Tuesday, December 3 2013
Lots of hullabaloo about the President’s pledge — then broken, now remade — that health reform will let you keep your insurance plan and your physician, if you like them. Do you like your physician enough that it matters? Maybe you shouldn’t.
I love my primary care physician. He is probably the best physician I have ever had. He’s one of the first to be younger than me, but from day 1 he was a model of courtesy, respect, and professionalism. He is friendly, patient, an excellent listener, and always spends more time with me than I think I deserve.
A few years ago, I tried to schedule an appointment with him, and was told he was not seeing patients. I freaked out — had a panic attack and everything. The rest of my life was kind of a mess, and now I had this other thing to worry about, and it was just too much. I tracked down his personal email address and wrote him a desperate plea, which he answered courteously and professionally despite it being pretty creepy on my part. It turned out that his staff was misinformed; he was on vacation or at a conference or something, but still very much seeing patients, and was happy to schedule me in. I was embarrassed.
After that settled down, I wondered about my reaction, and my attachment to my PCP. A few years before that episode, I had been in an NIH protocol administered by a young female physician. The study was pretty demanding of my time — about 10 to 16 hours per week — much of it spent with this physician. I was sick, so I didn’t have much of a social life elsewhere, which meant I wasn’t dating, wasn’t spending time meeting young women, et cetera. And over the course of the study, I developed a crush on this lady. I kept at it, even though I knew the medicine was not working and I was getting worse, just because I didn’t want her out of my life. And when I finally understood what was happening, I knew I had to drop out of the study at once.
After my PCP-induced meltdown, I realized I have a little man-crush on my physician. I really, really like him: I’d invite him to parties, if he didn’t know a lot of humiliating stuff about me. And I realized, this is not a healthy level of attachment to my physician. I’m to the point where I generally know whether a physician is doing a good job or not, but if I let my fondness for a physician blind me to that, I could be in serious trouble. So as much as I like my physician, I have to constantly remind myself that this is a professional — not a personal — relationship, and it is properly focused on my care.
It also occurs to me that there is nothing special about this physician — at least not innately. The stuff he does well is stuff that any physician could be trained to do well. The fact that physicians are not all well-trained is probably as big a problem for our healthcare system as anything to do with insurance reform. But in rough terms, any doctor should be able to do what he does, even if lacking his sterling bedside manner.
So I think it’s great when patients love their doctors, but I also worry it’s unhealthy. If you are that dependent on one person, on a single provider, you are incredibly vulnerable and powerless. That sort of co-dependency should be strongly discouraged in our health system; medical care should help patients be empowered, autonomous, and independent. If you love your doctor, that might actually be a problem.
This is not to justify or defend anything the Administration has done; it is simply to say that maybe protecting patient-physician co-dependency is not a priority in a functioning healthcare system. If nothing else, every time I see folks angry about whether or not they get to keep their doctor, it makes me cringe. I have a hard time believing that sort of passion reflects a healthy relationship.
I wonder if they need to step back a little, set that doctor free — and free themselves, too.