Service with a Smile

Its getting a little trendy to blog about the healthcare system, but I’m gonna go ahead and add my two sense on the subject. Actually, my current gripe has nothing to do with insurance companies or socialized healthcare. I’ve got a bone to pick with the medical field, mainly doctors to be honest.

I get the impression that some of these guys (and gals) have no interest in people whatsoever. This seems a little ridiculous don’t you think? I mean, this is a profession where one’s basic job function is to help out their fellow human being. I know there’s glamour and a high pay check that comes along with the cool, oddly stylish, white coat, but it blows my mind that so many seemingly antisocial heartless bastards devote their lives to a job like this. Maybe its a similar to the phenomena in politics. Only the most egotistical of people have any interest in controlling the rights/destiny of the masses (yes, I’ll agree that there are many politicians that honestly are the altruistic seekers of “the right” that they present themselves as).

Take for example my experience yesterday morning with an orthopedic surgeon in the Santa Barbara area, whose name I won’t slander, but will say rhymes with “I’m-the-man”. After waiting for almost an hour - which I’ve come to accept as part of the routine with doctors, because I do honestly understand how busy they are - the Doc arrives with fresh x-rays in hand.

“All right. Get that boot off!” He barks with his back turned to me.

“Lets here some good news!” I say with a smile, trying to keep things light and friendly.

“Hmm... Yeah.... Not very good.”

“No change huh?”

“Yeah. I don’t like this.” He approaches and almost jumps out of his coat upon noticing the irritation from a mild fungal infection (much like athlete’s foot) thats developed around the wound which he created during a debreidment surgery almost 2 months ago. “You gotta clean this up. You know like...uh... take a shower.”

“I’d love to, but the wound center hasn’t given me the green light yet, so I’ve done the best I can scrubbing around the bandages with a wash cloth and applying anti fungal ointment when the dressing is changed. They aren’t very worried about it out at the center. Seems it should go away pretty quickly as soon as the wound heals and I can expose the site to air and water on a daily basis.”

“Yeah man you gotta get in the shower. Maybe try using some soap and get rid of this dirty compression sock..... When was this dressing last changed?”

“24 hours ago.”

“On a Sunday? That’s not possible The wound center’s not open a Sunday.” he counters, almost trying to catch me in a lie.

“Uh yeah I know. The home nurse that I’ve been using for more than 2 months did it like he has been every other day. Remember when you talked to him last month?”

He walks away and continues to lecture me about the basics of personal hygiene while he washes his hands and puts on a pair of gloves. He then sits down and leans his head into one hand in that distressed thinker sort of position and begins to shake his head. From this position he proceeds to explain his plan of action, which seems in line with what Dr. Karch has recommended, so I don’t ask too many questions, not that he seems interested in answering any of them unless they revolve around whether or not I should be smoking or if soap and water is an effective skin cleaning agent (side note: In my first meeting with the good doctor he spent 10 of our 15 minutes together badgering me about the small marijuana habit I admitted to previous to the injury. I also told him that since the accident I’ve abstained because I understand that smoking is not conducive to the healing process. However, he still felt it necessary to point out that he was pretty sure that I developed an infection because of the depressed state my immune system was obviously in due to my one hit a day habit.).

After a quick explanation of where my treatment is going and barking a few orders at his assistant, whom I feel very sorry for because he seems like a nice guy, the Doc comes over and starts moving my foot around.

“Ankle mobility’s good. Pull back on your foot.” So I proceed to pull back as best I can and move the foot a total of a half centimeter.

“That’s it?” He says with an obvious look of surprise on his face.

“Well, I haven’t been using it. Remember 6 weeks ago when I asked you about that and you said it was too fragile to work with? Uh... I did what you said and left it alone.”

“No, no, no. You gotta be moving that thing.” He sighs like a disappointed father.

“Ok..?”

“Yep, so uh, move that thing around and get it cleaned up and we’ll see you in four weeks.” And with that he’s gone. So I reapply the dressing that he’s removed and then hop to the opposite side of the room to retrieve my cast. Does this scenario seem a little fucked to anyone else?

The subtleties of this exchange may not come across very well for a number of reasons. First of all, I’m not the most talented writer in the world. Secondly, and I think this is the important part, “bed side manner” is in fact a subtle thing. This doctor gave me the exact same report that another, oddly compassionate doctor gave just weeks earlier, yet I came away from this appointment with a very different taste in my mouth. For all I know, Dr. “I’m-the-man” is a great father, lover and all the rest, but dude ain’t bringing that loving feeling with him to work, and I for one find this more than a little irritating. Maybe he’s had a bad day. Its totally possible that he just got out of a stressful surgery or his wife just left him. The thing is all of his patients including me have had more than a few bad days recently, and many of us (I’d like to include myself in this group) show up and are courteous human beings. We stick to the basics like looking people in the eye and respecting their individual experience. Maybe we even ask about their day or try to lighten the mood with a joke or two. Its not that difficult, yet many doctors seem to forget about these most basic human needs when they don the white coat.

As is often the case I’m quick to point out the negative, glossing over all the positive interactions I’ve had with M.D.’s. Anyone who’s been reading this blog knows well how much respect I have for Dr. Michael Karch up in Mammoth lakes. This is a guy who’s delivered straight up some of the worst news of my life, yet I walked out of the appointment oddly comforted by his words. How many doctors bring a hopeful tear to your eye while they describe how they may need to hack off your left foot? Then there’s Dr. Stephen Hosea, the infectious disease expert in Santa Barbara. He was very clear during our appointments that there wasn’t much to talk about and that he needed to see me more out of procedure than anything else, but since I’d taken the time to stop by, he spent a good half hour encouraging me and offering advice with regards to my current condition.

And today, out of nowhere, a doctor went out of his way to help me out, well, just because. In hopes that I’ll be able to make a little money while debilitated, I’m going back to substitute teaching. One of the many hoops the county requires me to jump through is a routine TB test. So I head off to the Med Center and get poked by a nurse. On my way out I ask if I should worry about the test site rubbing against my crutches. Unsure, the nurse queries the head doctor. He’s, of course, busy, but takes one look at me and says,

“Well, it shouldn’t be a problem, but you know, those crutches aren’t set up right.”

So he leads me into an exam room. While he sizes me up and and resets the simple mechanism that I’ve managed to somehow screw up, he has the courtesy to to ask about my injury and crack a few jokes. Shit, he even looked me in the eye. On his way out I asked his name to which he replies

“Bill Meller. Good luck to you. Have a nice day.”

“Thanks Bill!” And with that I left, sort of looking forward to returning a few days later.

The best part about all this is I’m paying extra to see Dr. “I’m-the-man”. He’s decided that insurance companies don’t pay him enough, so he isn’t a provider. I don’t know nearly enough about the intricacies of the insurance company/doctor relationship to fairly say this, but really, I’m not surprised. My interactions so far have shown me that he could give a shit about my situation. What does “I’m-the-man” care if I have to go into bankruptcy to see him in the future? He gets paid either way right? Taking a slight pay cut to make my and many other patients (aren’t like 50% of people one accident away from bankruptcy?) financial situation a bit simpler is a ridiculous concept. He’s a doctor. He’s the man.