Four years ago following a medical runaround that persisted for close to a year, a friend insisted I get on a plane, travel to France, and see a physician there.
I did.
With my medical records, my scans, and my stories of who said what and who didn’t say anything.
I got answers. A diagnosis. And a treatment plan to put into practice when I came home.
It worked.
But first, I got a listening ear and the touch of a physician’s hands. It’s an expensive way to get answers. And the irony? The costs I did incur were considerably less than what I’d already spent, getting nowhere.
Just last month I received the latest in another series of medical runarounds, during which time I was told to take anti-depressants and aspirin for back and leg pain which may be related to injuries in a car accident – or not.
A Pill for Every Ill
Anti-depressants.
I’m not anxious. I’m not depressed. The pain clearly has a specific origin. It’s my body. I’d like some answers.
This, yet one more instance of consuming precious limited insurance visits, each with a co-pay that is considerable, and an exam that consisted of taking my blood pressure (the nurse), checking my pulse (again, the nurse), and testing my reflexes (tap, tap by the doctor). Other than that, the physician never touched me.
I’m going to repeat that: The physician never touched me.
Needless to say, the pain persists.
Whatever happened to diagnosis? Whatever happened to healing hands?
Our Health Care Debate
I don’t mean to belabor this issue. Then again, if ever there were an issue to belabor, wouldn’t the state of our health care system be an excellent place to start?
We worry about affordable access. We debate over any access. But what about the quality of that access? What about simple attentiveness? Asking questions? Listening to answers? Touching the patient?
I thought perhaps this was a localized problem. Murphy’s Law in effect. A spate of bad luck. A series of indifferent physicians at the medical center where I’ve been trying one doctor after another.
Apparently not.
Listening to Our Bodies
Only once in the past few years did I receive a thorough physical exam. That was 9 months ago – on the recommendation of a friend, and at a location that is out of the way. The doctor asked questions. He touched me. He ran a variety of tests and identified a problem that was easily dealt with. But all those months I was in pain and ignored exacted a toll, not only physically but emotionally and financially.
As other issues persist, I’m making the trek back to that doctor, hoping he can help again. I’m listening to my body. I’m steeling myself to deal with the energy and discomfort of getting to his office, and absorbing the “lost time” that will take.
Access isn’t just an issue of dollars and insurance. It’s a sometimes grueling logistical act of getting to and from a doctor’s facility.
Why didn’t I return to him sooner?
He’s retiring in two months. I was trying to find someone closer, and with whom I could establish an ongoing relationship. Doctor-patient relationship. Remember that?
The Art of the Exam (or Lack Thereof)
In my early morning reading, I came across this: an article in the Times, on the art of the physical exam. Apparently, it’s an increasingly lost art. Is my experience part of an unfortunate trend? Worsened by health care providers who are swamped with patients and paperwork?
No doubt.
But a physical exam that doesn’t involve examining the patient?
Unacceptable.
From the article, I gather this literal lack of connection is not a localized issue. Focused on the work of a Dr. Abraham Verghese, the article states:
At Stanford, he [Dr. Verghese] is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening — the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.
Touching, Looking, and Listening
Old fashioned “touching, looking and listening.”
Think about that. What could be more basic? How about “practiced hands and a stethoscope” over Prozac and aspirin? How many of us are walking around medicated to make nice, rather than treated for real problems?
The article goes on to say:
A proper exam also earns trust… and serves as a ritual that transforms two strangers into doctor and patient… Patients know in a heartbeat if they’re getting a clumsy exam.
Exactly. But patients doesn’t necessarily have the means for a prolonged search, or the audacity to speak up to the one in authority – to refuse what seems like an overly invasive solution for a manageable problem, to let the physicians know they’re sensitive to certain medications (different from allergic; may be a matter of lesser doses), or to ask for comprehensible explanations.
Who isn’t intimidated in a doctor’s office, especially sitting naked in a paper gown?
Ask Questions, Speak Up!
We accept what we’re told. We bow to credentials framed and hung on the wall. We suffer the arrogance of both.
We suffer.
