I like it, ita. I also like:

My displeasure with my June 14th visit to your hospital exceeds what I can indicate in multiple choice format.

ita, I suggest you copy your neurologist and migraine specialist on that letter, and let them kick the ER doc's ass.

Got a dangling modifier here: "Suffering from persistent and intractable migraines, it is too often required that I seek treatment above and beyond what is at my disposal." The subject needs to be "I" rather than "it". Not that I think your recipient's going to care.

I like it. My only suggestion would be a kind of list or timeline -- did he call your specialist or refuse to call him? What did he want to prescribe you instead? Was he arguing with you while you were in ridiculous amounts of pain (I know that's a yes)? What did he do for those three hours (or does that include waiting-room time)? I like a punch-punch-punch in my complaint letters, but that maybe a personal choice.

God, I remember a particularly fun migraine ER visit. We waited, what, six hours before they even took her in? Ooh! That was the night I got to watch the Red Sox win the World Series! Migraine + ER = total misery

This is really random, just as stuff grabbed me.

Approximately three hours after I entered the ER I was able to extract some grudging and partial acceptance of this plan, but I still ended up returning home in almost as much pain as I’d come in with.

This part needs to go somewhere else. The end or something. It interrupts the sequence of events.

However, it was with this concern in mind that the protocol was suggested to Dr. [asshole].

I'd drop the However.

He challenged the logic of the recommendation, but that is not for me to defend—especially in pain and on narcotic medication.

I do think you need to mention this - the inappropriateness of placing you in that position... but also make the point more clear that he was not listening to the patient and ignoring the patient's medical history. I don't know, this sentence just seems a little apologetic or something. May just be phrasing.

Lurking today and thought I'd jump in:

ita, as someone completely unfamiliar with whatever your situation was, (although it sounded horrible and I'm sorry for what you had to go through), I found your paragraphs in the middle difficult to understand. What is clear is that you got treated poorly, were sent home in pain, Dr. asshole failed to take whatever you said seriously, and you'll be choosing another ER if doctor asshole is on call again.

But I think it would be helpful to throw a few more facts into the naarative like, the time you got there, your specific complaint(s), the pain medicine protocol your specialists have recommended and that has worked in the past, how you tried to convey the protocol to Dr. asshole, the specific ineffectual treatment you finally received and what time you received it, and maybe some examples of the abrasive and dismissive conduct you were shown.

ooh ... back right after I had my stroke, I needed to make a follow-up appointment with the neurologist. In addition to getting my condition checked, I needed to get more medication. I called in August to make an appointment ... the neurologist's secretary offered me an appointment in November. I said I'd be happy to see someone else, but she wouldn't even discuss it. I scheduled it; a week or so later she called back and said the neurologist wouldn't be available until January. I started begging for an appointment with anyone - I was afraid of what would happen if I went without the stroke prevention medication that long. After two weeks of hassling, I finally got to see another neurologist about two days before the meds ran out, and I complained about the problems I'd had getting the appointment. They gave me a nice long prescription for the meds and when I called to get an appointment with a stroke specialist, didn't have any problems getting an appointment.

Speaking of brains- I'm listening to Radio Lab and it's making me feel Sylaresque. Brains are funky and this show's making me want to pick one apart to see how it works.

This woman had a headache, did aerobics because they'd made her feel better last time, had an attack and went to the hospital. When she woke up she had weird memories, like of being a little old man in Vietnam.

Thanks, guys. Every time I try and write it out, I get dizzy again. I can't find the structure for it.

What's a good structure? Summary, play by play, restatement, consequence?

Like...

• I like your hospital
• My last visit sucked and I was treated like shit
• here's how it went down
• here's how it made me feel
• here's what it will change

It's weird, since I don't have action in mind. I just want to be heard.

ita, I think the letter would be best served by starting out stating, "I am writing to complain about the medical care I received at your ER on June 14 by Dr. [Asshole]." Putting your intentions in the first sentence make it explicitly clear to whomever is reading it why your are writing and will, one hopes, make sure it gets routed to and read by the right people as quickly as possible.

Signed,
Works for a bureaucracy

I sign on to the above. The thought that popped into my mind is, has the course agreed on by your regular doctors been written down? If so, and Dr. [Asshole] had any way of getting to it, it makes the situation even more serious.