When my latest and repeatedly postponed annual “wellness visit” finally took place, late last year, my internist met me in one of the treatment rooms he shared with his medical colleagues.
I’d known him as an attractive man of indeterminate middle years. Now he wore a mask that made his ears protrude almost comically—the look of a silly teen-age clown. But his tone was all business when he greeted me, then shook his head when I suggested that, yes, I had questions but assumed I’d be sharing them when, at some point, we’d adjourn to his office.
“No, no,” he protested. “We don’t leave here until you and I are done. At that point, this room will be disinfected thoroughly before my next patient is led in.”
What a good idea! I thought. Then I wondered why, over the years, this practice hadn’t been followed routinely—by physicians eager to protect their patients and themselves from possible airborne or contact infections. I also wondered if this cleansing practice would continue, post-Covid-19—as it should, perhaps universally—before every patient enters every medical treatment facility. I certainly hoped so.
Actually, Covid-19 challenged the way doctors have traditionally served their patients—often in positive ways, of course. But some old habits have persisted, and with negative, often wasteful and potentially detrimental results. Time has been the perennial excuse; there is never enough of it.
A few weeks after my internist visit, I was scheduled to see a urologist. But after a series of postponements, obviously due to the ongoing pandemic, I received a call from a (presumably) young assistant in his office. She was phoning, she said, to see if my exam could be done remotely. “Really?” I asked, trying not to chuckle. There was a pause; she had no idea that what she’d proposed was ridiculous and unlikely, so was obviously awaiting my answer.
“No,” I said finally, “I’d prefer seeing him in person, so will call again, maybe next month.” She thanked me and, yes, I did see him finally. We both wore our masks, he pulled on a disposable glove, and the usual exam took place. My urologist smiled and shook his head when I recounted the phone call I’d received from one of his staff members.
Some years earlier, another of my doctors had sent me off to an imaging lab not far from his office. After changing into a stiff, much-laundered gown, I presented myself to a technician. “We’re supposed to do a CAT scan of your sinuses, right?” she asked.
“Correct,” I said.
”What’s wrong with them?” she wanted to know.
“Maybe you should ask my doctor,” I suggested. Shaking her head, she said, “Hey, if I did with every patient, I’d probably be on the phone all day.”
Our exchange ended, and I didn’t have to explain that if my doctor actually knew what was wrong with my painful sinus glands, I might not be needing a CAT scan. I also didn’t bother to repeat the litany that had once been drummed into me by a physician friend: “We never ask patients what’s wrong with them. We usually ask how they feel, then try to figure out why.”
Since then, I’ve often wondered why my doctors’ findings wouldn’t be routinely shared with the other physicians I visit, no matter where their offices are located or what hospitals they’re affiliated with. Why wouldn’t my medical history be available—on request, of course—to every other doctor I happened to see? Yes, I’ve been assured, medical records are all computerized now—even mature doctors have nimble fingers and can be observed savagely inputting as their patients speak.
“We can now access your whole medical history,” one physician assured me. “But, unless really pressed, I suspect that few of us have the time or patience to do that.”
.
Thus chastened, I’ve made a point of bringing a copy of my up-to-date prescription-drug-list to every office visit and sharing it any physician who’s about to prescribe some new drug or medication. That list came in handy only once, when a doctor—too busy to check my history—shook his head when I shared my list. “Oh boy,” he said, “I guess I can’t have you taking . . .“ whatever it was that he was about to prescribe.
I smile when I recall what I experienced some years ago, when a specialist I’d been referred to actually phoned my doctor while I was still at his desk. The specialist was rendering a positive report, so no detailed mumbo-jumbo was shared. Even so, I felt encouraged that, for whatever reason, one medical practitioner had opted to communicate directly with his referring colleague.
Alas, nothing so reassuring has ever happened again—not to me, certainly.
A few years earlier, the cardiologist I was seeing decided that I might be a candidate for a pacemaker, a small electronic device that’s routinely installed just under the skin, right over the heart. It’s there is to continually monitor and report heart-rate fluctuations.
Because of whatever had aroused his concern, my heart doctor sent me off to a specialist who routinely installs and monitors such devices. After noting my history and completing his exam, the physician said, “Before we do anything, I think your heart should be monitored.”
This meant that, for the next three weeks, night and day—but not in the shower—I would wear a heart-rate monitoring device tucked into a fabric sling looped tightly around my chest. Daytimes proved O.K.; I got used to the encumbrance. But overnights were a nuisance, resulting in night after night of interrupted sleep. Thus I was happy to return the device and its sling, ultimately, and assure myself, “A pacemaker could not be a bigger nuisance than this.”
Such a device was designed to be installed surgically, of course, just beneath top layers of flesh. But I was spared. During the follow-up visit, my cardiac specialist showed me an electronic printout with wavy lines that made sense only to him. And what he reported was a great source of relief: “This report shows no incidents or irregularities,” he said. “Your test was clean; I don’t recommend taking any action at this time.”
Several weeks later, I paid a routine office visit to that long-time cardiologist of mine, who at the end of his exam asked me this: “So, how did that heart test go?”
I was stunned. I mean, how was I supposed to respond? “Oh, it was fine. Your guy shook my hand and gave me a lollipop?” No. I’m afraid I really let loose, something I had never done with any doctor: “You’re asking me, for God’s sake? I wore that wretched monitor, night and day, for three miserable weeks. You sent me for that test and you don’t even know the result?”
“Calm down,” he said. “Don’t get excited.” Excited? I can’t recall ever being so annoyed with anyone, let alone a physician I was normally programed to trust. Even later, when I did calm down, I felt even more than ever agitated and angry. Suppose the report had been positive, not negative. Would that news have actually been shared? And if so, when?
Sure, I could’ve told my heart doctor that the test showed I was fine—no action was needed. But if there had been actual communication between those two practitioners, finite details might have also been reported—stuff I wouldn’t have known about or even understood but perhaps would be an important addition to my medical history. Of course I did find it hard to believe that no coordinated response to my three-week test had ever happened.
Could that experience—which occurred not so long ago—be replicated today, when most physicians at least seem computer-savvy? Yes, I think so. Why? Because I recall a doctor once telling me, “We like doing our own research—and are not too keen on sharing.”
I guess that’s it in a proverbial nutshell. It implies a kind of back-to-the-future situation that apparently forgives doctors who persist in shunning progress.
Instead of advancing their own electronic communication skills and sharing their findings and prescriptive treatments—which would surely refine patient care and eliminate much wasteful duplication of services—they seem happier holding back. And those of us, their trusting patients, remain their ultimate victims and, I guess, we always will be. [END]
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