Wednesday, August 04, 2010

On strong medicine

Okay, so I want a mean doctor.

Well, I don't want a mean doctor. Nobody wants a mean doctor. But given the choice between a doctor who's nice and a doctor who's good at doctoring, I'll take the latter.

What sucks is that it seems that lately, I actually kind of do have to make that choice. My recent experiences with the medical profession have been generally unsatisfying, due largely to the fact that apparently, I have to choose between bedside manner and medical knowledge. My current doctor--who shall remain nameless, because anything else notwithstanding he's a nice guy--is, to put it plainly, lousy. My experience with him, universally, is ten minutes of face time followed by what amounts to a big shrug and a promise to refer me to a specialist (which he may or may not remember to do). He's a nice guy, friendly, very sympathetic, but, oh, hey, have I mentioned that I'm sleeping twelve hours a day?

Contrast this with the nurse practitioner who was my dear and my darling from the moment I met her until the moment she left the practice. This woman was hard to like. She was brusque. She was brisk. She never bothered to warm up the stethoscope. She would harangue you for missing any aspect of self-care. I once suffered through a [VERY PERSONAL MEDICAL EXAM] that would have been a crowd-pleaser at Abu Ghraib. But you know what? She was good. As a diagnostician, as a clinician, she was the inarguable bomb, and I would gladly suffer through her drill sergeant-esque bedside manner to have her find out what was wrong with me and fix it.

I begin to think that physicians like my dad--ones who have both the medical knowledge and the compassionate presence--are becoming few and far between. I've had nothing but positive experiences with doctors of his generation, but get any younger, and they seem to have slept through crucial parts of medical school. What has changed such that I kind of have to get pushed around a bit to get the treatment I need?

I know (as a person who's spent a lot of time writing about it in a professional capacity) the focus lately in medical school has been on the medical humanities and the importance of positive interaction between physician and patient. And yes, that's important. A patient who feels comfortable opening up to you will give you more clues as to the causes of her condition. A patient who has a positive clinical experience is more likely to return for followup and future care. Spending that two extra minutes in the exam room could give you a chance to pick up something you'd otherwise miss.

But have we crammed those courses in at the expense of Maybe It's Stress-Related 1102? Let's Get You Some Muscle Relaxants Until That Referral Comes Through 2110? Intro to I Should Keep a PDR Around if I Can't Remember Drug Side-Effects off the Top of My Head? Wow My Med Student Asks Smarter Questions Than I Do (lecture and lab)? (Not to mention This Will Probably Work Better if We Don't Lose Her Labs and Referral Information Honors Seminar, which would benefit the entire office, thanksmuch.)

Should I have to choose between Dr. Benton and Dr... I don't know, was there a doctor on ER was really nice but not good at his job? It was so long ago. Dr. Carter, early on? Anyway, the point stands. I know there are a lot of people who aren't comfortable at all in health-care environments and need a softer voice, a gentler approach, and a little bit of hand-holding. Save the nice doctors for them. If I have to choose--and God knows I don't want to--you can keep Dr. Cuddlepants, and I'll be in here with Nurse Practitioner Ratched.

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