Good Medicine, Bad Medicine
Like many people, I owe my life to skilled medical practitioners. Back before there was a quick-fix for the Rh factor issue, I was born fighting for survival as antigens forming within me battled to reject my own blood supply. Even after a total transfusion, I required an emergency response team at least once before my parents could take me home from the newborn ward.
My husband Jack is similarly indebted to the researchers who discovered insulin as a treatment for Type I diabetes. We are both extremely grateful for the reprieves we’ve been granted.
But medicine is like any other field: It produces competent, caring professionals as well as some less admirable types. And because of its unparalleled potential to affect our quality of life, society holds the health care industry to the highest standards. (A miscalculation in surgery certainly trumps a slip-up in toilet installation.)
Some failures to meet these standards are dismissible as human error, of course. The ones that cause fear and trembling are rooted in greed, insensitivity, ineptness, or narrow-mindedness – traits one would hope might be sifted out through the arduous process of education and training. So, while most health care providers serve us well, some others, perhaps, could do better. I am sure you have stories of your own. Here are a few of ours.
We had the same family doctor for our first ten years of marriage. Dr. Good. Really. And was he ever. He treated my stepchildren with respect; he listened, and applied common sense; he took a conservative approach to minor problems and acted quickly on the major ones. He was a doctor, not a clinic – as his business card read. When you called his office, a human being actually answered the telephone.
By the time Dr. Good was approaching retirement age, he was forced to take on shifts at the emergency room in order to stay afloat. The giant machine of government programs and mega-clinics and mammoth insurance conglomerates nudged him right out of practice, no doubt earlier than he, or we, would have liked. Since then its been a kaleidoscope of changing clinics and M.D.s for us.
There was the megalomaniacal endocrinologist who wanted to micro-manage my husband’s life with no regard for how sending him to the local E.R. for weekly blood checks would disrupt his work schedule and his insulin routine. There he would sit for an hour or longer, waiting for the staff to get to him as a non-emergency, until his blood sugar had dropped to an comfortable low, throwing his readings off for days. And this doc insisted on monthly office visits, versus the twice-a year check-ups most of his colleagues recommended.
When the patient decided he could no longer comply with this overzealous tyrant, the doctor sought revenge on him by giving a bad report to the State License Bureau. Jack had to renew his driver’s license every six months for many years as a result. Perhaps Dr. X. could have done better.
Several years later, at my desperation-inspired insistence, we starting tooling 20 miles across town at least twice a month to an institute that advertised itself as solely committed to diabetes care. They were right there on the cutting edge; this was all they did and they did it well. They said so themselves. A few non-informative meetings with an overweight dietician who couldn’t tell me how many grams of carbohydrates there are in a potato should have been a warning bell. Unfortunately, the worst was yet to come.
Visit number one to a staff a specialist yielded a prescription for a new type of insulin. For decades, my husband had taken the same two insulins, one dose of long-lasting morning and evening, for continuous “background” blood sugar control, and a dose of fast-acting before each meal. Before breakfast, he would combine both insulins in the same syringe. This was recommended procedure; it was safe, effective, saved syringes, and meant only one injection instead of two. Sweet and neat.
Shortly after he started seeing the experts at the internationally acclaimed diabetes center, he was driving to an appointment with his eye specialist and I was along for the ride. Half-way there, he started acting strangely. I had seen this only once, a few weeks earlier at Taco Bell, when he had a blood sugar dip so radical and so sudden that he couldn’t speak, couldn’t even navigate out of his chair. It had never happened before. I thought it was a one-time fluke.
Yet this day, here we are, barreling 65 miles an hour down the freeway, when my husband begins to act as if he doesn’t know where he is, what he is doing, or what to do next. He could not put a coherent sentence together, and he was sweating like a marathon runner in mid-August.
It took me what seemed like an eon to talk him into doing what I was screaming at him: Pull over onto the exit ramp; get off the freeway now; do not continue driving. LISTEN TO ME: YOU ARE DOING THAT FUNNY THING WITH YOUR HANDS.
Apparently that last sentence connected for him and broke through the fog shrouding his oxygen-deprived brain. We executed a four-hands-on-the-wheel exit, got him a jug of orange juice from a convenience store, and made it to his vision exam – late and rattled, but in one piece. “Harrowing” doesn’t even cover it, and thoughts of what could have happened “if” haunt me still. God was working overtime for us on that one.