I refuse to be a victim of “the system.” So I keep trying, eating time and dollars I can “ill” afford, expending energy I do not have. But I’m convinced this pain has a reason, and I believe it’s treatable or at least improvable. I’ll be damned if I’m going to drag around in silence, accept dismissal, and not fight for my own health.
What about you?
- Do you take your medical care for granted?
- Do you have a regular physician you trust?
- Do you worry about the future, and your ability to have access – to quality care?
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I loved that article in the NY Times. It made SO MUCH sense, yet these super-smart doctors who are too rushed don’t seem to get it. I go to my family practice doctor when I am sick, which (thankfully) doesn’t happen very often. For my gyn care, I’ve been going to the same certified nurse midwife at a nearby ob/gyn office. Apparently, I waited too long past the magic number. Suddenly, even though I’ve been seeing her for years, I can’t anymore because she “isn’t taking new patients.” Not helpful.
I hope your far away doctor provides you more answers, relief, and hopefully a referral to a like-minded colleague!
@Andrea – Some doctors genuinely do seem swamped and rushed. And I love the idea of more extensively making use of PAs and nurse midwives and other health care professionals, so that the physicians would have more time where their skills are needed. There was so much common sense in that article, I agree. (I hope you read the entire article. It was fascinating.) And I don’t think this is a simple issue. But when you are repeatedly on the receiving end of crappy care, years of it, and “dismissed” – well – let’s say you’re mighty grateful when you run into a doctor who listens, talks, and touches…
@Gale – You raise interesting points. The fact is, I don’t even mind the waiting. I always bring some research, writing or reading, and I know that many doctors’ schedules get thrown off by emergencies or overscheduling. I get that. But the 7 minutes or 4 minutes of time, only? Maybe if it’s strep throat, but for more serious complaints? Hard to justify. Again – if there are PAs and others around, I’ve found them wonderful.
@Carol, @Kristen – I, too, have had good doctor-patient relationships, but it’s now been years, with only the occasional exception. In fact, other than the doctor mentioned this morning (and I don’t really know him well), the last time was 5 or more years ago. And yes, Kristen – I had a great experience with OB/GYNs, but that was 16+ years ago now. I think perhaps they take more time and care, given the nature of the field. Have other mothers had great OB experiences?
@Martini Mom – you’re fortunate to have some alternative medicine options in your area. Are they given the respect and airing they deserve, you think?
@Kitch – Ah, the malpractice trap. Yes. I can’t imagine what it is to sit on the other side of this complicated debate. Seeing your husband called at all hours for frivolous and costly tests that are only about CYA. I have a friend who’s husband is a doctor. Smart, caring, and sometimes I wonder how he has managed everything for so many years. And believe me, he’s not in a field where he makes a fortune either. Just “regular people” raising kids and trying to get them through college.
So what’s the answer? The hundred different answers? How many more decades before real improvements are made?
I have so many responses to this post.
First and foremost I must say: Good for you! The healthcare system is overwhelming, intimidating, confusing, and cumbersome. More times than not it’s easier just to avoid the whole affair and hope Problem X goes away on its own. And that’s what many people do. I’m so glad that you’re being proactive and persistent about managing your health.
Secondly, on a “who’s to blame?” note, the biggest perpetrator of the “lost art of the physical exam” is fee-for-service medicine. If you think about it, doctors make more money the sicker you are. The incentives are completely screwed up. The doctor’s financial incentives push him to see as many patients as possible each day. His compensation is in no way tied to the quality of the care he gives, only to the number of patients that walk in and out the door. If his initial exam is ineffective and you have to come back? $$$$$. Thankfully, the healthcare system is (s-l-o-w-l-y) turning a corner toward “value-based care” which addresses the appropriate balance of cost and quality. More and more, doctors are being held accountable for the quality of the care they give, and soon many will be incentivized to keep you healthy. I could go on and on about the system, its problems, and the currently proposed solutions, but I’ll spare you my soapbox. The good news, though, is that the government is finally realizing what a problem this is and PPACA (while not perfect) was a huge step in the right direction.
