Back in the '80s, when I was living in Watertown, outside of
Boston, I attended a concert by the great Beaux Arts Trio at Harvard's Sanders
Theater. Midway through the first
number, a commotion arose at the rear of the balcony. Someone called, "Is there a doctor?" This being primarily a Harvard audience, a
goodly number of medical students, Mass General residents, and junior and
senior Med School professors looked around, searching for the most senior
physician attending the concert [protocol in those days compared favorably with
that among the English Peerage.] The
trio fell silent while we all sat and waited.
After a bit, we heard the siren of an ambulance [this was well before
cell phones, so someone must have called on a house line.] Eventually men hurried in with a rolling
stretcher and carted some poor sod off.
The trio picked up where they had left off, and we all cheered them to
the echo when they finished, as much out of relief as aesthetic pleasure. Then, mid way through the second number, it
happened again! This time, Isidore
Cohen, Leonard Greenhouse, and Menachim Pressler threw in the towel and announced
intermission. The next weekend, I flew to
RDU to visit Susie on one of my twice-monthly trips. When she picked me up at
the airport, she told me with great excitement that she managed to obtain
tickets to a sold-out concert at Duke.
The Beaux Arts Trio was coming to town!
The concert went off without a hitch.
Nobody died.
I thought of this tidbit of ancient history this morning as
I walked because for some long time now I have been struggling with increasingly
invasive pain in many parts of my body and I have been unable to get my doctor
to really pay attention to me. I have
access at UNC to world-class specialists of every conceivable variety, but I do
not feel that I have a doctor. Let me explain. [I apologize for this shamelessly personal
post on a blog that has always striven for an elevated intellectual ambiance,
but the pain has destroyed my equanimity and undermined my philosophical
ability to view the universe sub
specie aeternitatis.]
Four or five months ago, I began to develop increasing pain
in various parts of my body -- elbow, thighs , neck, arms -- nothing remotely
life-threatening, let me hasten to say, but as it worsened, enough to destroy
my normal cheerful equanimity, so that in the past two months, my life has been
mostly about the pain. My doctor
did not seem to me to be paying much
attention to what I was saying when I saw him, so I complained loudly. At that time, four weeks ago, he was very
apologetic, thanked me for being honest with him, and examined me. He did three things. At the suggestion of the specialist who was
treating me for "tennis elbow" [a separate problem], he took me off a
statin medication I had been taking for years to lower my cholesterol [statins
can cause generalized muscle pain -- who knew?]. He prescribed Celebrex for the pain -- 100 mg
twice daily. And he referred me to UNC's
big hernia man for a possible femoral hernia.
And that was the last I heard from him. So far as I could make out, when I walked out
of the examining room, he totally put me out of his mind. Was he curious whether taking me off statins helped
with the pain? Apparently not. Did he want to know whether the dosage of
Celebrex needed to be adjusted? It seems
never to have crossed his mind.
Yesterday the hernia maven told me the CT scan showed no evidence of a
hernia. Does my doctor even care? Who knows?
I made an appointment to see my doctor this afternoon at
2:20. I am going to ask him straight out
whether he wants to be my doctor, because as of now, I do believe that I have a
doctor. What I have is access to a suite
of world-class specialists who will attend with great skill to neck or my thigh
or my left elbow [I feel like Koko in The
Mikado!], but I do not have a doctor who is treating me, all of me, in an intelligent on-going fashion.
Am I in the grip of a nostalgic fantasy? Is medicine no longer practiced that way?
