How to Get Good Healthcare, Part III

Meeting your team

While you are right that you are paying the bill, you are still at somebody else’s house. This isn’t just the physician’s workplace, it’s their home. They probably feel like they work a lot more hours than you do even if it isn’t true. They might even resent the fact that you are an uninsured artist and are usually pretty happy.

Consider doctors perversely socialized. Remember that year (or maybe the last decade) you spent working part-time at the Rainbow Club, drinking, smoking and generally having a blast? Unless he took a non-traditional path, your doctor probably didn’t have that year. Or at least thinks he or she didn’t – even if untrue.

The point here is simple: These are people who should have been building their social acumen and instead went home to do homework. They are the type of people who fret about the day’s work. They may be out of the ER, but their work isn’t done. They may have to take call and stay in the hospital. They may have to be on call for a week at time, not seeing their cat or lover. Hundred hour work weeks are not uncommon.

Consider these people a little strange. Many a physician is slow on the social uptake, failing to take time for late-adolescent social polishing necessary for normal smooth social interactions. So even if you are in the service industry, the doctor doesn’t need to make a sale, so don’t act like this is your house because it isn’t. Indeed, the hospital is frequently referred to as the “House.” As in, “The patient is in house,” meaning the patient is in the hospital.

That being said, you need some help. That’s why you’re there. Try to sit back an relax if you can. Let the doctors and nurses know what’s bothering you. Let them know if you are in pain. These humans want to help you, let them do it. You are going to be asked the same questions at least three times. Despite what it seems like, this is not a complete failure of communication. The doctors are going to compare notes with each other and a team of nurses, social workers and technicians. They will talk about you, however briefly, behind your back. It may be even worse than that: If you are at a teaching hospital you may have medical students, interns and residents taking care of you. Over ten people may be on the team!

How to Get Good Healthcare, Part II

The Combative and Impatient Patient:

We all realize that defenses mechanisms are on high at the doctors, especially when sick. Usually these defense mechanisms are kept in check; nevertheless, I cannot tell you how many times I’ve had an arguemetative patient (who I’m sure otherwise is a reasonable person) who comes to my exam room with unreasonable, rigid demands before I’ve even said a word.

My friend, Dr. Rob, who I refer to as the “Good, Not So Good Doctor,” tells the story of the patient who came to his ER, said that they have been to 3 ER’s that day, won’t be waiting and demanding a CT scan. Well, Dr. Rob knows a few things before even examining the patient. First, he knows the patient cannot really be in that dire of straits. After all, the patient has been shopping doctors all day so he cannot be in death’s waiting room. So Rob, who already has a busy emergency room, knows he can wait to see the not-so-acutely sick patient. Second, he knows this patient is impatient. Now Rob is a normal human being under the normal stresses of life. He reacts to stress like anybody else: He eats too much; he used to sneak cigarettes; he is sometimes passive-aggressive and if somebody is a demanding, impatient pain in the ass he will make them wait – oh and if somebody with a heart attack happens to roll into his ER, the impatient patient will wait that much longer.

How to get good healthcare, Part I

Your doctors may work in the service industry, but in their minds the customer isn’t always right:

How well your doctor takes care of you is very much a factor of you. As it turns out all doctors treat all patients differently. You want this. You are different from the next patient, even if you have the same problem. You want care individualized.

Your doctor (here to fore I will refer to doctors in the masculine as much of what follows is pejorative and when discerning betwixt genders, the chivalrous demean the stronger sex) has been trained, not only in medical school but in the entirety of his socialization, to identify certain characteristics and make judgments about them – subconsciously or otherwise. He will judge you and contextualize your problem. This allows for a better understanding of your health problems. Take for example chest pain. The high school girl applying for college, chest pain is almost invariably stress related. Chest pain in her 70 year-old grandfather on the other hand is a heart attack until proven otherwise.

Contextualizing allows fluid conversation. One speaks differently to a child than to the elderly, or differently to a hipster than to a jock. Your doc will make simple, social judgments about you. Unfortunately these judgments and contextualizations may undermine the care you receive. His judgments will influence how much time they spend with you and their investment in your wellbeing. Frankly if he likes you - or at least identifies with you as a person - your doctor is more likely to give you high quality care.

Think about it from your persective. If you worked as a server in a restaurant (your doctor works in the service industry!) what would influence you to invest yourself in your customer? If you thought the customer at table 8 was cute, perhaps they’d get a free dessert. Maybe you would want them to be friendly and open. You certainly wouldn’t want them argumentative or defensive. If you had to actually touch them or get your nose close to them, you would want them to smell nice. Fashion statements aside, clean clothes are always a plus.

Coming are a few guidelines for getting good healthcare. Most of which are directed toward an Emergency Room visit. By law, patients cannot be turned away from the ER. They have to see you and here are a few ways to make your stay more fruitful.