telling me 120 over 80, which is not where my blood pressure runs,” he explains. “I was now adamantly trying to get a referral to a nephrologist.”
When he returned to follow up with his doctor, Smith was given hydrochlorothiazide to control his blood pressure. A diuretic, hydrochlorothiazide is often given to patients with high blood pressure, but is completely inappropriate for a kidney transplant patient. He got lab results only a few days later, and they read that he was in stage three renal failure. Smith researched this drug interaction himself, brought a note explaining it into his doctor’s office, and increased the dosage of his previous blood pressure medication on his own.
When he returned to the office with his note, he was very firm about getting the referral to a specialist that he needed. A nurse frantically assured him that she was going to get his referral right after he left, but didn’t. “At that point, I was so frustrated I didn’t know what to do anymore,” says Smith. He had been doing all of the legwork and research just to keep his organ functioning to no avail—and being told by his doctor to relax and keep his blood pressure down.
NOT A SMALL TOWN ISSUE
Failings like these are becoming more frequently reported by patients across the country. It's common practice now to “advocate for yourself” with your doctor, who is paid to be your advocate. I contacted Senator Richard Briggs regarding Smith’s story and to hopefully hear something that could be a solution for this massive issue. First, Briggs recommended that Smith go to a larger, city hospital at the University of Tennessee. The notion that rural communities can’t get adequate medical care notwithstanding, Smith had done just that.
Following the disaster at his local practitioner, Smith looked into nephrologists at the University of Tennessee in Knoxville, found the one he wanted, and asked his GP directly for a referral to her. A full week later, his GP had written that referral—Smith, understandably, drove it to Knoxville himself. For a few weeks after that (while juggling concern for his health and trying to “stay relaxed”) he repeatedly called UT to see about any response or appointment that could be scheduled.
Finally, he called the UT Patient Advocate Office, begging for help in a voicemail. “As soon as I hung up, I got a phone call from some guy who claimed to work at UT,” he tells. Smith recounted his whole story and the man on the phone sounded sympathetic, promising to find Smith an appointment or a nephrologist. Again, he waited for weeks. When contact was established with the transplant team (by Smith’s stepfather, as he was at his limit) they claimed they had never heard of the man he had spoken with on the phone. The team also informed Smith’s stepfather that no one at their office took his insurance, counter to all of the information available online.
Thankfully, his stepfather managed to “somehow” get a referral to a nephrologist in Lenoir City who was connected to UT. Smith decided at this point to find a new GP, and settled on East Tennessee Medical Group “where the nurses continue to claim that [he has] perfect blood pressure.” Recently, he’s asked his new doctor for some sort of medication to help with now-daily panic attacks; all of which are regarding his health. This new doctor refused to prescribe him any such thing, claiming that benzodiazepines make anxiety worse before they make it better—a clear mental mix-up with the effects of SSRIs. He got bloodwork and urinalysis done with his new nephrologist over a week ago, but still hasn’t heard back. He’s also had trouble getting consistent prescriptions that keep his body from rejecting his kidney.
When I recounted all of this information to Senator Briggs, he sounded disappointed, but offered no solutions. “This is a doctor issue, there’s no easy answer for that,” he proclaimed. “There’s not a particular training program for forgetfulness.” Briggs went on to explain that doctors often don’t have time to handle administrative issues, and that’s why it is delegated to others.
Should the requirements to hold an administrative position in a medical office be more demanding? In regard to the failings of Smith’s doctors, Briggs noted that the Board of Medical Examiners can review a doctor only if there is a consistent pattern of causing harm. For malpractice cases, it can cost up to $50,000 to take a case to court, “and if there’s not a lot of harm done, the lawyer can’t even recoup.” What must happen to constitute “a lot of harm”?
NOT JUST ONE PERSON
When searching for anyone who could offer actual solutions, I was connected with Braden Kelley. Kelley is a student obtaining his Naturopathic Doctor’s License this year, who currently holds a Bachelor’s Degree in Sociology. He also is a six year victim of Chronic Lyme Disease, a condition often swept under the rug in the medical field which attacks every single system within the body.
Kelley, like other Chronic Lyme patients, went through years of doctor’s appointments while suffering from constant pain, fatigue, depression, and nausea. When patients like him enter an office, they are not cured—they are repeatedly given antibiotics regardless of how ineffective those antibiotics have already been, and a grocery list of other narcotic medications to treat individual symptoms. “Doctors are trained to treat symptoms and give drugs,” he remarks.
Kelley has found repeatedly that the prime directive of the “Doctor” title, to maintain the health of their patients and “build a sick patient up”, is often not the prime directive of individuals who hold that title. “It’s not helping people, it’s a range rover,” he sardonically laughs, “[Helping people] needs to be baked into the system.” Those entering the medical field must value the care of their patients above their profit margins, and they have to be schooled with that in mind. Doctors are supposed to be scientists, understanding the system of the entire body and being able to connect the dots of various symptoms to find the cause and eliminate it. Kelley points out that most initial doctor’s visits last about fifteen minutes: “How can a scientist take a complex human being and analyze their health in fifteen minutes?” he asks.
This is what drove Kelley to a four year acupuncture course in Austin, Texas, and eventually to naturopathy: the entirety of medical practice being rotten to its core. He hopes to be the doctor he wished he’d had over the last six years. Initial visits will be an “at least two hour conversation,” every system of the body will be analyzed in tandem with each other, and symptoms will be treated as what they are: signs of a root issue.
“Insurance companies bog the process down and overcharge,” he notes, but they don’t have any place within his field. It could be that the only solution to the absolute racket of medical practice today is in men like Smith who speak out, and men like Kelley who devote themselves to the wellness of others. While a change in the standards for medical practitioners and administrative workers is certainly necessary, these begin with one vital element: care.