Old School Medicine
Through a series of events I ended up seeing a physician I hadn’t seen in about 30 years. A very wonderful man. When he first saw me those 30 years ago I had a very bad infection. I was young and very frightened. I had been seeing a variety of medical doctors to try to figure out what was wrong. While no one could really figure it out what was happening was that I was getting treated badly in the process. The doctors stopped looking directly at me and started looking down at their desks. Then they stopped touching me. Then they stopped talking to me and messages were given through nurses or left on messages machines. I was a psychologist at the time and I understood how uncomfortable the ambiguity of my situation was making these medical professionals. Fortunately no one doubted that I was sick. So the waters weren’t muddy. The doctors just felt inadequate. But there was this one doctor who was different. He talked with me at the time. He even broached the possibility that I might not survive the illness and said it might be that it could be diagnosed at autopsy. He was the one who said that he would be available to make me as comfortable as possible right up to the end. I recovered and got better and he remained my physician for many years until I ended up in a health plan with a company he didn’t belong to. I worked directly for some healthplans for a number of years. So my choices of physicians stayed inside the networks of the healthplans.
Years ago, medical doctors used to meet with patients and take a history. The histories took at least 10 minutes. Christopher was different. His history was almost the same as mine as a psychologist. His history takes almost 30 minutes. In complex cases it can take longer. Managed care changed history taking for a lot of physicians. It didn’ change Christopher. There were probably six physicians involved with my medical care 30 years ago. I’ve returned to see three since that time. All three have remembered me. The case was unique. They remember different things about the case. One doctor remembers a story I told him about how I thought AIDS was being transmitted. One doctor remembers how my family reacted to my illness. Christopher remembers some of my symptoms. For him I was an individual, the illness was individualized and the symptoms were unique to me. It’s a manner of managing medicine.
I have an HMO. I paid cash to see Christopher out of the network, because I just couldn’t stand the idea of seeing yet one more new physician. People with run of the mill medical histories just don’t get a sense of how exhausting it is to see medical doctors. It starts moving up to trauma levels. The last several new physicians have been very disconcerting to say the least. There is limited eye contact and a degree of impersonalization that makes the experience cold. So for this referral I went back to Christopher.
I was rushed. The office had moved. The traffic was a mess. My schedule had everything possibly go wrong. But at the doctor’s office it seemed fairly calm. There’s weren’t lots of people waiting. The office staff wasn’t rushed. There was no sense of the frantic chaos I had just left from my own work. This place seemed serene. Then there was about 45 minutes of history with someone who actually seemed interested. This is about the second time a medical doctor actually seemed interested in taking a history from me. Most times I’m much more interested in providing one than they are in hearing about it.
The office was cluttered with images of Ireland. We talked about that for awhile. We share a heritage. We Irish are a chatty bunch. But it’s also the whole old school medicine approach. You talk to someone, you get more information than you do just looking at machinery. It’s the antithesis of Dr. House. It’s diagnosis by communication, by sight, touch and feel, rather than just by numbers. It’s personal and warm.
People are surprised at insurance companies when people go “out of network” to see doctors. There are several reasons people do this. They do it for the convenience of the appointments or locations. They do it because they trust the expertise. Or they know the person and want them.
Now the doctor I got for a referral may have been just fine. I have no idea. I just know I couldn’t see another new doctor just yet. I would either start crying if something went wrong or I would start screaming and either reaction would be way out of proportion to the situation. It would be the reaction to the last four MDs and that just wouldn’t be fair. So that reaction will be saved for my next trip to an emergency room when some idiot asks me either when I can’t breath at all or when my face looks like a balloon “What seems to be the matter?” then I’m going to let them have it. I always do. It’s never fair to them. But geez. The clerk at the desk wasn’t that much of an idiot and seemed to figure out what to write down on the form. I’m spoiled from the old school. Doctors used to take five minutes to take a pulse. They used to take it, not a nurse. They took the blood pressure. They listened to the heart. They looked at you. They touched you. They actually knew how to draw blood. They had their own laboratories in their offices. They has microscopes. They could stain cells. Young doctors rely on technology for diagnosis. They don’t recall that at one time there wasn’t a CT or MRI or the test they are now ordering. There were clinical signs. The clinical signs can show up before some of the lab tests.
Christopher remembered I used to do research. He remembered I used to have a background in medicine. It’s been 30 years. I can’t remember some of the people I saw last week. I can’t recall some of the people I saw this week. I do remember him though. He’s still wonderful.
