Pittsburgh Post Gazette, February 3, 1989:


          
                         Note: Straight ASCII text
          Please check paragraph end markers before reformatting
                  "_" marks beginning and end of italics
         Travis Charbeneau  3421 Hanover Ave., Richmond, VA 23221
            travischarbeneau@gmail.com    Phone: 804 358 0417
                         www.travischarbeneau.com

                      Demand a Doctor Who Cares
                           Travis Charbeneau
                            slug "patient"
                              953 words
    An open cadaver: pale blue-white, contrasting with the sickly
purple of exposed organs, and, on top of all, a human head with a very
human face. Pretty intimidating -- both for medical school students
and for the average person. And the reactions of both are remarkably
similar -- at first. Dr. Leon Kass recently told Bill Moyers in a
television interview that anatomy students, on first encountering a
cadaver, almost invariably demonstrate a genuine, hushed awe: this
was once a living person; someone's mother or father, son or daughter. 
Not just a collection of "tissue," but a human being.
    How ironic and chilling that this reverence can so thoroughly
evaporate that, after years of hyper-technical, mechanistic training,
new doctors in residence can stand before a severely-injured, living
person and, if the victim is under- or un-insured, label "it" a
"GOMER:"  "get out of my emergency room." It's a stinging indictment
of the present system of American health care that during the very
process of creating a physician, awe of the dead can so easily mutate
into contempt for the living.
    Further what effort _is_ spent cultivating a good "bedside manner"
can often stop with a used-car salesman's smile and a functional
slickness. After that, health care professionals can almost always
rely on the natural vulnerability of patients to keep them quiet, and
never mind extravagances like a demonstration of simple compassion.
    In recent years we've heard a tremendous amount about a more
"holistic," humane approach to medicine, treating the whole being, not
just some isolated malfunction. The "busted transmission" analog for
illness, where the doctor blandly assumes the matter-of-fact demeanor
of an auto mechanic, is supposed to be dying if not dead.
    But we all know how conservative and arrogant professionals can
be, from medicine to law to journalism. They are not eager to change. 
And why should they be?  Constantly exposed to suffering, working in
"bottom line"-oriented environments where profits are paramount,
they've understandably spent years thickening their skins. So what if
yours is tender?  Besides, are you going to repair that transmission
yourself?  You'll put up with the surly mechanic _and_ the unfeeling
doctor on the same day and you'll bloody well _like_ it.
    But this is not the future of American medicine. We already have
a surplus of doctors and hospital beds. Of course, "the immutable law
of supply and demand" hasn't held prices down here any more than it
has for colleges seeking an ever-decreasing number of freshman each
year. But market realities cannot be forever suppressed. They _can_
reach health providers, if not in the form of lower costs, then in the
viability of certain clinics, hospitals and private practices.
    First, however, they must reach you, the patient.
    If you live anywhere near a metropolitan area, as the vast
majority of us do, you are increasingly in a buyer's market for
health care. Your options, of course, depend entirely on what type
of insurance you carry, if any. If you are among the 40 million or so
without insurance, you're just poop out of luck. Sorry about that. 
If you're stuck in an HMO staffed with creeps, ditto. But if your
plan allows you to so much as consult a new doctor, you have the
chance to make an informed choice. If you're at all unhappy, take it. 
Shop around. Yes, "shop," a word unheard of in a medical subculture
of $150 initial-consultation fees, cushy referrals and bewildering
technologies. Forget all that. You're shopping for compassion. _That_
you should be able to recognize, and _that's_ worth everything,
including mustering up the courage to say, "you're fired!" Call it
"Patient Power."
    And Patient Power isn't mere selfishness. By dumping a careless
doctor or clinic, you're clearing weeds in a crowded field; doing in
part what the American Medical Association and government have
steadfastly refused to do. And now is the time to do it.
    It's been said ad nauseam: the United States is the only
industrialized nation apart from South Africa without some sort of
national health insurance. National health, socialized medicine,
whatever you wish to call it, will come inevitably and soon, whether
occasioned by sheer national disgrace or the accelerating velocity of
costs-out-of-control. When it comes, empowered, compassion-conscious
consumers can have gone a long way towards making the new system
responsive to human need; high tech _and_ "high touch." This is
absolutely essential if we're to avoid the well-known, de-humanizing
tendencies of bureaucracy to further afflict an already-dehumanized
profession.
    In the modern era we have tattered that profession into a crazy
quilt of specialties which rarely appreciate an entire human being
outside of that first day in anatomy class, when said being is
appropriately dead. Even a lot of knowledge, when too narrowly
focused, can be a dangerous, or at least a deadening thing. Even as
national health is aborning, it is up to today's consumers, for their
own personal needs and for the future of American health care, to
re-integrate some of the "whole system" approach to medicine our early
witch doctors enjoyed.
    After all, these primitives had all the impressive trappings of
modern professionalism: scary masks (white coats), secret chants
(incomprehensible medical jargon) and formidable reputations ("he's
done more total shoulders than any orthopedist in the City!"). They
even had a few things in their bag of tricks which actually worked. 
Most effective of all, though, they possessed an instinctual awe of
their patients and the many mysteries involved in real health
maintenance that too many modern doctors lose in becoming part of an
"industry."
    And, if they didn't, they lost their magic _and_ their patients.
    Bring back the magic. There are good, compassionate doctors and
hospitals out there. Pick the best. Fire the rest.