'It's better when it's about people'
My current office is at the end of a hall that I share with cardiologists and gynecologists, the idea being to facilitate communication. The shelves in the hall have information on cholesterol, blood pressure control, prenatal vitamins and birth control. Plastic models of the heart in all its glory sit next door to large plastic models of the vagina, uterus and fetuses.
I received a call a year or two ago from a patient mistakenly thinking she was calling one of my distinguished gynecological colleagues. All I knew was that the patient was talking about a Bartholin’s cyst.
Somewhere in the mossy undergrowth of my brain I knew that I once knew what a Bartholin’s cyst was, but my conscious mind was having difficulty accessing my own mental hard drive. This patient thought she was talking to a gynecologist; I thought I was talking to a cardiac patient. And I couldn’t, for the life of me, remember where on the heart the Bartholin’s cyst might be.
It wasn’t more than one or two sentences before I realized, when the patient mentioned something about pain with urination, that I was in the wrong anatomical hemisphere and that this woman was calling the wrong doctor. I explained that I was a cardiologist and not a gynecologist, but she persisted, looking for my advice. I told her that I really did not feel comfortable giving her advice since I specialized in a different organ entirely. She said something like, “But you are a doctor. Why can’t there be a doctor who takes care of people instead of just organs?”
While I knew, more or less, what treatments she needed, I still didn’t feel comfortable telling her what she was looking for, and I promised to pass on the message to my colleague next door.
More recently, a patient who received a stent for a heart attack began to have a bunch of other medical problems requiring a pulmonologist, a urologist, and a nephrologist. I was explaining the situation to her daughter who, while extremely grateful, wondered out loud why there couldn’t be just one doctor taking care of her mother, instead of all these specialists for different organs
The days of a general doctor with a black bag showing up at your door to deliver babies, comfort the dying and diagnose appendicitis or pneumonia are not that distant a memory, but certainly not the norm. A patient of mine complained recently that he went to the emergency room with gastroenteritis and was treated by a harried physician’s assistant who cared more about his illness than about him and that he barely saw the doctor. The treatment he received seemed reasonable and, in fact, he did well enough. Ultimately, he agreed his care was adequate.
Still, something seems missing in each of these cases. Leave it to a hilarious old pool salesman, Ronny Brauman, to make me realize what it is. Ron frequently reads this column and isn’t shy with his critique scribbled on a piece of paper that usually also contains several truly funny, albeit filthy, jokes. “Doc,” he wrote last week. “Last column was OK, but it’s better when it’s about PEOPLE!” The critique may only have been about something I wrote, but it is also right on target about what’s missing in medicine.