Your Doctor Doesn't Practice Here Anymore

From: Helen Dynda (olddad66@runestone.net)
Tue May 29 19:56:52 2001


[]> Your Doctor Doesn't Practice Here Anymore -- ( Scroll down to click this title.)

http://www.hmopage.org/

The young woman looked pale and tired. She was new to our clinic, having called requesting a pap smear.

As I prepared to examine her she smiled, but was noticeably uncomfortable due to the intimate nature of her first visit. She related she was frazzled and worn out due to a recent move from the east to the West Coast.

As one of the internist in our clinic I had no time to bond with her. I had been advised, four days prior to her visit, that I was too compulsive and meticulous and didn't need to stress myself by trying to fit a complete history and physical into a 15-minute appointment. I was further advised that, in the younger patients, I should deal only with the problems precipitating the request to be seen. The statement, from the head of Internal Medicine as he counseled me was: "You'll probably never see the younger patient again." He was under pressure from managed care to increase productivity.

Inwardly I was torn. An internist is a diagnostician and relies on a thorough history and physical to practice preventive medicine and to discover symptoms the patient might not volunteer. Years of training are involved, which enable the internist to analyze signs, symptoms and diagnostic data in order to diagnose the simple versus the complex.

Until now it had been a rewarding and satisfying professional choice, looking for the proverbial "zebra in Central Park." Diagnosed early, many illnesses can be treated and cured. Left unchecked, many diseases have permanent complications.

I knew that 95% of the time a cold was just a cold, but the lethal masquerader that might present itself disguised as simple symptoms was the impetus and the reward of my professional sleuthing. It was being eroded by the time constraints. Worst of all, I had no time to give of myself.

I laid my hands on my patient's waxen skin. Although the 15-minute clock was ticking, a gut instinct made me uneasy. She had filled out papers pertinent to her past medical history, but had not noted any previous medical conditions.

"Do you have any diagnosed past medical illnesses?" I asked as I rapidly examined her head, eyes, ear, nose and throat. I was working my way into a complete physical instead of doing just the gynecological examination. I didn't really want to hear anything complicated in that I had 30 more patients to see that day. Being a team player, grinding out numbers for the department was more important. Forget the 5%. But...I couldn't do it.

"Yes," she replied. "I have a kidney problem, but I've been okay."

"A kidney problem?"

"I had a biopsy in 1990."

"Do you know your diagnosis?"

"Yes. Focal glomerulosclerosis......but I'm okay. I haven't seen a doctor since."

We finished her examination and I sent her to the lab for kidney function tests and a blood count.

She probably thought I was cold and impersonal. I would tend to agree if she had brought the subject up. In my private practice, which I had quit after 13 years, I knew every nuance of my patients' lives: children graduating, marrying, financial woes, aspirations, etc. I was their family and they were mine. I quit to come to this clinic after managed care medicine made my solo practice too expensive to maintain. I needed too much staff to make the incessant phone calls to managed care requesting approval for care plans and patient referrals. Often the managed care telephones were busy or my staff was kept on hold on toll calls for prolonged periods.

With a sad heart I changed my practice style to a clinic setting. Six years later I still ached for the missing house calls. I missed the personal touches the patients gave to me and vice-versa.

The lab data came back on my pale patient. She was in kidney failure and she was down 5 units of blood.

I called to inform her. "This is Doctor Everett. I'm calling about your lab results."

"Oh?"

"Your lab values indicate your kidneys are failing and you're very anemic."

"But I'm fine, just tired from the move."

"No. You're not fine. I'm going to send you to a kidney specialist. You'll need dialysis until other options can be explored," I replied.

"No. I'm really afraid and I don't know anybody."

"I'm your doctor. You know me. I'll guide you through this."

"Know you?" she replied. "I only saw you for 15 minutes and you're ruining my life."

"I know what you're feeling and I know what we need to do."

"We?" she replied incredulously, " I don't know about that. What do you know about me? My dog gets more time with the veterinarian."

"Your dog gets more time with the vet because your veterinarian is his own person. I'm not anymore. But all of that aside, at the moment we have to take care of you. The kidney specialist will contact you. If you have any questions, call me."

I don't know if she ever called me. After contacting the kidney specialist about her case, and speaking to the head of the department who noted she was the exception, I quit my job.

I need to apologize for not being there, but my profession lives in my soul. It is not a job. I mourn for my pale patient and what medicine used to be.

Since leaving medical practice, Dr. Everett has started a patient advocacy service. For more information on patient advocacy and the service visit her Web site at http://www.pasomd.com or contact Dr. Everett at 800-644-9191/ lee@tfb.com.


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