Lastly, yes, I’ve been in your shoes. At my last check-up I sat in the waiting room for an hour and twenty minutes before being seen. The doctor was in the exam room with me for a total of seven minutes, and the exam itself lasted four minutes. I was furious, frustrated, and insulted. Thankfully I’m young and healthy and her dereliction hasn’t left me with any condition untreated. Nevertheless, I’m not going back. I asked around and when three different friends independently recommended the same doctor, I made an appointment. I’m having to wait six months to get in, but I’m optimistic this guy will be better. There’s nowhere to go but up, right?
Thank you for shining your own personal light on this issue. We can listen to politicians shout about it from the rooftops all day long, but hearing a single person’s story is always more poignant. Good luck with your upcoming appointment, and with the pain – physical and otherwise.
Doctor-patient relationships just seem to not exist anymore. Years ago I went to an FNP who was wonderful. She spent time with me, she answered questions, she always made me feel I was important. Then she moved to another practice, which would have required I take a whole day off work to go, so I switched. To someone I no longer even remember, so it must not have been impressive. Then I moved. And I’m still looking. I’m not sure of the cause, but I suspect it has to do, at least in part, with the fact that there are fewer doctors and more patients. The costs of being in business (malpractice insurance) are ridiculous, so why put yourself in that position? Maybe the cause is the litigious nature of our society.
I am very fortunate to have a wonderful, old-school OB/GYN with whom I’ve spent a lot of time in the past 3 1/2 years. She never makes me feel rushed. She takes time to answer questions. She makes quality referrals (including getting me in to see a physical therapist who only treats pregnant women – who knew such a person existed?). But I’ve never had that type of relationship with any other doctor so I know how lucky I am to have met her and to work with her.
As a side note, the Stanford doc you mention also happens to be a gifted writer. I am reading and enjoying Abraham Verghese’s novel, Cutting for Stone right now.
I hope that you are able to get helpful answers from your visit with this soon-to-be-retired doctor.
I have had phenomenally better experiences with “alternative” doctors. Luckily, I live in an area where naturopaths, herbalists, Chinese medicine, etc. is prevalent so I have lots of options. They aren’t appropriate for everything, though, and when i need a regular ol’ doctor, I’m generally disappointed. I’ve been seeing the same physician for years when it’s called for and, although I really like him, he is ALWAYS so rushed.
When my youngest son was born, we found a pediatric naturopath (who just happens to be located withing walking distance from our house) and couldn’t be happier with her. Her service is excellent. She takes as long as is needed in the appointment, and has taken the time to get to know us outside of a strictly medical sense, which I think goes a long way to being able to treat us better. When we were having trouble deciding what to name our son, she even gave us a list of resources and referrals to spiritual namers in the area. (Although I was intrigued by the idea of a spiritual namer, we didn’t take her up on it – but still, what service!) She also happens to be the one who noticed that our son’s collar bone was broken – something that happened during the birthing process and was MISSED entirely by the pediatrician and nurses at the hospital. I’m so glad we found her!
Good luck with your medical issues. It’s ridiculous that you have to go to such great lengths to get quality care.
Actually, Gale, I honestly want to say that there are a lot of doctors out there who are so against unnecessary tests. You know what causes unnecessary tests? Lawyers. Lawsuits. Frivolous, rampant lawsuits. And yes, some lazy physicians–usually ones in the ER.
Doctors are so worried about covering their asses, fearing lawsuits, that they’ll order a ton of things to rule out ANY kind of freak thing. My husband is a radiologist and he gets so upset when he’s on call, because certain ER docs don’t even really “think it through”–they just order a ton of scans, even if it’s highly unlikely that Mr. Jones has an obstructed bowel (most common reason for an ER visit: stomach cramps/pain). My husband gets called all night, reading scans that don’t need to be done, because every angle needs to be covered–and this is the ER, mind you–a lot of these patients cannot pay for services. But they can find someone to represent them and sue you if there’s a misdiagnosis.
It’s disgusting how many unnecessary tests are ordered, but it’s not as simple as blaming the doctors. The problems are more complex than that.
BLW, I am connected to the medical profession through my husband. Perhaps the physical exam is something that is done as a token gesture by certain doctors, but more often patients are demanding that certain expensive tests be performed (MRI & CAT Scan) even before they walk into the doctor’s office. Patients are more informed (which they should be), but also as a result are more demanding of what tests they want run. Sometimes the doctors have no choice but to opt for technology because it is what helps the patient’s peace of mind.
