Leftovers

I was going to blog something truly witty. But I'm tired. So I'm serving leftovers - some thoughts on doctors and the medical community in the US. I wrote them in response to an MD who feels that I'm "anti-doctor" and is concerned over those of us who view the doctor/patient interaction as "just a service" rather than as "a relationship". So, here are my thoughts, with a few edits for clarification that wouldn't make sense without reading the entire thread otherwise.

Kiss those babies!
~Dy

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I am not anti-doctor, but I do view the exchange of services for pay that takes place in a doctor's office as a service. I have a sneaking suspicion that we aren't all working with the same definitions, as I've noticed some people take offense to offering a "service" - they want to be more, to be looked up to more, or needed more. I'm not sure. But to me, it's not "just a service" - a service has value, it has worth. It is not a derogatory thing to point out that doctors provide a service and they make a living from that service. That's an honest way to earn a living and there is no shame in it. Ok, on to my thoughts...

I have a relationship with my in-laws, with my children, my neighbors, and my pastor. I have relationships with many people, and some of the people I do business with are also ones with whom I have a relationship on more than a business level. But the two are not connected.

We do have a family physician. She has been my doctor for 15 years. She's seen the boys when we lived near her, and I told Zorak recently, after a scheduled consultation with her to hash out some questions I have about a therapy that's been recommended to us, that while I wouldn't follow her blindly off a bridge, I do trust her enough to know that she wouldn't lead me off one, either. Time and shared experience have developed a relationship on some levels beyond the original agreement, yet she still provides a service, and I still pay for that service. It has value - for both of us.

I used to see the general physician/patient interaction as a relationship, but now, for the most part, I don't. Relationships must go both ways in order to work, and relatively few practicing physicians in the US (I can t speak for outside the US) are currently willing - or able - to treat their patients as true partners in care (granted, the corollary of this is that few patients will step up to the plate and shoulder responsibility for their care - but that's another soapbox). Fewer still care to know their patients on a level required to have an actual relationship.

I don't begrudge them that, but I won't fool myself into thinking that the pediatrician or the OB with the assembly-line process and the five-minute visits is in it for the relationship. There's no way. I do spend more time than that with my mechanic to make sure he's competent before I'll let him touch my vehicle, and even then there isn't a personal relationship - there is a level of trust, certainly, or I wouldn't be willing to seek services there. But it's a trust in the person's abilities and competencies, not a trust in the person on an intimate level.

The climate of our medical care right now, increasing in size and regulation, heading toward nationalization, frivolous lawsuits, practitioners put against the wall, insurance loopholes, outrageous premiums for practitioners that are driving many of them out of practice, legislation that infringes on patient choices... b/c of those things (I definitely don't believe the negatives in the climate are all stemming from the doctors) the concerns have snowballed to a point where the doctor/patient relationship is painfully skewed. There's a power struggle in the medical community that has no place in medical care, and unfortunately, the quality of care and the degree of trust suffer on many levels because of it.

Yes, I know that patients aren't the only ones who can do the firing. It's a contract by mutual consent of all parties involved, and either party is perfectly free to sever that contract. I was fired by one physician because I refused to give my newborn child a *third* bottle of Nystatin for his thrush (which was not responding to the treatment), and suggested that we try a course of Gentian Violet instead. She said she could not see us if we were not going to be cooperative. We agreed that this was not a fitting arrangement and got a copy of our files. We left, picked up a bottle of GV and never looked back.

I don't mind that. Doctors have to practice the way they see fit, but I don't have to take orders from them if I disagree with what they want. I often hear that doctors are humans, too, and that we should "give them a break". That humanity includes fallibility, which is not bad, or horrible, but ultimately *I* am responsible for the health and well-being of my family, and I take that responsibility very highly. I won't abdicate it or permit treatments based on an unyielding trust in this utopian relationship. What I'm seeing the doctor for is the advice and the knowledge that I do not have so that I can make better decisions. The final decision is mine, and if a doctor is not comfortable with that, then by all means, kindly show me the door. No hard feelings.

I also know that it's not always over something the patient cannot work with, but something the physician isn't comfortable tackling. I've known doctors to fire patients for lying about medications they're taking, or for seeing other physicians and not permitting everyone involved to make informed recommendations. That's got to be scary. Doctors do have a right to protect themselves, too!

I was asked whether or not I feel that I have "an obligation to make it better for the next person", via letting the practitioner know why I'm taking my business elsewhere. No, I don't. I have never once seen a physician make any changes at all based on that kind of feedback, but I do think it's important to put it out there, anyway. It's rude, and it's bad business, to just jump ship. I wouldn't terminate a contract of any kind without specifying the reason (move/death/no need of services/poor service, etc.), and the doctor/patient agreement is the same thing, in my opinion. Anyhow, I tend not to bring up this point when putting in my .02 about whether to give a new doc some time, walk away, or run screaming from the office. Certainly, I think it's just the right thing to do to let a doctor know why you won't be seeing him or her. Communication, whether highlighting to your service provider the wonderful things you appreciate (also overlooked, but important!), or letting them know that something is not sitting right with you is important.

We had a FABULOUS pediatrician in MD. I love that man and would recommend him highly to anybody who wants to be involved, informed, and a true partner in their children's care. I'd also recommend Lazer Lube on 235 for oil changes. Again, because I feel they are a good value with highly competent folks who will do right by you. A relationship? No. They are services traded for pay - value added, honest exchange. There is no shame in that.

And now, *gingerly* I do wonder if some medical practitioners might be a bit sensitive to the idea that they aren't considered an indispensable part of the family. Perhaps a bit offended at being "lumped in" with mechanics and the grocer, which aren't "life saving callings". I'm generally leery when I hear that my philosophy is tantamount to being Anti-Doctor, particularly when I am not ranting and raving that all doctors kill patients or get them addicted to prescriptions, or any other such thing. (None of which I've done, or believe, or purport, but I can't think of why else the idea that a doctor provides a service and that you have the right to pick where you get your service is an anti-doctor thing.)

I think what some physicians may perceive as anti-doctor is actually nothing more than the repercussions of the power struggle the medical community is waging against the patients: doctors calling CPS for those who selectively vaccinate; innocent midwives facing prosecution by zealous DA's, when even the families refused to testify against them; the "what have you got to hide" mentality when patients feel doctors are asking questions they do not wish to answer (News Flash: sometimes we have nothing to hide, we just really don't think it's your business); anger over parents being held against their will and threatened with losing custody of their newborn if they do not permit certain procedures to be done to the child before leaving the hospital; concern over the kind of medical establishment that would seek custody of a pre-born child because a doctor wanted to do a c/s on a woman without any medical cause at all, which the woman refused - and fear toward the State that actually granted that custody to the hospital. This is a small sampling of what patients face in today's state-medical melee.

In this day of Big Brother as the Ultimate Benign Mentor, incompatible philosophies toward health care can signal red flags for those who don't tow the AMA-line. It's not the human doctors we aren't comfortable with, it's the machine that's behind them. I believe that we must seek out compatible physicians in all respects. Our families deserve no less. We cannot afford to stay on with physicians who do not offer the services we need, just for the sake of "the relationship".

Dy