Wednesday, April 04, 2007

Thoughts on the Medical Professions

A couple of months ago I posted a meme containing "things you don't know." One of them was my hesitancy around medical professionals. I know that my anxiety around medical folk is not rational -- after all, I have two degrees in Biology and the second one was done at a medical school. I know my science. After my adventures over the last week or so, I have tried to figure out what it is that makes me nervous. I have come to some conclusions and feel the need to share them. These are my own opinions and stem from my own experiences. They are not meant to demean or insult anyone. (And I don't think that they do.)

My Conclusions

One: Medical folk are like anyone else, there are really good ones and really bad ones, just fine ones and so so ones.

The EMTs I have encountered (and I meet a lot of them in my line of work) all really seem to care. I haven't met a brusque one yet. The ones who treated me on Saturday were lovely and caring and gave off oodles of concern. We will forgive the odd helmet comment -- everyone is entitled to a verbal faux pas.

I've never met a nurse I didn't like.

On the MD end, however, I've met all kinds and they are the ones who drive my anxiety issues. There was the pediatrician who, when told that I was lactose intolerant, gave me lactose-free formula for my breastfed child. Um... breastmilk has lactose in it. When I mentioned this I was met with "well if you want your child to have colic ..." This was the same woman who walked out of a well child visit 3 times without even an "excuse me." Gee, I know that emergencies come up but at least have the courtesy to utter those two words especially if you are leaving me in the middle of a sentence. By the time Little Squid was a year old I had gotten up the courage to leave her and found our current pediatrician. We rarely see him beyond annual physicals but when we do he is wonderful. From Squidette's adventures with puberty to Little Squid's migraines, the man is just super supportive. I don't want a doctor who prescribes lots of drugs, just one who really listens and makes judgments based on the whole story. The fact that he spends tons of time with us is the cherry on top of the sundae. I see the insurance statements, I know that for his hour with us (half an hour for each kid) he gets only a smidgeon more than I do for two hours of overtime. I know teachers are undervalued but I also, honestly, would pay more for this doctor's services.

Then there was the clinic doctor last week who was wearing a dirty lab coat and didn't seem to believe me when I said I was injured in a bike accident. For his five minutes with me (maybe), he received, from the insurance company and copay combined, the equivalent of more than an hour's overtime for me. Do I feel the experience was worth it? Nope. I left with my stitches intact (fine by me) and a slightly dirty feeling.

Then there was the gyn who was wonderful while I was having my kids but then not so good with issues that arose afterwards. Fine, everyone has their forte. Loved his manner, hated that he never returned calls from a patient who rarely called. He reinforced the feeling that my questions do not deserve answers. He also reinforced the stereotype that doctors always run late. A friend hooked me up with a gyn who really listens to my issues and works with me to solve them. She also doesn't make me feel negligent when I go too long without a visit. The first gyn took my insurance, the second does not. Again, fine by me, the fee is not so outrageous as to keep me from going when I have to but then we are not fiscally challenged and do not have major medical issues. I'm sure there is someone equally as wonderful out there who takes my insurance but I played that field for a while and couldn't find her.

Dentists fall in the same categories. When I moved in with Mike, he was still using his pediatric dentist and she was kind enough to add me to her caseload for a few visits. When Mike needed more adult-type work done we started using a dental clinic that took our insurance but used the pediatric dentist for Squidette. While we loved her, Mike's sister hated her. Said she had no patience for the nervous. Shows how people view others through different lenses.

Regarding that dental clinic ... well we no longer use it and pay a premium for the dentist that we do use. He takes our entire family since our pediatric dentist retired. As a person, I love him. As a dentist I also love him. He has his "thing" -- very much concerned with cosmetics where we are not -- but he doesn't push. We've watched the staff shift and settle as he has established the practice and I like the staff that has stuck around. He also cared enough to call ahead and make sure that his friend saw me last week. I found out later that I was "slipped in" to the schedule before official office hours began. Says a lot for both my dentist and my new doctor. (My dentist had also "slipped me in" for a quick look-see and the patient he kept waiting was very understanding. (Something about my green face, I suspect.))

Two: Support Staff can make or break a patient's experience

Yo Doctors! Don't forget about your staff! You can be the nicest, most concerned medical professional in the world but if your staff is brusque or doesn't give you messages, YOU will get a bad reputation. A rough dental hygienist will kill your reputation for a light touch. The receptionist who says "I recognized you" when walk in and I've only met her by phone -- a gem. A stable, rarely changing, caring staff says a lot about you as a person. Remember the gyn from before -- his staff was constantly changing -- hence the communication problems. A long-time assistant will know the patients who call for the smallest thing and those, like me, who rarely call. My pediatrician's staff is like that. The receptionist will move heaven and earth to get me in if I say I need to see the doctor because she knows that if I call then I have to be worried -- because I never call.

