Tuesday, December 22, 2009


Years ago, a physician I knew was in trouble with his medical staff. He wasn’t dealing with problems at home, and his consequent irritability was affecting his practice and beginning to alarm his colleagues. Many of his patients had already fled.

I asked him, “Well, what did you think when Jack S., who’s been your patient fifteen years, didn’t come to you anymore?”

“I figured he was cured.”

Healthcare practitioners can’t reliably gauge the quality of their relationship with their patients unless they hear from those very people. There’s nothing—I repeat, nothing—within standard medical practice that promotes that feedback. It's entirely up to patients. (There are exceptions, such as the Kaiser Permanente system, which bases physician remuneration partly on patient satisfaction surveys.) The general bottom line is that your relationship with your doc is largely in your hands.

This blog’s December 11, 2009 entry tells the story of a woman with an excruciating facial nerve irritation who was hoping an impending tooth extraction would relieve it.

The oral surgeon she consulted said, “No, it won’t make any difference.”

Shaken, the woman asked, “How do you know?”

The surgeon replied, “If I’m wrong, I’ll put on a cheerleading costume and wave pompoms.”

If you wondered about the rest of this story, it has since unfolded.

The woman returned home, depressed. When she told her dentist what had happened, he advised, “You can't have him do your surgery.” He helped her get an appointment with another oral surgeon, whom she found supportive. After this surgeon removed the tooth, the woman’s nerve irritation plummeted, and it’s likely she’s permanently cured.

The woman wrote two letters. One was a warmly commendatory one to her dentist, thanking him for his help and especially for his compassion.

The other letter, to the offensive surgeon, was politely critical. She wrote that when he entered the room he failed to introduce himself, that during their six minutes together she found him arrogant and demeaning, and that he ended the meeting by summarily leaving without a word. There was no way, she wrote, that she could let him lay a hand on her.

A week later, she received his consultation bill in the mail.

“Ha!” she said. “Pay him for that abuse? He’s gotta be kidding.”

Then, thinking it over, she decided maybe she would hand him a check if he’d show up at her door in a cheerleading costume, waving pompoms.

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