Sometimes unpalatable observations force themselves upon us but a preamble is required.
We all grow up believing physicians in general, but especially OUR Primary Care Physician is really interested in our health and is concerned about us as individuals. We think that even though we only see the person twice a year for twenty minutes or so unless we get the flu or have a minor medical problem, our doctor knows us and is concerned about us as individuals. But the fact is that in MOST cases, you have less status with your doctor than…say…their pet hamster.
” NO WAY!” You say? Well, let’s see.
First, your General Practitioner practices ‘Family Medicine”. Sometimes it’s called something else, but whatever it’s called, it’s ‘General Medicine’ and the the job of your Primary Care Physician is to get you in and out the door. HMOs in particular are geared to do just that because YOUR doctor sees fifteen or twenty patients a day, 200 or so days a year and has to spend the first ten minutes of your visit reading your chart in order to even remember you. Your Primary Care Physician may have a case load (called a ‘panel’) of ~2,300 patients. In order to crank through that many patients, they either give you a simple prescription to give the complaint time to resolve itself (most medical problems simply resolve themselves), or refer you to a specialist. And they have to remain aloof because you aren’t a human – you are a paycheck – you are going to die eventually, anyway and someone else is waiting in the next exam room.
Anything more serious than ‘routine’ is handled by an Emergency Room visit. In fact, if you have a real medical problem in your doctor’s office or at a clinic, they call an ambulance to take you to the nearest ER where the facilities exist to actually treat patients. Even then, over a million people a year die in hospitals in the US from simple, preventable medical mistakes or infections contracted in the hospital itself, but at least hospitals have refrigerators to stash bodies and if you die at your doctor’s office it will interrupt the cash flow.
Here is where a little confusion arises. The physician doesn’t see you because they like you or care about your health. They see you because they are paid to see you. Either you or your insurance company or the taxpayers pay a lot of money so you can see that doctor who only chose the profession because it guarantees them money and prestiege.
In addition, people almost universally think that because someone has been to medical school and served a residency, they are (1) qualified to practice medicine, (2) infallable, and (3) know everything about your body, even though you are the one who lives in it and they only see you for about an hour a year. People do not grasp that YOU are responsible for making YOUR OWN medical decisions using your physician as exactly what they are: Professional Consultants. No better and no worse than any other professional consultant – a stockbroker, for instance. And it is your job to make sure you have the best Primary Care Physician you can find. It is your duty to yourself to find out all you can about your doctor, because your life can LITERALLY hang on a choice they make. Your LIFE depends on knowing your doctor is the best one available, and trusting them.
Not all doctors believe they are divinely gifted. Just most of them – because no one has ever told them any different. And patients enable that belief by not checking their doctor’s background and training; by not finding out what sort of patient satisfaction rating the doctor has – and by not asking for an explanation of why the doctor feels that the problem they believe exists and the treatment they want to prescribe makes sense to YOU as well as them. And finally, if it doesn’t, by not asking for a second opinion.
That’s another problem. Physicians have adopted the idea, and Lord knows where they got it, that because they averaged a grade point average of about 3.4 (which is the bottom level of “A” in letter grades) to get into medical school; and because they chose medicine as a profession – which is, interestingly enough, as much art as it is science – over another professional field in which people earn doctorial degrees – from PhDs to Veterinarians – all of which are entitled “Doctor” – that they, as Medical Doctors, are somehow mentally superior to their patients and, in fact, better in every way. In fact, many – if not most of them – consider patients to be unthinking cattle or sheep who falls below median intelligence and cannot possibly think for themselves; and that’s usually not very far off the mark. I am a terrible patient and not an easy person to know anyway. I am ‘eccentric’ at best and I say what I think. ‘Diplomacy’ is not a character trait of mine. But I don’t lie and I don’t cheat. I pay my bills, don’t borrow tools, my word is good and that’s about all I care about. That’s the way the world will judge my life.
Two things are evident. MY doctor primary doesn’t remember me from my last visit without reading their notes because they have seen a thousand other people in the mean time – UNLESS I made a sufficient impression when I first met them by causing them to realize I didn’t just pick them out of a hat, but that I was actually interested enough in my own health care to do some simple publc research about them before I chose them, and especially things they have written about themselves and published in the public domain on the Internet.
I have always done that because I expect to entrust my life to this person. It doesn’t get more serious than that and for me, at least, a trust relationship has to exist. It doesn’t have to be personal, but I have to trust that the doctor will tell me truth understand that I will do the same, even if it in embarassing for me. There is no point in lying to your doctor, but people do it everyday because they are stupid. And I have to trust that the doctor will present the best health care options to me that they can, based upon their experience and intelligence. Not just the same litany they give everyone else. I go to doctors for medical advice because they have more experience in medicine than I – but if they insist I call them ‘Doctor” – mainly to demonstrate that they are mentally superior and demand a certain level of respect over and above the rest of the human race, I balk.
I have always talked to every new doctor at our first visit and told them I check their background, and why and to what extent. Because if either I or the doctor don’t think we are a good match, the first visit is the time to find out and say so. In the past, IN EVERY CASE, the doctor felt both complimented that I bothered to qualify them at all, found them acceptable; chose them specifically; and was happy I was cognizant enough to take an interest in my own health care decisions – and if the doctor knows that I believe and expect them to be above average, it’s remotely podssible they will pay a bit more attention to my medical issue when they see me.
Recently I have has several bad experiences with physicians, and have been able to make some observations – none of which I found very palatable. One doctor tried to prescribe a drug to me which I had previously stated I didn’t need and wouldn’t take. So they by prescribed it in a generic form I wasn’t familiar with and expected that I wouldn’t look it up. But I did. That doctor and I had a trust relationship which is now gone.
Another doctor apparently believes that patients are not allowed to read the doctor’s own published information on the Internet – and that doing so is tantamount to ‘stalking’. It’s not. Reading isn’t stalking. So the doctor, being upset that a mere patient dared qualify them, went to the clinic chief with an unfounded stalking allegation. The clinic chief didn’t bother to ask my previous PCP of ~10 years, or anyone else whether it could possibly be true, or that would have ended it. He escalated the allegation to the HMO legal department and had another, secondary physician call me in on the false pretenses of an necessary check of my meds to accuse me of stalking. Of course, I had to pay for the visit as well as lose my plans for the long holiday weekend. I have no reasonable avenue for seeking redress. No attorney will accept the case pro bono if I don’t want a monetary settlement, and I don’t. Everyone’s world isn’t about money. I only wanted an apology which will never be forthcoming. In the distant past, principle was important and people would fight for right over wrong. Now it’s just money. The devolution of the human race from a society to mob is in progress. I can only hope the anthropogenic extinction event will prompt the survivors to work together again.
One inexperienced doctor plus one inexperienced clinic chief caused several people to directly and knowingly lie to me to get me in in order to discover that they had over-reacted. No one likes to be accused of something they didn’t do, but it’s OK because they are doctors and I am merely a subhuman PhD. So my newly chosen ex-PCP is terrified of me, maybe because they watch too much TV…and I am terrified of them because they are obviously too immature to adapt to the idea that patients are people too and some of them can read. So I had to choose the clinic chief as my PCP – but he was passed over during my initial research partially because his patient satisfaction/trust rating is one on a scale of five, and I didn’t believe he could make good decisions.
It was an uncomfortable way to prove I was right. Now we are all just pretending it didn’t happen so doctors can keep treating people like sheep and taking their money and expecting your trust. They have lost mine.