Support staff that lets patients know if a doctor is running significantly behind ... priceless! Support staff that stacks the patients like cordwood and estimates a one to two hour wait when the waiting room is bursting ... well, let's just say that we walked out of there without ever seeing the doctor.

My only two E.R. experiences have left me without complaint. I only have the one personal experience and the one ancillary experience when my mother-in-law had a stroke. Taking the latter experience first -- they were great! Kind, caring and professional. (The kind and caring went a long way for the worried family.) As for my own experience, also professional -- they did their job and I have no quibbles. I do not expect caviar service from any E.R. and certainly not Bellevue which is probably the busiest E.R. in the city. The E.R. was quiet when I went in. I was seen, treated and released fairly quickly. The resident who stitched me up couldn't find some stuff but he got it all sorted out in the end. Everyone and everything was clean and professional. No complaints other then I probably should have been told not to carry my bike out of there since the exertion is probably what reopened a part of my wound and sent me back a few minutes after leaving. I'd have no problems going back there. By reputation I know they do good work even tho my dentist said "Bellevue!" with a tone in his voice. (Two different links to Bellevue -- it really has an interesting history.)

Three: Time is Money?

In my profession, time is not money. We put in far more hours then our salary structure takes in to account. Time is only money if we are tutoring at market rate and not at contract- negotiated overtime. We are expected to have at least one graduate degrees and lots and lots of continuing education in order to keep current. Gee, much like doctors. Teachers, however, see our clients in groups of 34 at a shot. Do I begrudge my salary, no. This is what I chose to do with my life and it makes me happy. At the same time I have to recognize that other professionals are more realistic in the valuation of their time. If they can essentially self-value, then they do it. Good for them. I could do it, too, I just chose not to.

I am not the kind of person to ask a medical friend or relative for advice. I'm too embarrassed and why should they work off hours and for free? No one expects me to tutor in social setting. When I find a Doctor I like, I stick with them, even if they do not take my insurance. Some things are worth the money. Having someone who believes me (ie., bike accident, not spouse beating) is very important. Our last visit to the pediatrician ended with him reassuring me to call with the slightest question. Given how rarely we see him, this went a long way towards allaying my medical phobias. My experience at the clinic did not but was mitigated by the caring attitude of my dentist who steered me to someone like-mind.

There is the saying "time is money" and I know that is the case for doctors. The more patients they see in a day, the more money they bring in. Overhead costs have to be paid and I understand that they can be steep. Many insurance companies do not reimburse at what I view to be a fair rate -- my insurance company included. Should I switch to one that reimburses more, at a greater cost to me? Probably. Am I going to? No. I have a few doctors who take it and those who don't ... I pay full price.

A family like mine, coming with minor issues, is not a cash cow. A doctor who values time as much as money is a gem, a flower to be appreciated and cultivated. If any are reading this ... Thanks. (And if you want to read a really good essay about the time versus money thing, click here.)

(That said, it should also be noted that I coordinate a program for kids who want to be ... you got it ... Doctors. During my periodic visits to our partner hospital with my students,l I do get, you guessed it, nervous.)


Cookie said...

I think I agree with all of that. My medical coverage is different from yours, but my take on the medical profession is the same. We use docs employed by the HMO and only pay a co-pay per visit.

I'm so glad that you've been able to find a good team of people to look after ya'll. *hugs*

diann said...

What you said. Time is money, and just because I don't necessarily get paid by the hour (sometimes I do, and sometimes I don't) doesn't make it OK to make me wait.

My DH's doctor once made us wait 45 minutes while he met with a saleman from a drug company. I told him if it *ever* happened again he'd be getting a bill for my time. It hasn't.

Different topic: I have a box of yarn and needles for your knitting group. Are straight needles OK?

fillyjonk said...

I have all kinds of doctor issues.

#1 that I hate is the doctor who, when you show up with a sprained wrist, immediately looks at your weight on the chart, and without asking whether you work out, and what your diet's like, and IF you are even interested in weight loss, immediately suggests some kind of diet plan (or worse, diet drugs). Or who suggests that the injury is caused somehow by your weight.

