Your Doctor: Big League, Minor League, Little League, T-Ball

See the credentials, framed, hanging on the wall! The doctor is certified to practice. Great! What next? Has the actual practice been certified? That’s not a certificate hanging on the wall. I’ve looked. Pictures of the graduating class. Ah! The college of medicine. But what do I know about that? Which are the better colleges for medical training? I have read that doctors generally have only one or two courses in nutrition. But the true test of a medical “practice” is like a pudding, in the tasting.

I have seen some amount of doctors in my life. I can think back on the lot and remember those who were the cream rising to the top. The one model of medical practice sat me down in a consultation and went over all the tests and then “pronounced” me, the final “grade” after all the testing. How often that was? Rare. Only that one. He put the “CARE” in health care. He was subsequently asked to be on the faculty of the Northwestern University medical school.

Once I had the specialist I went to for a test. He called me back regularly although everything was always okay; couldn’t get out the door without setting the next appointment. That went on for some time, until I caught on, and paroled myself from his custody. I realized it had something to do with that one empty chair in his waiting room.

At an annual exam, I was telling the doctor about some ailments and anomalies I wanted to know about.

She said, “You are **.”

I thought, “What the [[[#@!*!**X~?◄≠↔‡†Шжф]]] was that? That was my diagnosis, MY AGE!!!?!”

Then she said, “Well, let’s see. You haven’t had a stress test since the last time. Better go get one.” (Or words to that effect.)

At the big machine room in the hospital, it was ‘full-body scan—treadmill—full-body scan’.
The results? Heartbeat up to 118 beats.

The insurance bill: $* * * *. * *

And the specialists read the results and got their fee.
Me? I never got the report. Not a word. I had my suspicions about waste, fraud, or abuse?

At the next exam, I was handed the blood survey results. There were highs and lows. The gobbledy-gook abbreviations are Greek to me. I asked for an explanation, and what I must do to raise or lower. She was dismissive. “O, you’re okay. They’re nothing.” Or words to that effect.

The credentials are one thing, to hang on a wall. The “practice” is something else. It is an art. It is a dance between the doctor and the patient. A pas de deux of the ballerina and the danseur noble. But there’s a third person in the dance, the ballet master, or mistress, she of the big stick and the stern visage who knows the score and every movement choreographed for proper execution to realize the art of the score. The doctor knows the score, or so you assume, the science of all that gobbledy-gook handed to you. Shouldn’t you expect — ?

There is one major test of a doctor’s quality of practice that I can see, from my experience, beyond all that stuff hanging on the wall. It’s a communication thing. I think medical schools are beginning to require a course or two in “bedside manner”, “communicating with patients”. The old community doctor knew some things about that, making house calls and seeing the patient as a personality inside a family inside a home. Today? None of that. Specialization thin-slicing the practice. Burgeoning population. Explosion in technology.

What I am suggesting would add a bit more of precious doctor-time to patient “CARE”. A certain facet of communication that has been sacrificed for efficiency but inefficient in the long run. And it’s so simple. The magic bullet, so to speak.

That “one major test” of the big-league doctor? Without which the doctor is little league or even so bad as T-ball?

The art of the doctor’s practice is in becoming “proactive”, rather than, for the sake of saving time, remaining strictly “reactive”.

The patient should also be a big-league patient in coming prepared with the homework for asking all the questions that the patient’s body condition dictates, especially if the doctor is merely “reactive” in style of practice. So that the pas de deux may have an artful outcome.

But the doctor has the score on which to choreograph the moves for every note for the entire medical corps de ballet. If the doctor, to save the doctor’s time, does not anticipate the questions the patient may have, the questions the patient does not know enough to ask, even after the patient has done his best to ask the questions he can, then the art of the practice will be lost.

I believe it was Alfred North Whitehead, the philosopher, who once wrote (I’ve lost the citation), “The final tuft and essence of science is art.” Einstein with his violin and his elegant formulation. Sherlock Holmes with his violin and his elegant ratiocinations. Darwin and his elegant theory.

If my doctor reads this, my gooseflesh is cooked. I’ll get “fired”.

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Published in: on April 3, 2010 at 8:05 am  Comments (6)  

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6 CommentsLeave a comment

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