6 comments:
My understanding is that Medicine is no longer practiced "that way." There's plenty of literature about this on the internet, but basically, the rise of malpractice insurance premiums, competition from "one-stop shop" HMOs, and hyper-specialization in the field have led to the demise of the old-fashioned "family doctor". There remains, of course, an enormous demand for healthcare practitioners who treat "the whole person"; this is reflected in the proliferation of Naturopathic Doctors, Chiropractors, and other "holistic" health practices. I am sure there are plenty of holistic health practitioners in the Raleigh-Durham area that claim to offer precisely the care you're looking for. The effectiveness of the treatments themselves are controversial, and generally don't stand up to scientific scrutiny... it's all the hippy-science stuff involving crystals and acupuncture etc. But the practitioners themselves are earnest, believe in what they do, and will be very, very interested in treating "the whole you".
I am sorry to hear this story. I spent three years helping my parents, who were in their mid-eighties at the time. I cannot say their experience was exactly like yours, but there is a commonality.
As the previous commentator said, there is stuff about this on the web. I've read a couple of things at "Naked Capitalism". (It's not their main interest, but it does show up from time to time, and they link to places where medical professionals are discussing the problem.)
The pain problem is a real bitch. About six years ago, when I first went home to help my mother and father, my mother had run out of Celebrex, and it seemed as though the doctors were conspiring to prevent her from getting any more. (She has arthritis and a degenerative spinal condition. If she doesn't have her pain-killers (there's another she's taking whose name I've forgotten), she is miserable.)
I helped my mother write a letter to the doctor who was supposed to be writing a prescription for Celebrex, and I may have even sent it to the group where he works. But I was in a mood to complain to anyone and everyone. The letter worked, but when my mother and I showed up at the doctor's office, he did complain about how ungrateful patients and insurance companies were. The idea that his daily annoyances were not in the same category as my elderly mother's daily pain did not occur to him. Among his office staff he is greatly admired for owning an expensive sports car.
I have worked in hospitals most of my adult life, the majority of that in support roles in which I basically could study how doctors functioned unnoticed. Coupled with my rather extensive personal experience with doctors, I can only conclude that your experience is quite common. The money, prestige and lighter work loads that come with being a specialist have contributed both to a decline in interest in students going into Family Practice/General Medicine and to existing FP/GPs being increasingly and terrifyingly overworked.
As for the pain, I can sympathize somewhat, as a week ago I broke a bone in my left foot and will be in a cast and on crutches for anywhere from 4-12 weeks, depending on how quickly I heal. Besides the obvious pain of a broken bone, I am also incredibly sore from using crutches. Now I'll be the first to admit that I lead a far too sedentary life, but wow am I sore all over from the unnatural twisting and balancing I must do. I hope you get through to your doctor and your pain is addressed adequately (this too - poor pain management- is a very common problem with medicine as practised currently in the US).
At any rate, I am only 33 and while I joke about being old (and am the oldest of my "meatspace" friends, I surely have nothing on you Professor! Which brings to my mind something that I have worried about whenever you mention your age or health - supposing something tragic happens to you, is there any way readers of this blog will know or will some day there just won't be any new posts? (I don't wish to be morbid, and I wish you as many more years as you wish for yourself, but the thought of you sustaining a debilitating or fatal injury or illness fills me with great dread - I can't begin to express how much your wisdom, wit, compassion, and joie de vivre have consoled and inspired me over the years, even though I am an infrequent commenter.)
Professor Wolff,
Medicine is still practiced that way in Cuba :)
What you are looking for is now sold as "executive medicine" and sometimes described/derided as "concierge medicine." It comes at a much higher price than ordinary care; the extra is course not reimbursable under a normal health plan.
Dear Prof. Wolff,
I wish you a swift recovery, and, as TheDudeDiogenes said, a long and healthy life.
As for your particular question, in Australia either we are a bit old-fashioned, or maybe it's just my luck, but my G.P. (general practitioner or family doctor) has been as competent as humane, sympathetic, and dedicated. I have no reason to complain on that respect.
Particularly a young female doctor from Singapore, who has been handling my case in the clinic she works for.
Whatever problems I've had on this area -- and there were some problems -- were always, invariably, due to the clinic itself, which pushes the doctors beyond any human limits, not the doctors.
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