Marcia ByalickWant to start a dinnertime conversation guaranteed to unite everyone, regardless of politics, wealth, temperament and intelligence? No easy feat ever but especially tough in the madness of today’s world. I’ve found one I believe that finds us all on the same side …the frustration of dealing with the before, during and aftermath of our annual visit to the doctor.
“We are experiencing heavier than usual wait times,” begins the process, upping the anxiety ante. When does the clock ever strike “usual” time” I wonder. Being a veteran of this time suck, I usually put her on speaker while I distract myself with some predetermined activity. An alternative to murdering somebody. It occurs to me how grateful I am not to be bleeding at that moment. “Your call is very important to us,” she continues. You know what? I don’t believe it is. Prove me wrong and just answer the phone.
When I was eight and had a 104 fever, I remember the family doctor and his little black bag coming one night to our tiny Brooklyn apartment. My memory doesn’t include his name or what he did to diagnose and fix me, but I can still feel the trust bordering on awe my family felt when he spoke. He treated migraines and broken arms, pneumonia and measles, ulcers and rashes. He defined primary care. And urgent care. I thought him the smartest, calmest, hardest working man I knew.
Somehow back then, general practitioners were concierge doctors before there was such a thing. They were, as my mother would say, a one-man band whose judgment was never questioned. Many worked in a home office. They’d pick up your call… or return it promptly. It seemed they worked ceaselessly, sacrificing any notion of balance in devotion to their calling. For this they earned an excellent income and deserved every penny. They were noble.
I’m grown up now, wise enough to know how few noble people actually exist. Whether that generation in family practice is more mirage than memory, 2023 medicine demands we all, doctors and patients, adjust to a much lower bar. Today if you’re feeling under the weather, be prepared to wait till the next season rolls around before being “squeezed” in for an appointment.
Seventy five percent of doctors are no longer in private practice. Chances are we see a physician affiliated with a huge medical entity which pays his bills and takes care of mountains of paperwork… in return for him agreeing to see a ridiculous number of us a day. For 15 minutes. While he’s checking off guideline boxes on his tablet. For you to read on a portal when you get home.
According to the New England Journal of Medicine, given the limited amount of time allotted to them, half of patients admit to not fully understanding what their doctor told them during an office visit. That’s why we need to prep for an annual check-up like a job interview. Most times if something is wrong, we’ll be referred to an “ologist” to handle it. We just need to feel seen, that he’ll be our guy if any health situation veers from routine,
I certainly respect a doctors’ choice to limit work hours and make fewer sacrificial life choices. They are not public servants. They’re no happier than we are with the constantly moving networks, the compromised ability to connect with their patients, and the limits imposed on their autonomy and discretion. Many are uncomfortable with being incentivized to not always deliver the most health benefit. I have doctor friends who see twice as many patients today as they did thirty years ago. Having their practice “bought up” is not what they envisioned when they became doctors.
No wonder only one in six medical students choose primary care as a residency. What an overwhelming task to confidently identify and address our chief concerns, be a clearinghouse for all our questions, prescribe our medication…and make each of a thousand patients on their caseload feel as if their doctor has a genuine investment in their wellbeing.
I admit I have different expectations of the many specialists I’ve seen in the past few years. I don’t mind if the doctor who takes care of my knees… or my eyes… or my cancer concentrates on whatever check engine light is blinking. The tools in their physician toolbox are nothing short of miraculous. But my internist, the main guy who oversees my healthcare, I want him to know me, apart from my symptoms and disease.
Everyone has a story that tells who they are, where they came from, what they think, and how they interpret the world. I want to be taken care of by a physician who is not headed toward burn out, someone who still loves his job. A person who’d have the time and the heart to ask what book I’m reading or how my kids are doing. Someone who knows my story.
I’ll trade that for a guy on a pedestal any day.