A friend and I had one of our typically desultory, meandering catch-up telephone conversations yesterday. Being of the aging Baby Boomer Generation (note that it is now obligatory to prepend “aging” to the already hackneyed term “Baby Boomer Generation”), it is our inevitable wont to discuss health issues. Having both recovered from a recent bout with the something-that-is-going-around virus (STIGAV-86), we talked about the measures each of us had employed to overcome our affliction. While I had eschewed the option of involving medical practitioners to intervene with my illness, Janet had gone to see the doctor, who prescribed an antibiotic, and that should have been that.
But it wasn’t. In these days of so-called managed care, meaning cost management for health insurers, this doc, who was newly assigned to Janet’s primary care by her HMO, felt it incumbent to stick his nose into other issues. He wanted to send her to a nutritionist so she could shed some poundage—although she’s not fat. He also asked her, “When are you going to quit smoking?” Her somewhat defensive response was that whenever she tries to quit smoking she gains weight. Alas, we’re conditioned to think that doctors, not ourselves, are really in charge of our bodies.
Hey, I haven’t had a father for 40 years and I am not in the market for one now. I hire professionals to do real estate work, taxes, give legal opinions, write wills, and so forth. I also hire professionals to fix my body when it is broken. If one of my legal or financial advisors treated me with the paternalistic arrogance that Janet got from her doctor, I’d fire the sonofabitch and get a new one. Why is it that we feel obliged to take this kind of crap from a profession that is growing more and more self-protective, while it is becoming less and less accessible?
Now, granted, it is true that doctors in private practice are in short supply because few medical school graduates really want the hassles inherent in practicing in the field. Physicians are in a constant insurance squeeze. On one end, their revenues are controlled and scheduled out at sometimes unconscionably low rates by the great governmental beast of Medicare and, to a lesser extent, private health insurance companies. On the other end, rising malpractice insurance premiums make it expensive to stay in business. A couple of years ago, my physician for some 20 years had to shut down his practice. Personal health issues made it necessary for him to cut his time down to two days per week. However, his malpractice insurance premium was still $30,000 per year. It is no wonder that doctors and their office staffs give us the impression that we patients are just mobile containers whose sole purpose is to bring them insurance cards. But I digress.
Why should we have to take this crap from doctors when we wouldn’t take it from lawyers, car salesmen, or Indian chiefs? Furthermore, why should we allow our intelligence to be regularly insulted as seems to be inherent in conversations with doctors? One of the reasons why I retained the doctor of the prior paragraph for such a long time is that he discussed my health issues and concerns with me as one adult to another. This doctor had a unique ability to discern the degree of intelligence and level of education of his patients and adapt his approach accordingly. The surgeon who did my hip replacement impressed me similarly. I continue to hold out hope because of these two experiences. However, the two so-called primary care physicians I’ve engaged since my long-time doctor went out of business did not even bother to look at my level of education (why bother to put it on their information sheet?) or attempt to do anything but intelligence insulting pontification. They gave me no credit for any knowledge in their vaunted subject area whatsoever. Talking down to patients is an effective tool for limiting interaction, but isn’t good interaction crucial to getting to the heart of the problem?
That brings us back to Janet. Let me say here that Janet is no dummy. She has two university degrees, one in computer science and one, an MBA. She knows that smoking is not good for her health. That she has been unsuccessful in quitting shows the strength of the addiction. So, what purpose does it serve for her doctor to add the additional stress of his admonishment? It could only make things worse. He had no solution. When Janet wants to quit, she’ll quit. If that doesn’t suit her HMO doctor, then he can kiss my flat, alabaster ass.
Doctors’ offices are nasty places. The office staff is generally a surly bunch who regard the patients who sit and wait for interminable periods as necessary pains in the ass. They really don’t care about the travails of the patients, as long as their insurance cards are valid. Legitimized drug dealers, those well-dressed GQ and Vogue statues you see loitering briefly in the waiting room before they are given priority access to the inner sanctum, tend to squeeze the patient’s time with the doctor and account for some of the lenghthy wait to get through the door to the examining rooms (where one waits even longer). The office staff will not so much as tell waiting patients approximately how far behind they are, and they seem to be as far behind at 8 AM as they are at 4 PM. Small wonder that they collect our co-payments in advance! They’re rightly afraid that we would bolt on them.
I fired one doctor because his crappily run office informed me three days before an appointment that the office was no longer drawing blood for lab analysis. I would have to go to a separate lab facility, so I could sit and wait there, too. So, I would need to schedule two appointments in two separate places for what was originally one. Between the short notice, the reduction in service, and the fact that this doc was an ex-Army physician who thought he should talk and patients should listen instead of shutting up and listening to his patients, I was fed up. I sent this clown a kiss-off letter in which I told him that I still had the neck pain that he didn’t seem willing to investigate but that was offset by suddenly losing my biggest pain in the neck: him!
There’s no end to the institutionalized patronization, either. I’ve had doctors considerably younger than I call me “young man.” Doctors’ office staffs call me by my first name, even if I haven’t accorded them that privilege; yet we’re supposed to kowtow to the godlike doctor using the full formal form of address. This not so subtle conditioning creates a barrier that impedes spontaneously open communication and promotes teacher-to-child or parent-to-child questioning and admonition. “Oh, please don’t punish me or look crossly at me, Mr. Doctor Sir. I promise that I’ll be good from now on.”
We have got to start having more of a voice in our own health care. Gone are the days of self-sacrificing doctors who made house calls at midnight on snowy nights on horseback. Now, we have doctors ensconced in offices where they can insulate themselves from patients until it is absolutely necessary to give them a cursory inspection so they can collect the office visit charge. There is no essence of an interpersonal relationship anymore in most cases. It is much easier to access—even to have a conversation with—your lawyer, your financial advisor, your CPA, or just about anybody else who takes your money except your internet service provider. (And, like internet service providers, how long do you think it will be before doctors figure out that they can outsource their patient relations interaction to an Indian subcontractor?) Why have we let this situation get so out of hand?
Let’s all just stop taking shit from our doctors and insist on making intelligent decisions after reasoned discourse.