The origin of the crisis in health care can be directly correlated with the decline in the respect for and support of general practice physicians now called family medicine specialists. As this society has moved farther and farther away from medical care given by someone who knows you and you know them [which I call "relational medicine"], costs have escalated due to excessive testing, inappropriate referrals to specialists, defensive practices [testing to avoid or to "cover your tail" against malpractice] and medical errors.
***If the doctor doesn't know the patient, more tests are done to try to make the diagnosis since there is no knowledge of the patient's life story--apart from the very sketchy profile we call the past medical history. That history is the bones but not the flesh and breath of the person.
***If the patient doesn't know the doctor, more tests are expected or demanded. "What does he/she know about me?" is the thought. "How can I trust this person to know what's wrong?" The patient trusts impartial tests much more than a rushed and exhausted physician--especially when her/his nose is buried in a computer, asking often obscure questions to comply with the demands of the computer's software program.
***If the doctor and the patient don't know the specialist, watch out! That person may or may not be good at communicating and may not be very good at whatever specialty for which they claim competence. Family physicians used to know and trust every specialist to whom they would refer their patient-friends--yes, patients used to be friends of and with their physicians--but now it's totally up to whatever "health plan" the patient has. That's why the first question anyone is asked now before being seen in any clinic, ER, hospital, surgical center, etc. is "What is the name of your insurance carrier?"
***If the doctor and patient don't know each other, the doctor-patient relationship is that of "strangers in the night". What is there to keep the physician from doing additional tests "just to be sure"? The specter of the malpractice courtroom where the attacking attorney is scoffing in hindsight at the physician's decisions, "You mean you didn't even do that simple test?" is on both the mind of the physician and patient. If the doctor knows their patient, many tests and even ER visits can be avoided. For example: When a patient of mine, the mother of a 2 y/o daughter with an acutely painful arm, called me after hours, I knew that she could follow my instructions on how to treat her child's condition because: 1. I had delivered her with that child, 2. I knew how she cared for her daughter since she had brought her in for well baby checks and on time, 3. I knew the mother was a physical therapist, 4. I knew she could give me an accurate history of what happened, 5. I knew she was capable of following my instructions and 6. I knew if it didn't work that she would come in and not go somewhere else and then sue me. So I proceeded to instruct her, explaining what I thought had happened and what the diagnosis was. She did what I said to do. The child was instantly better. We all went to sleep. Everybody was happy and not a dime was spent. Then I saw her the next morning to confirm that everything was OK.
***Errors happen when care is handed over to strangers. If the surgeon has never met the patient before and doesn't have any recall of the patient's problem other than what's on the chart, there is nothing to refute a typographical error. Whether something is wrong on the left or right side means little to the doctor but means everything to the patient. It's just as easy to type "L" as "R". For example, when a patient is asleep, there's no way to know which side the hernia is on. X-rays can be turned around so "left" looks "right" and "right" looks "left".
Family physicians become a family's doctor because that's what interests them--medical care in the setting of family dynamics, personal perspectives, life stories. People. And the human condition, the struggles coming into life and in leaving it. This is just how they are. These are the things that "turn their crank". Living in the community they serve--for good and for ill.
Surgeons become surgeons, because they like to cut bad things out or fix things and then be done with "it". They don't necessilarily know or care to know the strengths and weaknesses or life story of the patient. They don't want to struggle with the untreatable--things that can't be "fixed". That's their personality. It's not wrong; it's not good or bad. That's what they are and that's what they do. But you would be frustrated to go to one for some problem that cannot be "fixed" or cured. Surgeons are lousy when it comes to diabetes.
Next time I'll write about what's behind that decline in respect and support for family practice.
No comments:
Post a Comment