The Professional Patient Speaks

Mrs. Claus and I know a lot of doctors. We like to refer to ourselves as "professional patients". Mrs. Claus is so almost to the point of obsession, down to always obtaining copies of her x-rays and MRI's, as well as keeping informal journals of our blood pressure, my blood sugar, and our weight, on her appointment book.

This is largely in self-defense. With multiple medical specialists and lots of clinic visits, not to mention about 18 separate medications, it is foolish to rely on everybody involved to send on new data in a timely manner to everybody else. So we have to be prepared to do about 3/4 of the schlepping of things around to the various medical offices.

We are in the middle of the Medicare Part D mess, by the way, with our pharmacist just tearing her hair out because she can't find out whether anybody is covered or not, and by what plan! So the company is having to distribute critical drugs, in weekly amounts, without charging for them. I say "our pharmacist", advisedly because we have had to shop around for one that will give Mrs. Claus' problems the time and attention we need, as well as a company with humane policies toward emergencies. We chose her as carefully as we choose our doctors.

Professionals, as I said before.

One of the problems we have is that no one doctor is overseeing the scripts for all her medications. This can be highly dangerous with as many medications as Mrs. Claus deals with. We have more than once had to visit the Emergency Room with bad new drug interactions. Between us, we visit two general practicioners--one for osteopathic manipulation--two counselors, two psychiatrists, a gasto-enterologist, a rheumatologist, a gynecologist, a cardiologist, an ear/nose/throat specialist, a podiatrist, and, soon, we will also have a pulmonary specialist.

I, of course, am largely "just visiting". I only have three regulars for my care--a counselor, a psychiatrist, largely for bipolar medication management, and a g.p. I picked up a fourth to have a laproscopic peek at my colon every five years or so, and a fifth to intermittently look at all the various goobers and grody spots that my outer layer now grows: skin tags in the sweat zones, seborretic caritoses on my over UV exposed arms, and other peculiar market vegetables everywhere else.

But I must help Mrs. Claus with her rolling walker, her electrical lineman's bag, and, now, her portable O2 tank and tube in her backpack. She is also insistent that we join each other in the consulting rooms. I don't have much to do in there, and I am observant by temperament and from long habit. So I have become a connoisseur of American medical care.

We have adequate medical science in America, but we are sorely lacking in the Art of Medicine, particularly among the M.D.'s. Our g.p.'s are both osteopaths, and they preserve far more of this Art. So we try to obtain D.O.'s among our specialists whenever possible, because they are far more down-to-earth and much less likely to be self-important prigs. These qualities we prefer in our doctors are part of the Art: a sense that Medicine is more important than the medicator, a willingness to treat the person rather than the pathology, and a further willingness to consider the medical conditions in which they do not specialize and how these interact with the pathology of the moment.

Over-specialization has contributed to the decline of the Art. Mrs. Claus has had to dump a rheumatologist and obtain another. The first was a coarse and unfeeling man, with all the personality of a UPS truck, who insisted on wearing horse blinders to anything but the arthritis and refused to view the person on the examination table as anything but a biological specimen. This may seem a novel concept--firing your doctor--but, for the reasons above, it is, as I have said, a matter of self-defense.

Mrs. Claus has also walked out of doctor's offices when dealing with specialists--mostly part of the toplofty University Hospital and so, also, professors--who are chronically over an hour late to almost all of their appointments. Our time is just as valuable as their time. Period.

Because we are so familiar with medical offices, and are not intimidated by either doctors or nurses as authority figures, sometimes new medical offices just don't know what to make of us.

If a nurse seems overly stressed or distant, I'm inclined to put on my best George Burns face and say something like, "Have you heard that they just repealed the law saying only landscape paintings can decorate waiting rooms?" or "Don't look now, but we're actually in a sitcom." or "The good news is, I've just saved a bundle on my car insurance."

And Mrs. Claus presents a very striking figure as well, with her walker, her lineman's bag, her tattoos and her many liberal political badges [the ones about the size of file cards that we create and have made up at Kinko's] , such as America Has The Best Health Care Nobody Can Afford, attached to the strap of her clutch bag.

Because of the timidity of almost all the other patients, nurses talk more freely among themselves than is common in other offices with such large contact with the public, as if the patients weren't really there. So we already know that more and more doctors are now refusing to take on new Medicare and Medicaid patients, such as Mrs. Claus. She is terrified that, within the next decade, no new doctor will see her, except for Emergency care. This is a quite realistic possibility.

There are possibilities even more chilling. We were at the office of the surgeon who did Mrs. Claus' recent emergency gallbladder removal. The follow-up visit was uneventful. But we overheard the following one-half of a nurse's phone dialog: "I'm afraid we no longer take Aetna insurance.....Well, they simply don't pay our claims.....I'm sorry, but most of the surgeons in town no longer take Aetna.....The only place I know that you can go is the University Hospital, I think a few surgeons there still take it....I'm very, very sorry, goodbye."

Think about it.

It's not just indigent and marginal folks like me and Mrs. Claus that are at risk. After all, folks like us are the ones who "go to the Emergency Room for every little ache, pain, or cold", and need to be stopped from doing that, right? It's anybody. America's health care cost and insurance crisis is far worse now than it was ten years ago, after the Clinton Administration attempt to fix it was stopped cold by thousands of dollars of scare ads on television.

Fixing it just simply interferes with too many corporations making easy money from pharmaceuticals and insurance.

Too many corporations making easy money...