I agree that physician should slow down and have a dialogue with their patients. This is an important discussion BLW and I hope you get the listening ear that you need from the doctor you visit.
I wonder if this is a bit like the chicken and the egg, Rudri. Patients feel like they aren’t getting the care they should, like they must ask for certain tests or they won’t be listened to or taken seriously. Furthermore, I can’t help but think about the non-stop barrage of pharmaceutical advertising which hits us morning til night from every media source. Is it any wonder that we think there is a pill for every ill, that we conjure ills where they may not exist, and that we worry about our health, and hope that technology will catch something that the human eye will not?
That said, in my case, if something hurts, shouldn’t it be pushed, poked or palpated? I was after hands, not scans.
No simple solutions in this murky conversation.
My question is–is it the doctor’s fault or the health care system’s fault? Doctors are very limited on their time. And, if we have socialized health care, guess what? They will be EVEN MORE limited. I’m not saying I’m against it, just reminding all of us that this new health care plan still hasn’t addressed one of the most important issues: The number of doctors that are available. Once everyone has health care, doctors will be forced to spend even less with their patients. Unless they want to be there all night long–something that none of us would be willing to do for the type of pay they will be receiving. And the amount of debt they have. The health care mess is more than about insurance and doctors. Its about medical school admissions, medical school costs, the cost-benefits of being a primary care physician, and the tyranny of insurance companies.
Amber, I think the challenges are huge, the “fix” not simple, and I think we should all shift the conversation slightly, away from blame, and toward identifying issues that need to be addressed. There are crappy doctors, and incompetent ones. I’ve seen my share. There are also superb doctors, and good ones, and I’ve seen a few of those, too.
I agree with you completely that this isn’t an isolated set of issues any more than the issues around our economy or legal system are isolated. You raise the issue of medical school, the untenable burden of those years of expense, the terrible demands put on medical students, the tyranny of the insurance companies. Yes. And then there is our litigious society, the media, our cultural expectations that may be out of line with what is possible, and so many other social issues wrapped up in this. Certainly the economy, and the fact that people cannot get health care when they need it if they can’t afford insurance and they don’t have an employer subsidizing the cost.
It’s a mess. But as individuals, I think we speak out where we can, about the issues we face, ourselves, or others won’t be aware. You have a voice that comes from another perspective – an important one – what the medical students are put through, and their families.
Oh, and THANK YOU KITCH for coming out against the frivolous lawsuits. Another issues this wonderful healthcare plan does not address.
(P.S. Thank you for hosting this conversation, Wolf.)
My pleasure for “hosting” Amber. 🙂 Part Deux coming this morning…
I’m one of those people who have to be about dead before I voluntarily go to the doctor for anything. I waited 5 months before seeing a doctor about a shoulder pain (that ended up in rotator cuff surgery). I spent 3 months flat on my back with a blown disc before I found an acceptable orthopedic spine doctor that wouldn’t cut me open to fix it. I hate insurance plans that have a gatekeeper before you can see a specialist. I can manage my own health thank you very much. I go to the gyn only because I’m suppose to go every year. I’ll probably regret living this way but I don’t really like doctors!
Kitch – I totally agree with you. The malpractice industry is responsible for a lot of the problem. And actually, I think radiologists get unfairly fingered in a lot of this mess. Diagnostic tests are hugely expensive, but it’s not the radiologists who are requesting half a dozen CTs for a single patient. PCPs don’t take the time to coordinate with the specialists, so redundant and unnecessary tests get ordered all the time. Radiologists only know what tests have been ordered and it’s not their job to hunt through the backstory to find out if the test is really needed. The thing is, I think that if PCPs actually coordinated the care of their patients they could get by with many fewer tests and still have enough evidence available to defend their care decisions.
One of the most useful books I have read in the past few years is
“How Doctors Think” by Dr. Jerome Gropman
http://tinyurl.com/29hz5d5
I’m with you, rooting for answers for you, BLW. I saw the NYT article when it first came out and wanted to cry. Finding such a person to pay attention — it shouldn’t be so hard, so unlikely, and so costly to our wallets and our spirits.
{{{BLW}}}