Wednesday, April 27, 2005

The doctor vendetta

Martin teases me, "You're just doing that doctor blog because you have a vendetta against Western medicine." To which I reply, "Yeah, that's totally true, but I'm turning it towards something positive, aren't I?"

I have a lot of strong feelings about the health care system, caused by a combination of my yogafied disdain for non-holistic health solutions, and a series of bad experiences with doctors over the course of my life. But I'm a bit tired of ranting about it. So I'll excerpt some of the letters I've been getting about the project.

It occurs to me: lawsuits against doctors seem to currently be one of the strongest influences on the way that the system is set up; a lot of the cost, inconvenience, and dehumanization is connected to doctors covering their asses in case they get sued. And yet I strongly suspect that lawsuits are connected to an existing feeling of rage/disempowerment on the part of the consumer. If you have a warm family-type relationship with your doctor and suffer as the result of some slipup on their part, you might still sue them, but I'm willing to bet that it's more statistically unlikely than if you've already been stewing with resentment about being treated like a number and not having any attention paid to you - in which case you think, "Screw 'em. Might as well take 'em for all I can get, it's what they do to me." I wonder if there are studies on this? Somehow trying to correlate surveys of patients' attitudes about the friendliness of their doctor with the number of legal problems faced by the doctor's office?

It also occurs to me that you rarely hear about lawsuits related to baby-sitting, and most people seem entirely comfortable entering into this rather risky informal relationship. How can the cottage industry of baby-sitting exist without a strangling thicket of red tape? Is it that people have managed to maintain an informal code of trust and honour? What's missing in the health care world?

So, a few stories. The outrageous thing is not that these stories exist; I'm sure that there are bad eggs in any profession - especially a profession that requires you to maintain an obsessively Type-A achievement-oriented competitive personality for ten years of schooling to even qualify for it, and then expects you to suddenly learn how to display human warmth. The outrageous thing is that we have no way of holding doctors accountable for these stories.

From Jamia:
"Dr. Pineda in Dupont is a good doctor and gives good print outs of your ins and outs, but she told me I was getting fat and needed to exercize and eat better after I went from 105-109 or something while ON my period. She is a hater of skinny women. More women at my job who went to her reported the same thing, although bigger women had no problems. If you're skinny.
don't see Pineda... or else you might need to see a shrink for your newly acquired eating disorder."

From Volha:
"I had a fortune (or misfortune) to visit quite a few in different countries. It is fascinating how dentists have different standards. I come from a post-Soviet country, where at the method to deal with a problematic tooth was to simply remove it. There weren't enough fillings for everyone, and even if you were lucky to get one, the rumour was that they were white cement and fell out in several months.
Well, things are a bit different now. Private dentistry is also prospering. But having gone to the dentist I always want to know what they are doing and why. Although American dentistry is considered to be the best in the world, I feel like a number when I go to dentists, because they are so busy, and have no time to look at the human body as a whole, to pay attention to the patient. Instead they just look at the mechanics of how things should be done. I recently had a sensation that my tooth had affected my sinuses, they felt infected. The specialist I went to barely listened to me, suggesting it was an allegy to the blooming season (I don't have allegies of this kind) and making plans to treat my other tooth. I thought that she might have been a good specialist, but maybe too specialist. I went to a general dentist, who didn't dare to disagree with her...After I expressed my distrust that they were addressing the problems, I could see differences in their opinions. I asked more questions and I got more explanations... The downside of this, expenses and the maximum benefit on every insurance!
Shouldn't I be able to go to a dentist who could honestly tell me what he or she thinks and not treat me like I woudn't understand, not pretend like s/he has all the answers and work with me to find a solution? If you know of such a dentist, I would like his/her number!
On another thought, I never went to dentist school and if they wanted to mislead me, it would be very easy to give some seemingly reasonable explanation. So, I don't know what is the balance here. If anyone has figured that one for themselves, I would be interested in hearing!"

From Heather:
"The GWU-Medical Faculty Associates office has a problem with confidentiality. When I was attempting to make an appointment, the receptionist refused to schedule me unless I told her exactly why I was making the appointment. While my concern was not a big deal, it was still not a regular annual. I still felt more comfortable remaining private about my reasoning. The receptionist, while making a huge fuss about my difficultness, directed me to speak with a Triage nurse, who was not much better. This nurse did close the door to the main lobby, but kept the adjoining door to her own receptionist open, which was once again open to the lobby! What's the point in that!?
After this ordeal, the next available appointment anyway was a month away. By this time I told the nurse that I would not like to be seen by this hospital because I was worried about their lack of confidentiality and empathy towards the patients. The nurse smirked at me and said, "You can always close my other door." With a mixture of rage and embarrassment, I smiled, thanked her for her time and was on my way.
Not only do I not recommend this office, I would also encourage anyone who feels more private about their issues to phone for appointments rather than make them in person. This might sound obvious to most people but I have lived and worked in a hospital environment my whole life and never have I come across a problem like this. Anyone in the medical field is completely aware of confidentiality issues and I was surprised that in a University setting like George Washington Hospital employees were not adhering to this ethically important issue."

From Julie:
"I have mild eczema and a family history of skin cancer, so I wanted to find a good dermatologist in DC to keep an eye on things. When Marilyn Berzin saw me, I told her about my conditions, showed her prescriptions I had from a previous doctor and was going to ask her questions about whether I needed them, whether any came in generic brands, etc. She did not even examine my skin, but asked if I was interested in botox or skin peels or some such disgusting thing that a (then-)28 year old shouldn't even be thinking about. Once she saw that I wasn't interested in them, she was halfway out the door and I literally had to grab her arm to ask her a question. NOT worth it. Avoid her unless you're interested in Botox."

By the way, check out the Leapfrog Group, which perhaps might succeed in bringing a bit of reform to this system:
www.leapfroggroup.org

40 Comments:

Anonymous Anonymous said...

There are defintely studies on the correlation between doctor attitude and likliness to be sued. Malcolm Gladwell devotes and entire section to such studies in (I think) The Tipping Point, but maybe it was Blink. Apparently by FAR the single highest determiner in whether or not a doctor is sued is the social experience that the patient has during the visit. As Malcolm gladwell put it "Patients just don't sue doctors they like"
-Thoreau

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Blogger P. G. said...

I think a lot of the problem is just with the increasing specialization of society, and the absence of time or opportunity for most people to learn basic things about their own health. When people get sick, they have to put themselves totally in the power of the doctor.

A doctor could say "you're having an allergic reaction to the brain implant the Martians put into you" and many of us might just as well believe it, because we can evaluate that about as well as we can evaluate anything else coming out of a doctor's mouth.

In that climate (one remarkably similar to the climate relative to auto mechanics), of course there's widespread distrust on our part, some abuses on their part, litigation, etc.

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Blogger zzzzzoe said...

I've just been reading an interesting anthropology article on Ayurvedic medicine, and the main point is that while the Western paradigm is of health as this basic default state, to which we return by fixing ailments (much as you'd fix a car), Ayurveda sees health as something inherently unstable and needing maintenace and care - and yet also almost infinitely perfectible. It also takes a rather moral viewpoint towards health: it's our duty to preserve it. Who wouldn't want to be more productive, clear-headed, strong, energetic, and good-tempered? And I have to admit I agree. Knowing about how to stay healthy is not something you run out of time for; it's something that gives you more time for other things. And, unfortunately, it's not something that anybody else can do for you. Which I think gets to the crux of what annoys me so much about doctors. So many of them have the attitude that I should just bring in my body for them to fix. without bothering to help me understand the process or context - as if my body was just a car engine.

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