Demanding the best
Wednesday, April 22 2009
This is a follow-up to this post, in my ongoing saga about trying to find a new doctor.
Last week I saw the second of two doctors I decided to check out. Dr. 1, you might recall, works at a community hospital near my house. Dr. 2 works at a fancy academic medical center nearby. By all rights, Dr. 2 should be the better choice; her employers have a better reputation, better facility, and more resources than the community hospital. But I’m sticking with Dr. 1.
One reason is that the appointment was so fricking arduous. The hospital was super busy – I spent ten minutes just looking for parking, before giving up and handing my key to the valet. Then I spent another long while waiting for my appointment. Once I got to the nurse, she refused to read the paper I handed to her with all my meds and allergies. “I’m allergic to infliximab.” “How do you spell that?” “It’s right there on the paper.” “I never read these things, anyway.”
After that was finally done, I spent a good long while with a resident, giving her a detailed history. Then I waited for-ev-er to see the doctor herself. All in all, it took about two and a half hours of my day to get ten minutes of face time with this doctor. Her office is four miles from my house.
I might have just dismissed this as a busy day at the hospital, if not for the actual appointment. The doctor was very nice, very professional and knowledgeable. We talked about my surgical options, and she suggested I consult with a surgeon at another hospital, on the grounds that he has the most IBD experience of anyone she knows. She doesn’t know the surgeon at Dr. 1′s hospital, whom I was told also had lots of experience. I’m paraphrasing here:
“I don’t know,” I said, “that hospital is clear across town from where I live. It’s damned inconvenient – both to me, and my hetero life partner, if she wanted to visit me there.”
“But he’s the best. Don’t you want the best?”
“Well, sure,” I said. “But I don’t want to force my partner to have to truck across town to see me in the hospital, just because there’s an incremental benefit from a slightly better surgeon.”
The doctor was flummoxed; she couldn’t figure out why I would put anything before my health. But of course, that’s not what I’m doing. In theory, I could be perfectly healthy if the doctors cut out my entire gastro-instestinal tract – esophagus to anus – and fed me TPN for the rest of my life; no bowel, no bowel disease. The only catch is that I’d be hooked up to TPN for most of the day, unable to really do anything, and it would be massively expensive. Not even Dr. 2 would endorse that plan.
I spent a large part of my life hoping, waiting, and trying to cure my disease, and not really doing much else worthwhile, before I realized I had to get on with it. Since then I’ve cut a pretty reasonable line between what’s best for my health, and what’s best for me. I recognize there will be trade-offs and I weigh those trade-offs as best I can; part of that is moderating my expectations for what’s possible from my health care. I think I have come to a realistic, sensible understanding of what I can and can’t get out of our medical system. Yet I find that many doctors – like Dr. 2 – find my lack of unrealistic expectations insulting, even baffling, and push me to “demand the best”. Which is why I get so angry when patients get blamed for their unrealistic expectations; we really aren’t getting this from TV.
I think Dr. 2 is probably a better physician than Dr. 1, at least technically. She seems a little more knowledgeable, a bit more engaged, and certainly is on the leading edge of the field. But all of that blinds her to the fact that I have a life outside of this disease; I get the feeling she would sacrifice everything else that I am on the altar of medicine, in pursuit of the best possible outcome. So I’m going with Dr. 1, instead. I have a life, and I think Dr. 1 is more willing to help me live it.
Also, the lobby smelled ferociously of pee.
A couple of observations from a nurse who would never treat you as rudely as “office nurse” did.
I think the pee thing is the real reason you opted out of the MD. Our noses are the closest route to our brain, and piss is a powerful decision maker.
1. You made the right decision. The number one rule in choosing a doc is that you have to be comfortable with them.
2. TPN will eventually kill your liver. Sorry.
3. (OK, I know three is more than “a couple” don’t call me a weasel
Reality – the office nurse’s behavior didn’t strike me as rude, so much as silly. But I do know that’s not typical of the profession. On your comments.
2. How long is “eventually”? “The rest of my life” does not necessarily mean a long time, in my world view.
3. I meant the lobby of the hospital, not the waiting room of the doc’s office; I didn’t have sit around waiting in the pee smell. In fact, I hadn’t really noticed the smell on the way in, but on my way out after the appointment, I ran into someone I know. I stopped and chatted briefly, but long enough to get a couple good whiffs. In any case, I think I had decided well before then – even before I saw the doctor – that I wasn’t coming back.
You made the right decision but expect to receive criticism for it. Sometimes we make decisions between two nearly equal things based on a whole host of things. Looks like you made your choice based on your lifestyle, comfort level and sense of smell. I don’t care how good a physician is technically, if I can’t bear to be in the room with them or find them condescending we’ve got a bad match.