My friends, I am offended. I’m insulted and frustrated. Part of me screams, stomps, and rages inside.
I am embarrassed.
My friend went to establish care with a new primary care physician last week. Before the appointment she was told to bring all of her medical records. No instructions, no specification of which parts or in what form. So, being the tech-savvy and eco-friendly woman she is, she downloaded all that was available to her onto a thumb drive, as it was rather copious now in her 7th decade of life.
Upon arrival, she presented the drive to the woman who initiated the evaluation. She thinks this was a nurse; but she’s not sure. The woman said she could not ‘handle’ the thumb drive, but said, “I can just pull it up here online.” What? Ok whatever, clearly the medical record request was simply a routine request made of all new patients. Thereafter the woman proceeded through routine medical questioning. But as my friend answered the interrogation, she felt distinctly ignored. Her concerns were not addressed and she did not feel any rapport. The woman did an EKG and left the exam room.
Later, while my friend was still sitting on the exam table, the woman returned with an old man in a white coat. He stood there, hands behind his back, and informed my friend they had called for an ambulance to take her to the emergency department. The EKG showed an abnormal heart rhythm. They said she would likely be in the hospital for two days for observation and tests. The nurse and doctor spoke to each other but not to my friend. They did not ask her how she was feeling, or what she knew about the/her condition, and they did not check the online record for evidence of past evaluations or recommendations.
My friend refused, for various reasons, not the least of which was that this condition had already been thoroughly evaluated, multiple times, and was actually well controlled. But the doctor and nurse showed no interest in knowing my friend, nor did they seem to care to include her in any medical decision they made about (for) her.
Granted, this is my friend’s side of the story. But for right now this is where I focus, because her experience is all too common, and I hate it. She experienced everything that makes physicians and our healthcare system look and feel so broken, and that contributes to the widening relationship gap between patients and physicians/providers.
She was asked to bring her records, she put forth the effort to do so, and they were not reviewed.
She felt ignored and dismissed, even though the objective of the visit was to establish care and initiate a long term, collaborative relationship with a new primary care doctor.
She was ordered to submit to an ambulance transfer to a hospital emergency department, with neither discussion nor negotiation of other care options, and without regard to the financial and other costs to her.
She felt harassed by the office in the following days, receiving calls admonishing her for not presenting herself to the emergency department.
The bottom line is that my friend felt completely unseen in this encounter. She felt treated like an object—a set of data, a statistic, a box on a flowchart. Context, history, and individuality be damned. When you’re in a relationship with someone who is supposed to help you, on whom you rely to help you understand the best plan of care for you personally, feeling unseen, dismissed, and belittled is exactly the opposite of helpful.
Maybe we should not judge the nurse and doctor too harshly. We all know the time and volume pressures primary care providers live under these days. Maybe they were distracted by other, sicker patients they had seen that day. Maybe that made them more vigilant and aggressive with care recommendations for her, and put them behind schedule so they felt they could not take the time to explain things in more detail. Maybe the doctor had seen this arrhythmia once before, treated it more casually, and the patient died. We have no idea. And it matters, insofar as it impacted how he presented to my friend. Because his presence was dominating, authoritarian, rigid, and cold.
The patient-physician relationship serves as the foundation for medical care and healing. No matter how much we talk about and try to honor patient autonomy, the power differential in this relationship remains fixed and real. The doctor has the power and the responsibility to make the patient feel safe, to earn the patient’s trust. On this day, in this visit, this doctor blew it, in my opinion. It was their first encounter. He should have taken the time and interest to get to know her, even a little, to agree on how they would work together. If he were truly concerned about her health, knowing she had an arrhythmia (which are often made worse with stress), might he not have noticed the distress he was causing her? Couldn’t he have given her additional care options, like referring her to a specialist within the week? Or perhaps he could have opened the electronic health record and looked at her previous cardiologist’s last note?
He did none of these things—or at least not in any way that my friend perceived.
Further, he not only failed to establish a good relationship with her; he undermined her trust in our whole medical system. How many experiences like this does a person have before she starts to reject the medical community altogether, ignoring symptoms of disease because she would rather deal with pain and disability than try to navigate a hostile system? Fewer than you might think. This is how patients end up in emergency rooms with truly life-threatening illness, where, guess what? They get shamed again for not seeking help sooner.
It’s rather tragic when you think about it.
There is hope, though. But as this post has already a thousand words, my thoughts on solutions will have to wait.
I hope you all had a restful and joyous holiday season. My unplanned holiday writing hiatus lasted longer than I intended, and it’s nice to be back. May we all reconnect with one another in more meaningful, productive, and uplifting ways in 2019.