Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, August 18, 2005

    Got an impassioned comment response to my TB-patient post below. You might want to skip down and reread it. In part, the poster says:

    Regarding your post about the patient who saw a specialist rather than have his condition evaluated at the county hospital.. You need to put yourself in his shoes and stop thinking and acting like someone who has a difficult stressful job. It's one thing to feel frustration about complete irrationality or someone who acts like an a-hole, but that's not really what happened here, is it?

    First of all the patient doesn't know you. You're not his regular Physician. He doesn't know the doctor who orginally treated him. In fact YOU hadn't even seen him! He came to your clinic because you were open. Given all the media attention on shoddy medical care, penny pinching insurers, niggardly HMO's and the state of the American healthcare system in general, do you honestly expect him to trust you with his life just based on your medical license? I haven't read much of your blog, but I'm under the impression you're the one who makes many if not all of the administrative decisions for the clinic regarding treatment, referals, tests and such, which right off the bat is a great big corporate bottom line red flag, justified or not. We don't care who you have contracts with, we want the best medical care available.

    Secondly you didn't tell the patient he may have a cold, you told him he may have a potentially debilitating condition--I suspect that's more than likely what he heard anyway.. I'm not a medical practitioner so I don't know how serious a condition TB is nowadays. Furthermore since you couldn't precisely diagnose what he did have (not to mention "didn't have time" to deal with his case more promptly) he may well have been worried about something else. Doesn't AIDS cause those lesions?

    It's not only petty to downgrade/upgrade patient status because he hurt your ego, it's unethical and I'm sure against the law.

    As far as the insurance comment is concerned, you're both right. Although I wasn't there to hear the tone of the conversation, I don't think he probably meant he was entitled to better care than the uninsured, I think he meant "I spend thousands of dollars I work hard to earn to safeguard my health, and I'm ENTITLED (and YES we are) to whatever care best guarantees it.

    I agree with the patient's decision to seek treatment outside the protocols of your office just based on this post. It tells me you're unprofessional and not to be trusted.

    Where the **** do you get off giving someone who is struggling with the emotional ramifications of poor and possibly debilitating health a hard time about seeking treatment he thinks is appropriate? So what if he was wrong. Did you learn anything about depression in medical school? Hypochondria? Humility? I know they didn't teach you anything about bedside manner because nearly every younger MD I've had the misfortune of encountering couldn't hold a candle to the guys who were trained 30-40 years ago.

    Up until the post in question, I was actually enjoying your blog. I suspect you know what you did was wrong, otherwise you wouldn't have posted and asked for feedback.

    My response:

    Clearly reading this touched a nerve for you... but if you had read more closely you would have seen that your accusations are wrong. I spent a lot of time on the case. I had multiple phone conversations with the patient. I encouraged the patient to call me back with further questions. And, though I didn't specify this in the post because it was not relevant to the situation, I had seen the patient several times before and in fact had performed a physical on this person. So, they knew me. Your speculation is incorrect.

    There are two sides to every story, which is why I asked for feedback. I've certainly got yours. One of the nice things about having a blog is that you can say whatever the hell you want. I think it's a good thing for people to see what a doctor is REALLY thinking sometimes and why. And as for the "old time" MD's you extol, let me tell you I've seen them with their hair down and they're the biggest bitchers of all. If you think what I wrote was bad, you haven't seen ANYTHING.

    I do think you should comment again. I know patients can burn out just as much as doctors can and I think it is, in fact, healthy for people to air their concerns. We might learn from each other. I did not pull punches in this post for just that reason. I knew I might very well come off as a self absorbed asshole but after drafting and thinking over the post multiple times I didn't see a reason not to post it. And it was cathartic to write.

    Just to be clear, I didn't write the post to look like a put upon saint and I didn't mind if it made me look bad. I never expected everyone to agree that what I wrote was OK. I do feel more like a real blogger though now that I've gotten my first piece of hate mail. (Kidding. No, I do not consider this hate mail.)

    Perhaps I should change my blog title to 'The Disenchanted Doctor'. On second thought, no - but I do have a new entry for my sidebar. And perhaps I should be more articulate about HMO's, medical regulations, and other issues that health care providers face. It might provide readers with some useful information. Something to think about for future posts.



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