Tuesday, January 29, 2013

It's looking a little dusty around here

My poor, neglected blog...sigh.  It's been a while.

This morning, as I was taking my pre-dawn walk around the neighborhood, I was thinking about the state of medical care in this country.  I have a primary care physician, but I almost never see him.  There are two reasons for this: 1) I am rarely sick.  2) I find him to be generally useless.  I think I find him useless because he has completely bought in to the idea that patients just want a pill to make them all better.  As I was walking this morning, what occurred to me was that it's not so much patients who want a pill to make things better as it is doctors who want the patients to go away.  And they won't go away until they feel at least somewhat better about whatever is ailing them.

I've seen my primary care physician for 3 things.  First, shortly after my daughter was born, I had pain in my hand, wrist, and elbow.  He diagnosed me with De Quervain syndrome, gave me a splint, prescribed ice and ibuprofen, and said it would probably go away eventually.  Second, I went to see him because I thought I had an ear infection.  As it turns out, I injured my ear, probably with a Q-tip.  I got some ear drops for that, and the advice to stop sticking Q-tips in my ears.  How am I supposed to scratch my brain if I can't put a Q-tip in my ears???  (I think anyone who has seasonal allergies will understand what I mean by that.)  Finally, I was in a car accident and I saw the doctor for my whiplash.  It was at that point he started treating me like I was a drug-seeking hypochondriac.  I think I should have told him straight out that I was looking for a physical therapy recommendation, so he could have skipped the ibuprofen and ice routine. 

In contrast to that jerk, I recently saw a surgeon to get my umbilical hernia repaired.  Of course, it was an entirely different sort of situation, since my problem was clear, as was the solution.  But when I asked how long I should take off of work, and what the recovery would be like, the doctor was all sorts of optimistic.  I wouldn't need much more than a weekend and a couple days.  I would be done using the pain medication quickly.  I would be moving around moderately freely shortly after surgery.  I should take it easy, but I wouldn't be an invalid.

After surgery, the hospital gave me 2 doses of pain medication within an hour or so - probably enough to get me dressed and into my car.  They also brought my prescriptions to my bedside - I highly recommend that service!  I went home with 30 painkillers - enough to take the max dosage for about 6 days.  But my doctor told me I'd be done in 2 or 3 days.  So, by day 3, I was done with the painkillers.  I don't like opioids anyway, but I did feel much better.  I had surgery on Tuesday.  I took my daughter to story time at the library on Saturday (there would have been hell to pay if I hadn't - the kid loves the library).  I did a little shopping on Monday (I don't work Mondays anyway), and felt like I overdid it, so I took the following Tuesday off too.  By Wednesday, I was back at work - not doing much more than taking up space, but back at work nonetheless.

The next Tuesday, I had my follow-up visit with the surgeon.  One of his first questions was "So, are you back to work yet?"  Of course!  You told me I wouldn't need more than 4-5 days at home!  It was about that time that I realized that he had made every effort to set me up for a quick and successful recovery.  He told me it wouldn't hurt too much after a few days.  He said I'd be capable of working inside a week.  He told me most people stopped the painkillers after 3 days.  I think it was a concerted effort to create a mindset that would facilitate a more easy recovery.

Contrasting that with my primary care physician, I can only determine that it's kind of a matter of trust.  My primary care physicians trusts only that I will come and complain and want him to immediately fix things.  My surgeon trusted that I would listen to his advice and make the best recovery possible.  If I had problems, they wouldn't be due to having a bad attitude - there would be an actual complication to deal with.  My primary care physician believes that I am not well-informed, nor am I a partner in my health care.  Maybe it's because I never get physicals.  Maybe it's because I refuse to  have my pap smear done there (I have the most awesome OB/GYN ever.  How do I know?  Because he actually read my chart.).  Maybe he's just a paternalistic dickhead who doesn't believe that there are any reasonably smart people within the area he serves. 

I don't pretend to know as much about healthcare as someone who went to med school and has been practicing for a number of years.  But I'm not an idiot either.  I know many doctors are wary of treating patients like partners, because patients are so often ill-informed.  But it can be done in a subtle and reasonable way - my surgeon's method shows that.  I can only hope that more medical offices and hospitals are following that sort of protocol.  An informed patient with realistic expectations is more likely to feel satisfied with their care, regardless of the outcome.