Thursday, March 29, 2007

Physician, Heal Thyself—You're Not Doing So Great with Me

Hey, Doc, are you wondering why we, your patients, are flocking to alternative medicine? Arrogant cretins (the word I wanted to use here also has six letters, but rhymes with sticks) that most of you are, you probably attribute it to patients’ ignorance and not your own failures. You would be wrong.

Once, years ago, I was going through a particularly rough patch with my physician. He was hectoring and paternalistic and would badger me about my weight no matter what I went into his office for. Now, don’t misunderstand me. Yes, I am overweight. Yes, I should lose weight for my health. Yes, he had a duty as my physician to address that issue with me. My problem wasn’t that he brought it up. It was how he delivered the message. He would sit in the chair across from me with his large, rotund stomach sticking out and his shirt buttons straining, showing me glimpses of his hairy belly through the gaps—while angrily telling me I was wasting his time because I would not lose weight.

Finally, after one of these sessions, I snapped and did something I have to be very pressed to do. The very next time I had an appointment, I confronted the doctor and told him that the last time he saw me he had been rude, patronizing and paternalistic. Further, I said that he needed to look at his own weight issues before being so angry about what he called my “failure to deal with” mine. He was extremely taken aback. It was probably like being bitten by his stethoscope. In a movie, he would have had an “Ah, ha” moment and taken a look at his bedside manner. In real life, he said that if I felt that way about it, perhaps we would both be happier if I found another physician. I said, “Perhaps we would, but this is an island, and there aren’t that many choices.” From my point of view, things improved after that. He was more respectful and consultative, rather than condescending, in subsequent visits, if a bit wary. He seemed quite happy, though, to tell me a few months later that he was leaving the island to take a position in another state. I was happy too with his successor, a woman. In fact, I believe he was the last male primary care physician I ever had.

I have wandered a little off point here. During those same years with Dr. Fat Daddy, my husband and I were in a car accident in which we both suffered significant soft tissue injury when our car was rear-ended on a freeway. I had gone to my doctor after the accident, where I was told to take ibuprofen and, effectively, don’t call me back. Not literally, but Western medicine has lots of little areas where doctors simply eschew to practice at all and one of those is soft tissue injuries. Probably, without costly drugs and procedures, there just isn’t enough money in it. A friend that I trusted suggested going to a chiropractor, something that I would never have done, thinking that alternative medicine was practiced by medieval quacks that couldn’t get into medical school. (Yes, the propaganda arm of Western medicine is highly efficient.) When my back continued to fail to hold the adjustments after a few weeks, the chiropractor referred me to a naturopath. It is here that we reach the crux of my point.

I remember that first visit so clearly. I am sure that I was struck by the contrast to all of the medical experiences that had gone before. The waiting room was full of soft, vibrant colors and eclectic pieces of art the doctor had collected. When I walked in the door, I was greeted by the receptionist with a broad smile and genuine interest. I asked to use the restroom, and I remember that the medical personnel that I passed in the hall all stopped and greeted me. Before I saw the doctor, a medical assistant snapped my picture with a Polaroid. That photo was attached to my file so that when anyone spoke to me or referred to the file, they were looking at my image. The doctor listened intently to my responses after asking me why I was consulting him. When I finished speaking, he asked me if there was anything else I wanted to tell him, and he waited while I thought about it.

Now, the point of this piece is not: Western Medicine Bad, Alternative Medicine Good, Unhhhh! It is that patients today are losing respect for Western medicine and flocking to alternative medicine because as Western medicine is being practiced, it has completely lost its focus on the patient. And, doctors, arrogant creatures that they have trained themselves to be, don’t get it. They don’t understand that much of the exodus is their fault. Fellas, let me put it in terms you understand. Dollars. People, your patients, your potential customers, are so disgusted by the level of care they receive and the manner in which you dehumanize them, fail to meet their needs and fail to treat them with basic respect, that they are willing to seek out alternative treatments FOR WHICH THEY HAVE TO PAY FULL PRICE OUT OF POCKET SINCE MOST ALTERNATIVE MEDICINE IS NOT COVERED BY INSURANCE. That is how much what you are doing sucks.

Let me give you another example. A couple of months ago I began experiencing worrisome symptoms. I went to my primary care physician who gave me the alternative of going immediately to the emergency room (in the Orlando area, an ordeal straight out of Dante’s Inferno to be in no way desired unless your demise is otherwise imminent) or to a specialist’s office that had the equipment she did not.

Since the series of visits to that specialist’s office would be a tale all by themselves, let me cut to the bottom line. After two highly unsatisfactory office visits and a battery of tests, like Daisy the Cow jumping the 10-foot wall of the slaughterhouse cattle chute, I bailed. Taking the time to do some research, I found another specialist who got high marks for competence and for patient care. And, in a relative sense, this doctor is a luxury sedan to the first’s cheap import sub-compact, but only in a relative sense.

In terms of the absolute, all of the problems of the Western Medicine System remain. In this system, patients are cogs traveling a conveyor belt that the doctor focuses on for only a few minutes (as few as possible since time, after all, is money) before the belt moves on bringing the next cog into focus. This system has been streamlined for the convenience and benefit of the doctor and of the system itself NOT TO MEET THE INDIVIDUAL NEEDS OF THE PATIENT AND THE PATIENT’S SITUATION.

