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Sunday, November 25, 2012

After this week...

This was just one of those weeks when my efforts at blogging, writing and posting definitely took second place to family matters. By that, I mean that we took off for Kansas City, where we could gather for our annual four-day weekend of relaxing, swimming, reacquainting, chasing children and, of course, EATING. All of which was done with abandon by the fourteen of us. I think we got better gas mileage going up to KC than we did coming back, because of all the eating that we had done. Hmm...

And so tomorrow it is with some definite lack of enthusiasm that I throw myself back into work. And, as some of you know, that work for me involves taking care of the desperately ill of Oklahoma City. And many of those are just as lacking in enthusiasm about being ill, injured or recovering as I am to be there among them. Now, I am not normally so underenthusiastic about my work. I can typically produce some level of umph to get it going, and to make a showing of being there for the downtrodden.

But this week has got me thinking seriously about just what it is that I do, and why. This business of medicine, in particular, has taken turns most assuredly for the worse. Now, I know that many of you have gotten to feel that there is now a growing distance between you, as the patient, and your doctor. And let me expound upon that just a bit. When I began my medical training, as a first-year medical student, just looking around at the upper-class medical students with some envy, with their short white coats, their own stethoscopes, bulging from their pockets (not hung draped about their necks in the current fashion), I couldn't help but think that they were becoming privy to those marvelous traditions of actually taking care of real patients - out there on the "wards." That there was something very special - almost blessed - about the whole scenario.

And then I got my chance. My very first patient was an old, shriveled-up shell of a man, who had deep, necrotic bedsores, which smelled just awful, and whose only communication with me were simple grunts and moans of pain. But here he was, my very first patient, for whom I had some real responsibility, and for whom I dedicated hours of caring, and continued study. My very young and enthusiastic medical self was being nurtured by years of tradition. And let me skip ahead a few more years to my first day as an intern, at the VA Hospital in Ann Arbor, Michigan, where I picked up a service of eight patients, and I was also on call that night (we were on call every third night - meaning we were expected to stay all night, and take care of those admitted to us, and to have their COMPLETE history and physical exams written down on the chart by the next morning). And besides that I was the MOD (medical officer of the day), which meant that I was responsible to be the voice of the VA to those within the hospital, as well as physicians on the outside who wanted to send their sick veterans our way. Well, let me tell you that I did it, and I survived it all, including the three years of internal medicine training, as dished out by The University of Michigan. And I did it all with the knowledge that, by the time my training period was done, I could handle almost anything that the world threw my way. I was ready, willing, and (yes) enthusiastic to begin my real practice of medicine.

But then something happened, something that ate at the core of medicine, something pernicious and pervasive. It began, simply enough, with a clerk in New Jersey, inventing the DRG (Diagnosis-Related Group), which was immediately and fully taken up and greatly expanded by Medicare, then by the state's Medicaid systems, and then by the insurance companies. This was a means of forcing physicians to cut back their expensive medical care provided to the sickest of patients (those in the hospital).

If you want to look at what has happened since then, you need only observe what has happened to the doctor (health care provider) - patient (client) relationship, and the training that a new physician gets. Believe me, there is no comparison. A new physician is very well-versed in the computer, and its intricate composites of what patients look and act like, and what their laboratory tests, their vital signs, their intake and output look like "on paper" (though that, too is going the way of the dinosaur). But just bring in a live patient, with real pain, real dyspnea, real emesis, real and acute neurological changes - and suddenly those are all symptoms which are deferred to all those others who are "taking care" of the patient. Their own doctor jobs are at the computer! But to actually "get your hands dirty" with the ill human being presented before you in agony - well that just doesn't show on my computer screen.

Well, this has been kind of a roundabout way to tell you that my own novel (in three parts) is, in many ways, a tale of my own frustration with what medicine has become. It is no longer the respected trade taught by those who have themselves been through the trenches. It has become something else entirely, and I'm just not sure that I am equipped to take it on. Not tomorrow, at any rate.


  1. My pet hate when I visit the Dr is all the questions they ask you about your illness, whilst typing and staring at the computor screen "Hello I'm over here". I miss my old Dr, he knew my name, I felt like a person in front of him not a diagnosis to be made, he once called me at home to tell me about a film he had just seen at the cinema because I was the only person he new who liked sci fi, sometimes going forwards feels like going backwards. Anyway I'm glad you had a nice break.

    1. Your pet peeve is precisely what I'm dealing with, on a day-by-day basis. The doctor-patient relationship is never allowed to flourish in today's environment.