Patient upset by doctor’s seeming rejection

Dear Dr. Roach: I was seeing my primary care physician every six months for about five years. We had mutual respect, and I enjoyed seeing him. Then, I got diagnosed with breast cancer and had to see other doctors for a long time.

Meanwhile, the spinal stenosis my primary care physician had diagnosed was becoming untenable and ruining my quality of life. Even though I am still seeing cancer doctors, I called my primary care physician to make an appointment to discuss the spinal stenosis situation with him.

After a long wait, I finally got someone in my primary care physician’s office and, after another long wait, was informed that he could not see me for six months — there was not one opening until then. I was flabbergasted and asked to be put on a cancellation list. “We don’t keep those,” the lady responded.

I reluctantly took the appointment and decided to wait it out.

Meanwhile, I saw one of my cancer doctors today, and after explaining this situation to him, he replied: “Doctors don’t do that. He obviously doesn’t want you as a patient anymore. I would find another primary care physician.”

What is your response to this? I am 71 years old, and other than spinal stenosis and breast cancer (which was caught early and treated with surgery and radiation a year ago), I enjoy reasonably good health.

J.E.Y. I hope there is another side to this story, since I am horrified that a physician would make a longstanding patient with cancer and spinal stenosis wait six months for an appointment. That is not appropriate medical care.

While I fully understand the point of view of your cancer doctor — and would be tempted to find another doctor — it sounds like saving the relationship you had with your primary care physician might be worth another try.

I think speaking directly with your primary care doctor might clear up any misunderstanding. Dear Dr. Roach: I always have had small breasts. Suddenly, in my mid-70s, my breasts grew, and now at 80 I have outgrown most of my clothes. My doctor said that it is fat, but I have gained only a few pounds. Could this be hormonal? Have you addressed this issue before? S.F.

I haven’t addressed this before. Breasts change size during a woman’s life for many reasons.

Breast tissue is a mixture of fat and glandular tissue. For young women, there’s proportionally more glandular tissue, the amount of which tends to decrease over time. After menopause, the breasts become less glandular; what is lost is replaced by fat, as there is less estrogen.

About 20 per cent of women will notice significantly larger breasts after menopause; however, this usually occurs along with overall weight gain. Significant breast enlargement without much weight gain is not common in my experience.

Hopefully, your doctor did a thorough examination. However, I think it is very unlikely that your breast size changes represent a tumour.

Very rarely, there are estrogen-producing tumours, so if there were other reasons to be concerned, your doctor might check blood levels of hormones, including estrogen. Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu