"Here's an experience I've been having," said a Potomac woman.

"When you go to more than one doctor, you feel like you're just little pieces, not an individual with everything connected."

The problem she was talking about was lack of coordination among doctors, lack of feeling that any one is "in charge." Many patients report just the same experience.

Over a period of two years, she had seen two cardiologists, a gastroenterologist and a surgeon for a continuing problem. The problem had never been resolved.

She was not sure that enough attention had been paid by any one physician. But what bothered her more was this: The doctors had not communicated well with each other. "They all make you feel that you're really not their patient, that they have no responsibility for you."

Talk to doctors, and you hear that the situation is often the patient's fault. Many patients hop from doctor to doctor on their own, without letting any one doctor take responsibility.

Talk to enough doctors and many will admit that there is far too often a lack of coordination, lack of one doctor taking and retaining responsibility. ::

There is no publication in which patients' problems with doctors, and doctors' with patients, are discussed more frankly than in Medical Economics. Most of the articles in this well-read doctors' magazine are by physicians. A recent one -- "Why Wouldn't My Doctors Talk to Each Other?" -- was by a Long Island patient who had to have an eye removed because of a tumor.

Her name was Marion Deutzman. Her story was chilling, simply because each part of it seemed so ordinary.

At age 62 she began to see strange images. "Dr. Archer," a local eye doctor -- she did not use her doctors' real names -- sent her to "Dr. Berry" in New York, who said the problem was a cyst and advised periodic checks.

A few years later Berry said, "It's now a tumor." She asked him to operate. He said he was going abroad, but Archer could do the surgery.

Archer's secretary said she would need a physical first. When she saw her regular internist, "Dr. Cherney," "he was surprised to hear I was going to lose an eye."

Came the disturbing surgery. She awoke weak, nauseated and unable to eat and stayed that way the next day. Dr. Archer nonetheless looked at the operative site and said, "O.K., you can go home now."

She said she was too weak. "My concern is with your eye, which is all right," he said. "If you feel you must stay longer, you'll have to take it up with your internist."

She asked a nurse to phone Dr. Cherney. A few minutes later another nurse re- ported, "We called his office. He wasn't there, but his secretary said that as long as you have no fever and your blood pressure is O.K., we can discharge you."

The next day the look of the operative site alarmed her and her husband. They tried to call Archer. His answering service told them he "was satisfied everything was normal, but if I was worried, I could stop by his office the next day."

She did so. For days the site remained irritated, but soon an artificial eye was successfully fitted.

On a visit to Archer eight weeks after surgery, "I asked, as I had several times before, whether he'd received" a laboratory report on the removed eye. Yes, he said, it was malignant. "My heart sank."

Archer consulted Berry who advised a new "workup." For three days she tried to phone Berry. His receptionist at last told her Berry said she should call a cancer specialist, "Dr. Davidson."

Davidson said he couldn't see her until he got the biopsy report and slides. Archer's receptionist told her to ask the hospital to get them for her.

Now "I lost my temper and demanded to know why doctors didn't communicate with each other directly." The receptionist then offered to get the slides and send them to Davidson.

Next, Davidson's receptionist phoned to say he had seen the slides, all the malignancy had been removed, and if her doctors wanted more tests, they should have them done.

"I was fuming. Dr. Archer had told me to call Dr. Berry . . . Dr. Berry's receptionist wouldn't let me speak to him and told me to call Dr. Davidson, and now Dr. Davidson was asking why I wanted to see him."

Davidson's receptionist finally arranged for her to go back to her internist, who did arrange tests, which did show that she was out of danger.

"I have no complaints about the quality of {my} medical care," she concluded, but "virtually everyone . . . treated me as though I were an object . . . The worst moments were brought on by physicians and hospital personnel who made no attempt to explain what was happening, to encourage me or to calm my fears. Since my doctors weren't talking to each other about my case, I was caught in the middle, forced to cope with matters I didn't understand.

"Ideally, I suppose, one physician should have assumed the overall management of my care, coordinating tests, explaining procedures and assuring me that someone knew and cared what was happening to me."

None of her doctors saw that as his job. ::

In an editor's note, Medical Economics said good care should include full communication between doctors -- for the sake of patients and for the sake of avoiding malpractice suits.

In later letters to the editor, an eye doctor said the doctor who operated on her should have supervised Marion Deutzman's whole course -- "he's not just a technician whose responsibility came to an end" with the surgery.

Another doctor said that "many physicians possess the management skills and concern," but insurers won't pay for the time needed to use them.

True enough. Physicians are reimbursed mainly for doing things, not for talking -- to patients or to each other. Groups of family physicians and internists are attempting to get better pay for talking and managing.

I hope they get it. Meanwhile, I hope they will not abandon the responsibility they undertook when they accepted their degree and license to practice. ::

What can patients do?

You have no choice but to: Be aware that such situations often exist. Ask your doctors -- particularly the first one you see in cases like Mrs. Deutzman's, cases where there need to be referrals and teamwork -- "Will you remain in charge? If not, who will? Who will be keeping track of my whole case?" If surgery is needed and both a primary, referring doctor, then the surgeon give unsatisfactory answers to such questions, try to find a set of doctors who will be more responsible. In virtually every insurance plan, including Medicare, you are entitled to seek a second opinion. If the answers remain unsatisfactory and you must have the treatment, at least be aware that medical care today is indeed often fragmented, and you simply must take charge of your own case, or get a friend or relative to help.

Some patients try to solve this problem, and frequently do, by patronizing a group medical plan or clinic where all the care is given by one group of doctors working with each other.

All the same advice applies if you find yourself in the hospital, where you may see a dazzling parade of men and women in white, without any clear indication of who's in charge.

Many medical and hospital people worry about this problem, too. At least one hospital has come up with a solution.

The medical staff at Saint Joseph's Medical Center in South Bend, Ind., recently decided there should be a "physician captain" for all critically injured patients -- not necessarily the same doctor if the patient's status changes during a hospitalization, but one who will at all times "be the primary coordinator of care . . . throughout the hospitalization."

Next Week: Waiting to see the doctor.