Thrush
Thursday, October 23 2008
Peter’s comments on my post about the social obligation of doctors reminded me of a story I had forgotten.
A year or so before I started college, I developed a bad case of thrush – i.e. oral candidiasis, a fungal infestation of the mouth. I had thick white fuzz all over the back of my tongue, and everything tasted like mushrooms. At the time, I had no idea what it was, except that it was disgusting. I happened to be at summer camp at the time, so I went to the First Aid hut. They didn’t know what it was, either, but they told me to gargle with hydrogen peroxide. That didn’t help, so when I got home I went to see my doctor. The doctor prescribed mycelex troches – a thin candy-like wafer that dissolves in the mouth. I took five of those a day for several days and was fine.
When I was a freshman in college, I got thrush again. I knew exactly what I had and exactly what I needed, but mycelex trochees are a prescription medicine (although vaginal suppositories for the same drug to kill the same organism are not). So I had to see a doctor. I made an appointment at the student health center and was examined by a resident.
I don’t think the resident had ever seen a case of thrush before, but I told her what it was, what I needed, and what the dosage should be. She went to go check with the doctor in charge, and came back looking like death. “I have to ask you a few questions,” she said. “Have you ever had a blood transfusion?” No. “Have you ever used intravenous drugs?” No. Now she got really nervous: “Have you ever had sex with, um, well, you know, another male person?” What? “Have you ever had sexual contact with another man?”
Then I realized: she’s giving me the AIDS interview. So I asked her: “Do you think I have AIDS?” She sighed: “Well, usually that’s what’s going on when an adult patient develops thrush.” I could see the relief wash over her face as I explained how my medications had led me to be immunocompromised. She was sure I had AIDS, and she was terrified of breaking the news to me. For me, it was just an exasperating (and slightly expensive) waste of time.
Point being: Peter thinks lawyers are not socially constrained. Maybe so, but here’s an important difference: if I need a lawyer, I can represent myself. If I am charged with a crime, or need a divorce, or want to sue a negligent doctor, my access to the courts is not limited by my ability to afford legal representation. I may be far less successful without an attorney, but I have access to the system regardless.
But where medicine is concerned, I can’t write my own prescriptions – even if I know exactly what I need, and even if that drug is available over-the-counter in a different form. Physicians act as strict gatekeepers for much of the medical system; beyond a few ordinary ailments, patients are denied access to the care they need unless they have a physician’s approval.* There are good reasons for these safeguards, but that means there are good reasons for the social obligations we expect from our physicians.
If you’re a doc and feel like these obligations are too onerous, you’re welcome to take your skills elsewhere. But you can’t abandon your obligations and expect to retain the power and privileges you currently enjoy – granted you by society through government, I might add. On the other hand, if getting government out of medicine means I don’t need you to write my prescriptions, then maybe I’m for it after all.
*For those baffled by the attraction of alternative, natural, and homeopathic medicines – despite their lack of efficacy – consider the fact that they do not require prescription. That alone makes some patients feel better about their circumstances.
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