The family doctor is something of an endangered species these days, something that doesn’t get a lot of attention in all the healthcare hullabaloo out there.
You can’t hardly read a newspaper or blog post or listen to a podcast these days without hearing about health care. It’s a gigantic national issue because Obamacare, for all its flaws, is under the knife. Without it millions will lose health care coverage. I am a strong advocate of “Mend it, don’t end it,” but it’s in a few senators’ hands (really a few, like 3.)
Ironically the Senate vote is delayed a week because Sen. John McCain, a strong vote to dismantle the protections of the ACA, had to check in at the renowned Mayo Clinic to have a 2-inch blood clot removed from under his skull. That operation was possible because John McCain gets top-notch tax-payer paid health care. Also he’s a millionaire. Most of us are not in that same yacht.
My current worries about health care are on a more personal level, even as I am aware that I am a lucky duck. I have excellent health care coverage from my job, so Obamacare only touched me in the guarantees it provides — pre-existing conditions covered, no lifetime caps, coverage of essential services. I’d be totally uninsurable without my job and Obamacare.
But I have my job and I have insurance. What I don’t have, or won’t have at the end of the month, is a doctor. The internist my husband and I have seen for over 20 years is becoming a full time hospitalist. Good for him, good for the hospital, bad for us.
Bad for us because more than 20 years of working with our doctor has set the bar pretty high as we look for his replacement, a task made more complicated by the fact that most doctors in town aren’t taking new patients at the very moment that legions of his patients hit the market.
Medical care has been changing around here anyway, as it has been everywhere. IU Health, formerly Clarion, has gobbled up most practices (including Premier, where we see our doctor) and the hospital as well so it’s difficult not to see someone in that system. And financial and efficiency concerns have made the “seeing your doctor” process more bureaucratic, less personal. For instance, you no longer call your doctor’s office, you call a central switchboard and beg to speak to someone who knows you. I remember being hospitalized in NY for a week and my daily calls to our doctor’s nurse kept me sane. Not sure I’d even get through to her now. Doctors are double booked and on a tight time schedule. Time for chat is at a premium and a lot less listening happens as a result. Referrals take forever unless you are a burr under the scheduler’s saddle.
So I know all that is true even for our internist and my GI and OBGYN (all part of IU Health now.)
But still I dream of finding a family doctor who can almost be part of the family in the sense of sharing absolute trust, dark secrets, hidden fears, and the occasional good laugh. Wouldn’t hurt to share political views, either, given OUR day job. That’s what our doctor was for us for so many years, and that’s what I am seeking to replace.
I feel like Jane and Michael Banks advertising for the perfect nanny. Hello? Remember Mary Poppins?
“If you want this choice position,
have a cheery disposition.
Treat us as equals. Always.
Never tell lies, truth pays.
You must be kind, you must be brainy.
Really listen, care insanely.
Fit us in your schedule, don’t make us wait
Return our calls, not late.”
I guess I could waste my whole morning composing this silly song but I am not going to. For one thing, if I tear it up and fling it in the fire, no magical doctor is going to capture the pieces and drift to my rescue under an umbrella. Pretty sure.
And for another, I know that such a doctor doesn’t exist. Mary Poppins herself wasn’t a permanent fix; the story doesn’t end with her spending her life with Jane and Michael. Her mission was to heal a family and move on, not hang around in perpetuity.
But I do have a sense in my mind of what we need in a doctor. Here it is. No music, no rhymes.
I want someone both my husband and I like and trust and who can be doctor to both of us. At critical times in our life, the fact that we both had a doctor-patient relationship with the same guy was vital. We could discuss concerns about the other with him without it being a big deal.
When Jerry was diagnosed with blocked arteries, I called the office (direct line) and our doctor was at the hospital within hours (it helped, ironically, that he was also a hospitalist. I was grateful then but be careful what you wish for.)
He coordinated my husband’s care and, when all the brouhaha of surgery and complications was over, took one look at the nervous wreck I had become and suggested he treat me for anxiety. When I balked at taking an antidepressant he said “I am taking this out of your hands. Try it and if things don’t get better we’ll revisit.” It says a lot for the trust I have in him that I did what he told me. And he was right. Life changing.
But I trusted him then because we’d built that relationship over years. When I was totally wigged out over the first textbook deadline in a series of what would be many, and was suffering multiple stress-related symptoms, he looked me in the eye and summarized his treatment plan: “Finish the fucking book.” How can you not love that? So I finished the fucking book and felt a hell of a lot better.
When I have had multiple cancer scares over the years (he was not my doctor when I did have cancer in 1993, but he understood that that having had it makes you feel eternally vulnerable) he took me seriously, and calmed my fears.
When my husband had a weird rash on his legs, that we thought was just a weird rash, he had him in a local dermatologist’s office the next morning (the hardest appointment to score in Bloomington, by the way) to be sure it wasn’t leukemia (a possibility we hadn’t even known to worry about, Dr. Google not being then what he is today.)
When I had a disconcerting feeling of weakness and a wonky pulse, he clipped a pulse oximeter on to my finger and made me march up and down the stairs with him. When he didn’t like the results, he booked me with a cardiologist that afternoon for a stress EKG and then showed up during the test, his lunch in hand, to see how I was. Diagnosis: really, really out of shape. (I was so glad to have an audience for that.)
But it set the scene for what happened when I had a frustrating digestive diagnosis (this was some years ago, not to be confused with my current one.) He suggested that I take my frustration and turn it into motivation to get really fit. At the time I was probably 40 pounds overweight, had absolutely no upper body strength, and was chronically ashamed of myself. I had never been “really fit” or even a little fit. I could not conceive of myself as “athletic.”
It wasn’t the first time he suggested that I get fitter but this time I really heard it. His words kept echoing in my head and when I looked at my mom and saw the frailty that results from not getting fit, I got what he meant. Did Weight Watchers for real, got a trainer, changed my life, my shame, my self image. He woke me up and empowered me with a hard truth. It may have taken multiple tries on his part but the point is, without constantly harping on it, he gave it multiple tries. He didn’t give up just because I didn’t like hearing it.
I need that in a doctor. No bullshit.
And the respect was mutual. He never condescended to us over anything. He respected our profession, owns multiple copies of our textbook, and peppers us with questions about politics before we get down to whatever we are seeing him for. The one exception was when he came storming into the exam room where I waited, his eyes bulging with frustration, saying “You PROMISED me he wasn’t going to win. You PROMISED. What the hell happened?”
“Sue me,” I told him. “Political science, like medical science, is fallible.” And we commiserated for a while before getting to work.
As I write this I realize that I do indeed have a Jane and Michael Banks list of requirements for a family doctor:
- Smarts and skills
- No bullshit
- Mutual respect
- Sense of humor
- Refusal to see doctors (including him/herself) as gods and to see the flaws in the system.
And when I remember my first visit to my doctor, more than 20 years ago, when I had just passed 40 and he wasn’t quite there yet. I realize I didn’t really know any of those things about him yet.
I know I liked him right away and thought he was good at what he did, but we weren’t old friends yet. Only time made that happen. And that’s what I want, and what even Mary Poppins can’t get me.
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