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.


  1. Well then, I am glad that you decided to wipe the dust off your blog.

    I like how well you have been able to contrast the styles of both your doctors. I recently experienced a similar situation with Figlia. With her boil having turned to cellulitis, our regular ped gave us a referral for a pediatric surgeon. We consulted the latter as well, but our pediatrician insisted that we first try with medication (and thereby see if we can get away without surgery). The surgeon wanted to go for the I&D at the earliest. Eventually, with the change in antibiotics and their IV delivery, the inflammation went down, and my ped became even more enthusiastic about the probability of no surgery.

    Long story short, we had to get the operation done. The surgeon said two things "1. Only when no option remains, should surgery be considered. 2. He hated how peds dawdle on the decision to stop trying themselves and refer patients for surgery, letting the surgeon do what he has to." Both 1 and 2 are contrasting statements, and both were true for Figlia's case.

    It's just how it is.

  2. Glad your surgery and recovery went so well.

    Get a new PCP right away!! Maybe your surgeon or OB/GYN can refer you to a like-minded PCP. If your insurance company gives you a hard time about switching (I've had that happen), tell them he's a paternalistic dickhead.

  3. Someone told me that the general practitioners are at the bottom of the medical food chain. I find that to be true sadly, I have met only one GP who really knows her shit. And when she doesn't, she says so and sends me to someone who does. Her office is quite far from my house, but having experienced so many other twats, I'd rather go to her.
    Glad to hear you are recovered and well now.
    Please post more often, I don't really have time to harrass you now. :-)

  4. That would be haRass, thank you, sorry-excuse-for-typos tablet.
    I should make time to harass you into posting more though... I recall it worked once. What do you think?

  5. Huh... this is a very interesting post. I also found my old GP fairly useless. (I just switched, so I don't know much about the new one.) It felt as if she had a script, and she couldn't stray from the script, even if what she was saying no longer made sense. She would preach a vegetarian diet. When I explained I've been a lifelong vegetarian, she paused, looked at me, and then continued with her speech.

    I do prefer to go directly to specialists, even for minor problems, just because there tends to be plans that are concrete.

  6. P.S. Sorry for the shizzlebean of me for not commenting on your surgery. I am glad it went well, and you recovered well enough.

    Also, I forgot to add that I know a great GP where I am originally from. No such luck in the current city, though.

  7. I agree with BabySmiling that you need a new PCP. And I'm snorting with contempt what Mel said. And I like your surgeon. Glad you're healing well!

    I don't like it when the doc takes on the role of expert. The doc may be an expert in medicine, but I'm an expert in ME. It's hard to find one that see it as a partnership.

    Nice to see you here :-)

  8. Ooh surgery, nasty. But I agree if your surgeon had filled you with worse case scenarios you'd probably be over cautious and hurting still. I much prefer a no nonsense approach. Get a new regular doctor though!

  9. Glad to see you back! I'm just starting to get back into the swing of things myself.

    Really glad the surgery went alright. I haven't had to see my GP yet for myself but for my daughter she was helpful if so busy that we were waiting forever. Waiting seems to be the norm where I am for everything and there are days I miss my half-deaf GP back home. To bad he's retired now.

  10. Glad to see you writing again! I've had some really positive experiences with doctors, and other not-so-positive experiences. I think a big part of it is WHY people choose to be doctors. Those who choose to be doctors for the right reasons probably end up being better doctors.

  11. I have found a great pulmonologist and a fantastic rheumatologist. Not so much luck on a general practitioner. I'm happy you had a good doctor for your surgery! And the blogging is nice too.

  12. I left a comment because I could. :-)

  13. First of all, if you're not happy with your GP, I would find a new one. Finding a doctor you have a good relationship is so important to your overall care.

    Secondly, just a different view point as to why your GP might assume you're a drug-seeker:

    I used to work for a family doctor, and I cannot tell you how many patients came in all-but-demanding (and sometimes outright demanding) that they get a prescription to make them better. Even if they didn't need it. Even if the doctor tried to explain that it's a virus, it'll run its course, you don't need an anti-biotic and it won't help anyway. It's relentless. Over, and over, and over again.

    And honestly, I have a family member who's the same way. On day 2 of a cold, she's in her doctor's office demanding an antibiotic. FOR A COLD. If I or my husband get the slightest bit sick, she's asking by day 2 or 3 if we got our meds yet. And God forbid we try to explain that we don't like taking unnecessary medication, that we'd like to see if it gets better on its own, etc.

    It just has me wondering if maybe your GP is burnt out on the demands, so he just assumes that's why you're there and succombs. Which isn't good medicine, and is all the more reason to look for a new GP.

    Just my 2 cents!

  14. Hear hear! I know this is an old post (found you through Lavender Luz), but I just had to shout out and say YES!!!! I have had so many doctors over the years who were patronizing jerkfaces. Finally I have a doctor who treats me like an equal partner in MY health care. Because guess what? It is MY body and I know it best. It took decades, but I finally have a doctor who doesn't make me feel like an idiot when I am in pain. It has made a world of difference.