They
call the Hanukkah-Christmas-New Year’s time of the year the most stressful.
People are trying to get everything done at once and run themselves ragged.
There is work, there are travel plans, there are family get-togethers, there is
buying the latest gadgetry. There is cooking and eating, and the obligatory
extra-gym visits. And then there is the stress of all things combined. A new
year is coming, of hopes, yes, but of challenges. And one would think that with
all this planning, and traveling and cooking and eating going on, that there
would be little time to set appointments for check-ups at the doctor. But from
a medical standpoint, this actually ends up being the busiest time of the year
in the office. Particularly for the eye doctor. Whose glasses broke before the
holiday season? Who ran out of contacts and can’t possibly have their picture
taken without them? Who has had an optic neuropathy for ten years and decides
that Christmas Eve is the day to start the
workup? Who got poked in the eye by their Menorah? Or their Christmas tree
lights? Who simply cannot have a stye
when boyfriend comes to visit? (I’m not making this stuff up. Truth is indeed
stranger than fiction).
But,
as I reflect on the last year these first few days of 2016 – (which, incidentally,
marks almost 10 years post-residency of providing care to the community. Where did the time go?)- I ask myself: If I
were to pick one thing that makes me feel like I’ve accomplished something
worthwhile every day, what is it? What gives me a sense of satisfaction when I
go home at night? For me the answer is simple : I get more out of teaching
patients how to seek out information about their health for themselves than I
do actually diagnosing and treating them. You cannot even imagine how many of
my Spanish-speaking patients are surprised to find out that there are certain
medical websites online where they can read up on their eye health in Spanish. And,
surprising as it may seem (especially in this day and age when vast knowledge
is available at our fingertips) they wouldn’t know this information unless I
shared it with them.
One patient in particular comes to mind in this regard.
She’s been coming to the practice for many years,
although I myself have only begun to examine her recently. She has Fuchs
endothelial dystrophy and has been given the typical OTC regimen of hypertonic
saline drops and ointments to help control the disease. One would think that after so many years of
being told to use this eye drop or that ointment, that somewhere along the line
she would have developed a profound knowledge and understanding of her eye
problem. But the truth is, one day she expressed confusion after I explained why she needs these drops and how they
work. She appeared utterly bewildered. I repeated the name of the disease. I
explained what it is. I explained why it happens, and what can be done about
it, both medically and surgically. And after explaining this in Spanish, I told
her that sometimes a person needs more than spoken words to understand a
concept. I directed her to www.ojossanos.org , and clicked the links to Distrofia
de Fuchs and printed out the pages and gave them to her. With papers in hand,
her appearance was not unlike that of Helen Keller’s in the Miracle Worker- understanding and
relief at the realization that the letters being spelled out in her hands truly
meant something. Here, my patient finally understood her disease and better
yet, knew how to find out more information regarding it.
I
think this is an important point. I have learned in the course of my profession
that being a good doctor, rather, being a good anything, is not about having all the answers. It’s about knowing
where to find the answers, and about teaching others to find the answers for
themselves. I got such satisfaction out of this one patient encounter, that it
makes me sad to think, especially as one year rolls into the next, that where
medicine is headed, less and less time is being made available for teaching and
for caring of patients.
Out-of-control patient schedules are not uncommon for the holidays, but
unfortunately the future of medicine is that these schedules will become the
norm. When this is the case, everyone loses, but especially the patients. This
isn’t the field I signed up for years ago. It’s not the field that my beloved
family doctor from childhood practiced in. One where he created his own patient
schedule, took time to examine and re-examine. Time to talk to the patient and
hand-write his findings. He could take 45min to an hour with each patient if it
so required, and the other patients were not unhappy with the wait because
their appointments were scheduled accordingly, giving ample time to everyone.
But
today, doctors aren’t doctors anymore. We’re providers. We’re employed by insurance
companies. We survive in groups where business hierarchy dictates that the
office manager with a business degree has more value than we do. He dictates my
schedule—someone who’s never examined a patient in his life. He decides when I
should be double-booked and how many patients I should be seeing in a day. And
his administrative assistant henchmen see to it that I’m booked every 5 or 10
minutes. Insurance companies decide what medicines to cover for patients and what tests can be ordered to rule out disease. It makes me very angry and I want to
stand up and say, no more! But all the other doctors comply. They fall into
line like cattle corralled for the slaughter. If doctors as a whole continue to
ask “ how high? “ when told to jump, what are a few dissidents like me to do to
improve the system?
I
am not sure what the answer is, or if there even is one. I can’t leave you, my
reader, with a clever anecdote and a problem-solved moment of satisfaction. All
I can say for myself is this, that for 2016, I am going to work hard to wring 5
minutes dry. I will continue to examine and diagnose and treat, but especially
and most importantly, I will work to create an education plan for the patient’s
well-being. I will continue to make time to teach, because knowledge and how to
find it is what keeps a patient healthy in the long-run. Woe is the society that takes away a doctor’s
ability to do just that:
doc.tor,
from Latin docere, to teach.
References
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| Coral Pink Sand Dunes, Utah |
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