Essaying the Situation
Wednesday, January 12, 2005
Doctors and Patience
    My mother's still bleeding a bit from her urinary tract. I gave her a second third of an Augmentin pill tonight to work on her while she's sleeping. I wonder if cutting back on her fluids may have encouraged the infection. It's hard to know what I may have done right and wrong. I feel better having witnessed doctors making the same mistakes.
    Less than a week ago I emailed a friend who is doing informed medication management on his own behalf with the following encouragement: is absolutely an exciting, strength affirming process to participate actively, rather than passively, in medicine/healing. Even when a particular strategy doesn't work, you know you have the ability to come up with other strategies. Keeps everything openended and life seems to favor the openended approach.
    Although I think the process of medication management is more often, at present, practiced by caregivers (including parents), I know that it is becoming more widely accepted and utilized by everyone. While I suppose at one time it was wise to leave medication management to those with formal medical education, I think almost everyone has, within the last two to three decades, experienced at least one incident in their or their loved one's lives in which medical professionals managed medication badly. In the last decade lay people have been able to discover, through sources on the internet, pharmacists asserting their medical knowledge as they fill doctors' prescriptions and the expanding willingness of medical libraries to allow patients to conduct their own research, that medication mismanagement would have been easy to avoid if their medical providers had been more attentive. I do understand, from both sides of the fence, why medicine is suffering this problem. Despite the speech to which one ER doctor treated me about Medicare in rural communities and the need for patients to become active in promoting their doctors' interests, I think what needs to happen is a sea change within the medical profession. This could be prodded by the increase in patients arming themselves against their doctors' advice but will only be accomplished by direct, active participation of medical professionals.
    It's hard to change a conservative profession from the inside or the outside. How often, for instance, have you, as a lay person on the receiving end of medical treatment, sneered, within the last few years, at the blurb tacked onto almost all advertisements for products of a "medical" nature, whether prescription or over the counter, that urges you to, " your doctor..."? Even Andy Rooney, in December of 2002, sneered publicly at the blurb in an essay published on 60 Minutes - Ask Your Doctor. Yet medicine hasn't changed much in the 2+ years since he vocalized the problem on national TV. If anything, the tag line "...ask your doctor..." has become more prevalent and less respected.
    My medical experience of the last several years with my mother tells me that the most important change taking place in medicine, currently, hasn't been initiated from within the profession. It is the movement of ordinary citizens, all of whom, at one time or another, are medical patients, who, out of desperation, are making judgments about their own and loved ones' treatments based on two criteria: The availability of medical information to the lay person; and the inability of their professional health providers to adequately address their medical needs and concerns. Little by little we are pleading with, and beginning to convince, our medical providers that they need to pay attention to our zeal to try to keep medicine from making mistakes on our behalf that should and could be avoided with a little more thought, attention and research.
    Who knows how long it will take for the AMA to get it? Over the years of my mother's intensifying medical treatment I can tell you that it is the two youngest, freshest doctors that have been the most adamantly against my questions and research on my mother's behalf. They have also been the most likely to threaten me with, "...but she'll die!" I managed to convert one through my "unprofessional" successes on my mothers' behalf. The other, though, was so upset by my efforts that she dismissed my mother as a patient after three months. My observation is that, since medical schools are turning out more rather than fewer young doctors who are patient resistant, it's going to be awhile before medicine hits bottom and starts noticing that if it reaches out to its patients it will rise in stature.
    Patients want to trust doctors. Few of us who have become avocational health care providers for ourselves and our loved ones want to be doing this. We know that our efforts can't match a medical education. Unfortunately, we also know, for the time being, that our efforts can match, and often excel, the efforts of currently beleaguered medical professionals. We also know that it is only medicine, itself, that can turn this situation to rights. In the meantime, we'll do what we can to keep medicine from clumsily mistreating us and our loved ones.

FOOTNOTE:  Do any of you remember the doctor from about a year ago of the Dismiss The Mother Because The Daughter's a Troublemaker, Asks Too Many Questions and Makes Informed Decisions Which Get In The Way of Me Generating Money for My Clinic episode? At the beginning of last month I finally got a bill from the office (my mother was dumped at the beginning of last March). I noticed that both appendages of my mother's insurance denied coverage. My guess is that this office's bill was denied either because they applied with incorrect information (which is common) or my mother's primary insurer noticed that we didn't have this doctor very long, there appeared to be no break in my mother's visits to her Mesa PCP, thus made the decision not to fund this office because it couldn't be considered a PCP or a consultant. I sent the bill back to the office with Mom's insurance information (which they supposedly already have) and a note explaining that, since the doctor dismissed us and didn't do a hell of a lot for us otherwise, whatever the office could get from insurance, however they wished to code the visits, was all they'd be remunerated for rendered services. I haven't heard anything since. My guess is that, despite medicine's continued crown polishing, it is beginning to jump when patients say "Jump!"

ACKNOWLEDGMENT:  A hearty thank you to MFASRF for his precise, perfect editing and the kick in the ass it gave me to edit a bit further.
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