Saturday, February 20, 2010

Time: A Doctor Who Acts Like It Doesn't Exist

When I was a kid, I remember the doctor made house calls. Not the pediatrician; there wasn't one. He was our family doctor. And I remember being very angry indeed that he once was allowed to come into my candy-striped bedroom, stick a tongue depressor in my mouth and make me say "ah!" when I just wanted to be left alone to enjoy my raging fever.

But from an adult perspective, how wonderful that was. My parents didn't have to bundle up a sick little kid, drag her into the office and wait until the doctor could see her. Better for everyone, though less efficient use of time for the doctor.

Today, everyone's a specialist. Everyone is overbooked. No one has time to leave the office unless it's to visit the patients in the hospital. A doctor's visit means a long wait in the waiting room, then a long wait in the examining room, then, with luck, a pleasant though somewhat harried physician joining you with your chart in hand, asking what exactly seems to be the problem.

The good ones manage to come up with a name for the ailment and the treatment. Or sometimes you get sent for tests. Lots of them.

Yesterday I saw a dinosaur. He looked like a regular doctor but trust me, this guy was from the stone age.

Here's what happened.

We arrived for an appointment. Nothing serious, just a few things normal for bodies that have lived awhile.

"The doctor is running an hour and a half behind," the nurse said, looking around the waiting room. "If anyone wants to reschedule..."

It took awhile, but a couple of people bailed.

"This gentleman's getting a physical," the nurse said, looking at one fellow.

Another patient decided he could wait to see the doctor on another day.

We said we'd wait. We went out, got a coffee, came back and waited. And waited.

It was more like two hours than an hour and a half. But here's why we waited:

The doctor's staff went home at five. The building was empty. And the doctor kept on finishing his exams, taking all the time he needed with each one, explaining things to his patients, grabbing books to better explain what he was telling them, getting later and later by the moment.

Our appointment lasted well over an hour. The doctor showed no sign of feeling rushed, hungry, even the least bit impatient. He chatted, explained, asked questions, answered questions for as long as there were any questions to ask.

After a relaxed visit, with every single question answered and promises from the doctor that he would take care of calling any other doctors necessary, he moved on to the next patient. The last patient of the day. It was already seven thirty at night. He hadn't had dinner. And he still had to go to the hospital, check on his patients, and return phone calls.

My inner-mother-voice says he should restructure his days, make sure he doesn't book his day so full, allow himself time to eat, to rest. He cannot keep up this pace. He will burn out. It would also eliminate the ridiculous waits endured by his patients. When, I wonder, does he relax?

But he's a man comfortably in middle age who appears very happy with his profession, very excited and interested in medicine and in the people he treats.

Perhaps he has no life. Yet his life is very full.

Remember that line from Field of Dreams with Dr. Burt Lancaster? Later Dr. Burt has to step across the line to save a child's life, ending the miracle that brought him back to life and made him young so he could fulfill his dream of batting in the major leagues?

Ray Kinsella: Fifty years ago, for five minutes you came within... you came this close. It would KILL some men to get so close to their dream and not touch it. God, they'd consider it a tragedy.

Dr. Archibald "Moonlight" Graham: Son, if I'd only gotten to be a doctor for five minutes... now that would have been a tragedy.


Jo said...

I remember when I was a little girl, our family doctor was a friend of the family, and he made house calls -- day or night. It never occured to me at that time that one day house calls would be a thing of the past.

I work with doctors (respirologists) in a clinical setting, and I see how much they care for their patients, and how bad they feel when they get behind, but still they do take the time -- particularly with the serious cases -- to spend time with the patients, but it's not always easy. And I have seen them go into their office and cry when a patient has died, too.

But yes, nowadays it is very difficult to find a good doctor who acts like time doesn't exist.

Susan said...

My experience in the US, Jo, is that the doctors try hard but a doctor's visit is an assembly line experience. They're so overworked, so jammed, that they do what they can but it doesn't feel like the personal relationships I remember my mother seemed to have with our doctors is even possible.

Our small town doctor, who just recently died at a very healthy old age, knew every kid in town, had delivered most of them. He pierced my ears for me when I was thirteen and did my mother's at that appointment, too.

Maybe it's the specialization that's changed things, maybe it's the high cost of doctor's malpractice insurance that requires more and more productivity, maybe it's the insurance companies' demands for endless paperwork.

But except in very rare cases here, things have changed. And I feel as sorry for the doctors as I do for the patients - we've all lost something of value.

Reya Mellicker said...

One of my clients in an MD who is almost constantly in a fight with her office manager who insists on booking her day way too full. This doctor is excellent - does all of what you described, but she definitely is exhausted at the end of the day. Turning medicine into an industry is a big problem for so many reasons. Have you read "How Doctors Think" by Jerome Groupman (might not be the exact title, and I think I misspelled his name). Fascinating book.

Glad you got good care!

Pauline said...

My doctor is much like the one you describe - which is why his waiting room is always full and people wait. We're lucky to find them - but the price they pay is far larger than our having to wait for an hour or two.

Russell said...

Nice to know such doctors still exist.

I admit that the doctors I have seen over the years have been very good, for the most part. My current doctor -- who tells me I need to get in more often -- is very pleasant and never seems rushed.

But I know it is, as you say, an assembly line operation and that is true. It is just the reality of our current society.

Enjoyed your post very much and really liked the reference to one of our Iowa-based movies!

Susan said...

Reya, I'll add that book to my growing list of "read this!"

Pauline and Russell, good to know there are other doctors trying to be the kind of physicians they probably wanted to be...despite a system that makes it harder and harder.

And Field of Dreams...well, who doesn't love Dr. Burt?

Lindy said...

I had a doctor like yours about 20 years ago. So dedicated and compassionate. One day he packed up his family and moved to the Caribbean. I hope he is still practicing medicine, only at a more leisurely pace.

Ruth said...

That's quite amazing, that doctor. It sounds to me as though he just lives in the moment and doesn't allow himself to feel rushed or stressed. Thus, no burn out!

Inspiring, really.

Susan said...

Lindy, I think being a doctor in the Caribbean would be just lovely.
Exams under the palms.
Ruth, "not allowing" yourself to be rushed or stressed. Isn't that interesting, that we so seldom realize that we "allow" that to be our state?
And we can just stop. Just like that! It's not easy, but it's just that simple.