Example One, Patient Records. After my harrowing experience at the hands of Specialist 1, I wanted a second opinion. When I made the appointment with Specialist 2 for the second opinion, part of the process was to sign a release to get my records from Specialist 1. I very much wanted Specialist 2 to have all of the results of the series of the expensive tests that Specialist 1 had performed on me. When I asked if those test results would be included in the records released to him, imagine my surprise and dismay to be told by both the staffs of Specialist 1 and Specialist 2 that “No, only the doctor’s notes about the test results would be sent.” But, I reasoned with them (in vain), how could Specialist 2 draw an independent conclusion and make his own analysis of the test results if he could not see the test results for himself? There was no answer. I was just told it was not done that way. Medical records person for Specialist 2 told me that there was no way she could get the actual test images. If I wanted them, I would have to personally go to the office of Specialist 1 and get them. Specialist 1’s Medical records person, expressing complete incredulity that I would want such a thing, did finally allow it was possible, but said that I would have pay $5 a page for each test results image I got. So, a patient and the patient’s insurance company may pay for tests and procedures, but the records of those tests and procedures are treated as if they are the property of the physician. Having ascertained this, it still took one solid week, myriad phone calls, and physical visits to both Specialist 2 and Specialist 1’s offices. (Medical records person at Specialist 2 lost the authorization form I hand-carried there—at her request.) Medical records person at Specialist 1’s office referred us to someone else in the office who never returned our phone calls. I emerged, bloody but unbowed, with the images from the key test, but never got those from the other tests performed. It was all worth it, however, when Specialist 2 referred to the images during my consultation, and the one he considered key was not the same one I had been shown by the medical staffer at Specialist 1’s office. (Never saw Specialist 1 himself about my test results—part of that horror story.)

Example Two, Make ’em Wait. My symptoms and the underlying medical situation were quite serious: A situation that involved possible mortality; a situation, depending upon the outcome of the tests, which could involve major surgery. In other words, something that was very anxiety producing. I remember that one of my reactions was to start a list of all of the most special moments of my life, in case that life was to have not much more to it. While I certainly had so much more I wanted to be and do, I remember being quite joyful and relieved at how long my list of special moments was. It was a list I could live with if it was to be all that I was given.

The end result of my consultation with Specialist 2 was that I had to have yet another test procedure. Because of his office’s possession of some cutting-edge technology, it was NOT the invasive procedure Specialist 1 had recommended. There was a chance it would not be definitive and Specialist 2 might still recommend I undergo the original procedure, but, to me, it was a chance well worth taking. At last, 42 days after I first went to my doctor with the symptoms, I was going to have the procedure that would supply the needed answers on the course of treatment. WRONG! Imagine my surprise that I underwent the test and my appointment to get the results of the test was set for 33 days later!!!!!!!!!!!!!!!! I still don’t have those results today.

Do you know what I have been doing in the interim? Telling myself that if the tests had revealed something immediately life threatening surely they would have called. So, no news is good news, right? I can just relax and wait until I see the doctor.

Now why would I have that confidence in the people, remember these are the good, competent practitioners, who have so far: 1. Lost, then miraculously found, my medical records release authorization. 2. Failed to set up the separate follow-up appointment their own office procedures call for regarding receiving my other lab test results. In the case of the latter, I learned that when someone else from Specialist 2’s office called me to ask about my lab tests. When I said that I had undergone the lab tests at their office and was awaiting the results, she informed me that I should have had a separate appointment set up at the time I had the blood drawn. It was then up to me to follow up and call to ask if I was supposed to have this other appointment scheduled, and to learn (they apologized) that “Yes, I did need to have it?”

Oh yeah, so there is no way they could screw up and make me wait 33 days only to tell me I might die any minute and I need major surgery or tell me the tests weren’t definitive and I need the invasive procedure anyway, but only after 33 days of waiting torture? Right? Hah!

And the real point here is why is this system set up to keep me in suspense about my health situation? Surely anyone in my position would be anxious about the results? After the doctor reads the results, why can’t someone in the office be designated to call and say, “The doctor wants to go over your results and treatment options in detail with you at the appointment, but he asked me to call and let you know that the tests do not show anything that is immediately life threatening or that will require major surgery. There were some important findings that will impact your lifestyle and that dictate your future course of care, and he will go over those with you at the appointment.” The relief would have been tremendous. But I have been denied that relief.

Perhaps if every doctor was forced in medical school to be a patient, really to be a patient. To be denied all except minimal information regarding their own body. To be forced to wait ungodly periods of time in institutional waiting rooms, or at home waiting for results more than a month. To be treated regularly with impersonal disdain, as if they had they IQ of a plant, as if their medical care was the concern only of the physician and not of the person receiving the care. To be called by their first name by strangers who then expect to be addressed by their professional title and last name.

Perhaps then there would be changes to this broken system. But until then, patients who are angry or disheartened or disillusioned will continue to seek care from providers who express interest in them as individuals rather than as billable items.


Anonymous Anonymous said...

I am with you on all points, having had many similar frustrating experiences.

Some naturopaths practice a fair bit of quackery -- there is dearth of scientific support for homeopathy and other remedies popularly used by them. I'm all for placebo effect, but not at full retail. ;-)

Check out concierge medicine. Tell me if you think it is unethical for some to opt for a plan that most cannot afford.


11:49 AM  

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