Just make my wrist stop hurting and stabilize it. Trust me, I know I'm fat. Trust me, I'm doing what is reasonably possible about it. No, I don't want to take potentially dangerous drugs to maybe make me lose weight.

(Part of the problem is that around here, a lot of the doctors have sidelines in "bariatrics" or "weight control." Apparently it's quite lucrative. Which tends to make me distrust it.)

#2 is the doctor or dentist who pushes sedation or "gas" or something on you. Yes, I'm an apprehensive patient. But I can control it once I'm in the chair. I also have a pretty high pain threshold. And I have to either drive myself home afterwards or have you find someone to do it for me. Don't come at me with that nitrous!

#3 is the person who won't explain things. I'm a biologist. I know what the big words mean. I want to know what's going on with my body. I promise not to freak out if I don't understand something.

#4 is the "purely cosmetic reasons" stuff. Yes, I know all about tooth whitening. My teeth are not that bad. I am not interested in it, thank you. My teeth are sensitive and I know whitening will only make it worse. And yes, I know I have a bump in my nose. It actually helps my glasses stay up. I don't want to go through the surgery and recovery to remove it unless it's impairing my quality of life...which it is not at this point.

I think because I have good insurance, a lot of the doctors suggest things I really don't NEED done, because they can make money off of it. It's frustrating. I finally have a dentist and a gyn who aren't all about the unnecessary stuff. I just need to find a good internist...

Debby said...

There are some great discussions here. I would like to add my concerns too:

1)If your particular case doesn't fit the doctor's model, and he can't put you into a stereotype diagnosis in five minutes, you are treated dismissively as a difficult patient. I saw my MIL become allergic to every food she encountered, and allergist #1 only made it worse. Allergist #2 has her back to regular eating, and I think at this point she has healed enough to eat most anything. Caring and taking time to hear the whole story makes a big difference.

2)Experience plays a part. No, I'm not a doctor, but I can learn a lot about myself, my DH, and my cats just by watching for repeated patterns. Just because it's not in your textbook doesn't make it so. DH's former doctor insisted that stress did not aggravate his IBD, but didn't hesitate to up the dosage on his meds during, oh, the bar exam.

3)I can't think of the term right now; is it preventative medicine? If I tell you I don't feel well, and you haven't started by asking me how much I sleep, what my diet is like, if I exercise, etc, I'm going to be nervous about how you diagnose me. Some doctors don't ask the most basic questions about our self-care, but are all too willing to reach for the prescription pad. I was shocked to hear that doctors take only one class on nutrition.

Anyway, thanks for giving me an opportunity to get on the medical soapbox. :) I may not be able to afford some doctors who don't take my insurance, but I'll drive a zillion miles for a great doctor who does. And I have. :)

Susan said...

I have a lot of thoughts on this subject. I work with doctors and have for almost 30 years. There are good, there are bad, just like in any profession. I find it fascinating that some that I think are just too fine, others may find abrasive, uncaring, whatever and vice versa.

I too believe that the people who answer the phones and take the messages are maybe the next most important part of a practice and really appreciate the helpful polite ones. I also know, however, that some of the ones that don't make the top 10 list are doing EXACTLY what they are told to do. Not that the doc would ever own up to this.

I really, really appreciate being seen promptly and I also really, really appreciate the doc that takes extra time to spend with me. Unfortunately the appointment after me may have not the same feeling LOL

I'm really glad that I have co-pay now, and even more happy that the docs I love most is a part of that. It's rough out there for those who don't have the ability to pay or insurance that covers them. And I don't see it getting any better.

Helen said...

I once left a doctor because she was ALWAYS running late, and her staff could NEVER tell us that. When I'd spent 45 minutes in the waiting room with two toddlers (sick ones), perpetually being told I'd be seen soon, I'd had it. I'd told the doc several times that it would be REALLY nice if her staff could tell us when we arrived that she was running x minutes late. That way, if I had another errand, I could go do it and get back...
That 45 minute wait was too much.

The new doc, who had left that same office over management issues, never kept us waiting more than ten minutes. Never.

I often noted that if I'd ever made a client wait for an appointment for 30 minutes, I'd lose the client.

Meanwhile... on the good team front.. we have a great team. They're all "out of network" for our shitty insurance. I'm not HAPPY to pay the extra, but I'm very willing just to have a team of professionals all of whom I trust, all of whom communicate with each other, and all of whom talk to me as though I'm an intelligent informed consumer.

I hate it when docs don't tell you everything you need to know!