ART IS ART AND MEDICINE IS BUSINESS

After reading this blog

http://allbleedingstops.blogspot.com/2010/09/physical-exam-why-bother.htmlmade,

I wondered if this doctor was asking the right question:

"The the dying art of the physical exam"?

I think it is more the dying art of patient care. In fact, there is no art in it, but just cold business.

Yesterday, I went to my Ob/Gyn complaining of pain that was similar to what I had experienced this May pre-surgery. I was pleasantly surprised to be given an appointment in a week, because I am certain I've waited 2 months for check-ups.

I arrived promptly, and always bring a good book as I expect to wait when a Dr. has an Ob practice too.

I signed in, and checked-off insurance change, and included the notation "cash patient".  The front desk immediately called me up to inquire on my new insurance, and I replied that I wrote in I was paying cash. I could see she had the sheet, legibly written, but commented that I guess my writing is not as clear as I think it is.

She announced loudly: "cash patients need to pay up front. $250 please". I was shocked that she knew the cost beforehand, because when I called to make this appointment, I had asked 3 times for the price, the base price, or a ballpark figure. I was told it was impossible to determine because unknown test or procedures would take place.

I repeated this info to this unpleasant woman but preceded it with: "it is a bit annoying that you can tell me the price without hesitation." She responded coldly: "I don't know who you talked to, but I'm front desk!" I guess there is a cast system that defines authority in doctor’s office, but I don't understand the lack of communication in a practice of less that thirty people.

I retrieved my wallet and handed her my MC. After returning to my seat, I heard “you need to sign it!” Honestly, I assumed it would take time to process the transaction, and I wanted away from her, but I hardly sign credit cards anymore. I don't know why, but a clerk will mostly tell me “no signature required”.

I don't know if this thought was in my head then, but at some point, I realized this must be how poor people are treated. I have lived my adult life in a privileged world (certainly compared to my childhood), but for the most part I reject the cloakatively of it. I no longer belong to the country club, and see few of those friends.

I was immediately called by a nurse. I remarked I have never been on this side of the office, and she said something to the fact that I was a new patient. I replied, I have been with the doctor for 14 years. She brought me to an examination room, and told me Dr. “Redacted” will be with me soon. I burst into tears. I don't know this man. I am having a hard time in my life. I’m in pain, and it is emotional too. She was very comforting, but I was never told it was not with the doctor I am comfortable with, and he would have known by looking at me that I was not well.

Most woman feel vulnerable undressed, but really that was the least of my concerns. I am an avid coffee drinker and was not given any after my last surgery. Upon hearing that news, my ten year old announced: “Mom would show her vagina for a coffee!” I could write a book with the stuff she says, and does but the way I explain that child is to relate that I have said since she learned to put sentences together: “we have college funds for our first two, and bail for the third.”

My predicament relates more to the anxiety I have, and how I practiced in my mind what I would say. Do doctors realize patients worry about what is charted? I know that a diagnoses of depression could impede me from new insurance. Dr. “Comfortable” knows me from the club, our kids go to the same school, and most importantly I would feel not judged.

I waited a long time but lost tract, really, I was in a state. At some point, a nurse came in to tell me he was delayed with an emergency in the sonogram room. I really understand, but it was just another stress for me at an inopportune time. The good news is that I must have written a chapter for my book, because it was likely over a half an hour.

The doctor arrived and I knew he had been told. I wondered what they call women like me?

FUOA (fucked up on arrival)?

MWIT (menopausal woman in tears)?


He was rushed. You can’t hide it, and it made me more anxious. I nearly forgot to tell him one of my symptoms. He dismissed it as hormonal and recited circumstances under which a woman loses her hair.

His examination was brief, and he immediately informed me I would need no further test. I saw his obvious amandation MO, and I panicked. I hadn’t told him I can’t sleep, I am so anxious, and I can barely function. I wondered if he thought I was “doctor shopping”. Is that what they call prescription drug users? Dr. “Comfortable” knows I don’t take anything. I can count on two hands the amount of aspirin I have had in my life. I delivered a baby without an IV, and hence no drugs. I don’t drink alcohol, and the only pill bottle I ever finished was because the doctor warned me to adhere to his directions, or end up back on the table.

He inquired about the sources of my stress, but honestly, I felt I was looking at someone who was curious, and not for my benefit. Do they have an office pool to see who wins the guess what’s wrong with this one contest? Gynecologists see everything in their practice and must master the art of the blank expression early. I remember life before HIPPA, and I think that it has been the most efficient killer of gossip.

I could not open my mouth. I only looked at him. I wish I was clever enough to use a word that had meaning, but I could not. If only I remembered cagastric afterward. In fact, I had to look it up in my list of obsolete words. I play an amusing game with a fellow blogger, and it gives me a slight thrill when I win a point with the words of defeat: what the hell does ________mean? Language disappears with obsolete functions, or with the growth of knowledge. I have always loved words.

He gave me a prescription for Zoloft, and a paper with the billing information on it. I told him I don’t know what to do with it, I’ve already paid. He was annoyed with me; I guess I interrupted his ritual. It is my observation most doctors have raging cases of OCD, and God bless you if you interrupt a fucking compulsion. I departed as quickly as I could dress.

The nurse who had told me of the delay called after me to check-out at the desk. “I’ve paid, thank you”. “You need to make an appointment for two weeks”, she said loudly. I never turned my head, but replied “I will call, thank you”.

I have never run out of a building so fast.   Upon reflection, it is more than interesting that I have been in a house fire, and stopped to look a the burning damage. I have experienced a Hotel fire, totally uneventful in my mind. Finally, I was on a plane with an emergency landing, the deplaning felt like any other time.


I will never go back there again. My best friend is the wife of an OB/Gyn, and wanted to resolve my experience through the most efficient channel: the DWN (doctors wife network).

I really don’t want anything said. I don’t know this front desk woman’s life. I may have been the straw that broke the camel’s back. I know working with the public is tiring. The initial appointment lady was more than polite. If I was bamboozled, I’m too stupid to know it. I am certain of two things: I won’t go to any office that doesn’t practice medicine first, and this has been my annus vicissitudo.