Sunday, December 27, 2009


Dr. Martina Nicholson commented on my December 17 blog entry to the effect that she wants conversations with her patients to extend beyond the day’s chief complaint into what really matters, but there’s no billing code for that.

She resents the industrial style into which American healthcare has detoured, and I couldn’t agree more. During the past couple of generations, economic pressures have steadily morphed physicians into interchangeable cogs in a high-tech assembly line. You’ll get paid, Doc, after you’ve filled in all the blanks and fitted the patient into a billable code. And by the way, Doc, we’re reducing your reimbursements again. Healthcare’s economics are operated by distant agents who combine zero appreciation for the examination room’s subtleties with hefty incentives for augmenting profit.

Though Dr. Nicholson and I and a growing number of physicians want to "humanitize" healthcare, don’t wait for us, as the most necessary changes must come from patients. Robert S. Mendelsohn, a pediatrician, wrote in his 1991 book Confessions of a Medical Heretic, “We physicians will come down off our pedestals as soon as patients get up off their knees.”

We traditionally think of patients as passive. The doc’s the expert, and what could the patient possibly know? The doc’s the provider, the healing agent, the active principle; as the consumer, you need only to lie still in your paper gown.

If you still buy into that view, you’re short-changing yourself. Surgeon-author Bernie Siegel confirms that the feistiest patients (often labeled “difficult” by practitioners) fare measurably better than the most docile ones. “Feisty” means learning enough about your condition to ask important questions. It means demanding answers, getting second and third opinions, negotiating for exactly what you want, recruiting effective support, and continually asserting your dignity, unique selfhood, and ultimately control of your destiny.

1 comment:

  1. I've found that the least knowledgable physicians were the ones who became instantly defensive at the slightest provocation from their patients. Pressing these doctors for answers was an exercise in futility. This was a tough lesson to learn. Undiagnosed and untreated by the physicians who considered me "difficult," I became disabled and went on SSDI during my peak earning years. It took me six years to track down knowledgeable doctors who encourage patient participation and together we created a treatment protocol that may at least help me become mobile again. The damage to spine and CNS from untreated infections may never resolve.