We later learned that, oops; nobody at the Cadillac-of-diabetes-care flagship had bothered to tell him that he was not to mix the newly prescribed fast-acting insulin with the long-lasting. It might cause a severe drop in blood sugar. Yeah; I guess you could say we noticed that. If there had been a multi-car fatal crash that day, no one ever would have known why. Perhaps they could have done better.
We have since left that clinic and discovered on our own a non-mainstream system that answers all of the questions the “experts” were clueless about.* But because this is not an approach rubber-stamped by the American Diabetes Association, the (diabetic) physician who developed and prescribes it – and is living proof of its efficacy – is a lone wolf in a brood of clucking hens who defensively refuse to acknowledge his incredible success. Perhaps they could do better.
Doing better is what we got from the doctors who treated the diabetes-related eye conditions that Jack developed while we were still dealing with “the brood”: A specialist in vitreo-retinal maladies who listened, answered questions, and skillfully restored his vision virtually to normal, and a local ophthalmologist who performed a perfect cataract surgery on July 3rd, then met Jack over at the closed clinic on the Fourth of July holiday to do a follow-up exam. These two stellar individuals served us better than well. I wish I had a few medals to hand out.
In my stack of imaginary medals there would have to be a few more booby prizes, though. One particular booby would be the fellow who “treated” my mother-in-law for an uncommon condition called hyperparathyroidism. When our research revealed radical complications associated with the surgery he was recommending, this fellow never addressed her concerns, answered her questions, or put any of her doubts to rest. He just mentally labeled her “deaf, old, and uncooperative,” told her it was her choice if she wanted to end up in a wheelchair, and strung her along with bi-annual visits and ineffectual medications for five years. She finally left in disgust when he told her there were no side effects to yet another drug he wanted to add to her regimen, and research revealed not only some very dangerous side-effects, but contraindications for use with her condition.
You’ll note that the only difference between “medical care” and “medical scare” is the “S.” Buh-bye, Doctor S.
But a lot of harm had already been done, and this 88-year-old had suffered greatly – with mood swings, disabling fatigue, elevated blood pressure, even a mini-stroke. Until, that is, we located specialists in Florida who do nothing but this type of surgery, use a minimally invasive procedure, and have a 99.9 (vs. the usual 40) per cent success rate. The local, inside-the-box medicos weren’t too thrilled with our discovery, but one quick trip to Tampa, and she is on the mend, having had all of her fears put to rest by extensive, well-communicated information, both pre- and post-op. Another medal please, a gold one.
The list does go on. The dermatologist who couldn’t recognize a patch of psoriasis and thus cost me a $260.00 out-of-pocket fee for an unnecessary scrape biopsy; questionable medicine. The RN providing end-of-life care to my father who had never heard of, and therefore didn’t recognize, steroid psychosis. Maybe if I had called it Roid Rage? Confidence-eroding medicine.
The joint specialist who dressed like a pimp; entered the exam room without making eye contact or acknowledging my presence; gave me seven minutes of his time and then billed insurance for a $350.00 consultation; directed me to sign up for $12,000.00 worth of thumb-joint replacement surgery on his way out of the room, with me calling questions after him as he sauntered down the hall to his next entrapped fly. I mean patient. Bad medicine.
Once I had washed the slime from my hands, I visited the Mayo Clinic for a second opinion. The senior physician there had done more of these joint replacement surgeries than anyone in the world. From him I quickly learned that Dr. Smarmy had lied about the success rate, the recovery time, and the aftercare for this procedure, and I was advised to try a much less expensive and invasive treatment, which still holds seven years later. Exceptional medicine.
And the list could go on even further. But you get the idea, which is simply this: do lots of research; arm yourself to the teeth with information; keep asking questions until you get answers; expect to be respected; hold your health care provider accountable; get second opinions; and be your own – or your loved one’s – outspoken advocate.
My husband’s vision is in gifted hands, and we are delighted to have settled on general practitioners we trust. But if the United States keeps marching down the road toward socialized medicine and rationed care, we everyday Joes may lose access to a lot of the medal winners, and be stuck with the “should-do-betters.” Our best hope is to actively fight for our freedom to choose, and to take very, very good care of ourselves.
*Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars; Published by Little Brown. Richard K. Bernstein, MD; Fellow, the American College of Nutrition, the American College of Endocrinology, and the College of Certified Wound Specialists.