Monday, August 3, 2015

Health Care Providers I Have Known

This post was actually written a few years ago; it's been sitting patiently in a file, waiting to be uploaded...One year, during the week of Thanksgiving, my family didn't get together anywhere because nobody felt like eating turkey. Perhaps surprisingly, nobody was sick enough to call a doctor. I felt sick enough to think about the possibility of having to call a doctor. 

At that time, some people were saying that “patients should choose doctors and treatments” is one of those code words for subtle race and gender prejudice. I have known people, mostly from my grandparents' generation, who didn't want to undress in front of a doctor of the opposite sex. I don't think the doctor's physical type needs to be considered, but I certainly want to choose any doctor and treatments to which I expose myself.

At that time, a popular local "health management organization" was steering people to a Dr. Ananthula. I had met her; she was Mother's patient's primary physician, and one year Mother listed her as Mother's own primary physician. She seemed like a kind, competent, allopathic-type doctor. That was why, after meeting Dr. Cote at church, Mother switched to consulting her instead--Dr. Cote is a nice, competent, naturopathic-type doctor. 

If I had to call a doctor, heavenforbidandfend, I'd want it to be Dr. Cote. It has nothing to do with age, race, or gender. It's easy to prove to a bean-counter that this preference has nothing to do with age (I think they're about the same age) or gender (they're both female), but what about ethnicity? I mean, I know that my husband was more Indian than anything else, so I have no hang-ups whatsoever about that ethnic type, but would a bean-counter know that? Do bean-counters even know the difference between allopathic and naturopathic medicine? 

So it occurred to me that a few more examples might help bean-counter types, if any readers know any of them. Here's a quick list of the providers of medical care in my life, and what they looked like:
1. I don't remember my first pediatrician, because we didn't live in Los Angeles very long after I was born, but he had a Spanish name.
2. I’m told I was seen by my brother’s pediatrician once while I had a high fever from flu, but I must have been too delirious to remember the middle 48 hours of my really bad case of flu at age four. What I remember about our pediatrician was that he thought it was cute to get me to read aloud from medical journals. English name, Caucasian, middle-aged.
3. My brother and I saw a dentist regularly as children. We actually looked forward to seeing our dentist. He was White, with a Scottish name, and old; he retired when I was in high school.
4. In Washington, my gynecologist was young and new (she might still be in practice), and Asian-American.
5. In college I cracked a molar on a bit of incompletely popped popcorn and needed emergency dental treatment. The dentist who handled that sort of thing for the school was old, male, and White. I don't remember his name. He said the procedure was technically considered surgery and he was supposed to refer me to someone else, but he did a good job at removing the tooth. However, he made one mistake. He said I wouldn’t have any trouble with wisdom teeth as I didn’t seem to have any. Next year the upper wisdom teeth came in without problems, and one lower wisdom tooth moved right in where the molar had been.
6. The other lower wisdom tooth was badly impacted and had to be surgically removed by an oral surgeon. He was young enough that he's still in practice, and warmly recommended. English name, male, White.
7. I don’t remember the name of the doctor who kept me out of the Gulf War. All I remember is the good news: “You have had mononucleosis. If you want to join the Army, come back in six months.” What a thrill—both an officially diagnosed physical disease to explain sixteen months of flu-type symptoms, and the hope of an end, all at once, free of charge! He was male, White, and fairly old.
8. Nevertheless, there was a swollen gland that didn’t shrink back but became encysted and puffed up to an alarming size. This was the year when several people with “chronic mononucleosis” turned out to have a rare form of lymphoma, and died. I panicked. I checked into the emergency room and was seen by a young male doctor from India, who did a biopsy and referred me to an otolaryngologist.
9. The otolaryngologist was White, male, and old. By the time I got there the cyst had drained and healed. The two doctors, emergency room, and biopsy cost about $900, together. I paid it off in a month or two. It was still the 1980s and the insurance industry had done relatively little damage.
10. However, the doctor who actually helped me recover from “chronic mononucleosis and opportunistic viral hepatitis” was an exchange doctor from Kenya, about sixty years old, very dark, very energetic. He spoke English fluently, with an extraordinary accent. He didn’t have an official practice in the U.S. but was allowed to counsel and consult on behalf of people he knew from church, of whom I was one. He gave me good advice on diet and exercise, free.
11. Around age thirty I dislocated a bone in my wrist. At that time the insurance industry was setting policies for M.D.s but not chiropractors. To have the bone replaced by an M.D. would have involved a long wait, lots of “process” and paperwork, and several hundred dollars. To have it replaced by a chiropractor would have cost $60 and could be arranged the next day, because chiropractors had not yet been sucked into the insurance gambling scheme. Could I find a legitimate chiropractor who wouldn’t try to sell me a course of spinal readjustments? Not only that, but on learning that I was a massage therapist she gave me some samples of lotions my clients appreciated for years, and when she replaced the bone it didn’t even hurt. She looked very young but was old enough to have an impressive collection of diplomas and certificates. African-American, female. Highly recommended.
12. The National Certification Board officially recommends that massage therapists trade services and have lists of colleagues we can recommend. Two that I recommended were White, female, baby-boomers. One was Anglo-American; one was Russian.
13. Then there was a man, born the same year I was, who was only studying massage as a hobby because he was making more money coaching a football team. He had talent, though. He was African-American.
14. In Washington, I shared my husband’s dentist. Afro-Caribbean, female, not young but she might possibly still be in practice, so I’ll say this: While urging me to schedule a root canal, she told me she was installing a temporary filling. That temporary filling held up well for ten years.
15. Back home, I tried to get a filling replaced free of charge at a RAM clinic in 2006. Didn’t work. I went to a local dentist. Because dental care was still usually not managed by the insurance industry, I paid a little over $100, cash, same day. "My" current dentist is White, male, baby-boomer age...I'm not sure whether his name is English or something else.

So there are sixteen of the nicest people I hope I never need to see again. Crunchy numbers for the bean-counters: White-not-Hispanic, 9; Hispanic, 1; Asian, 2; African, 1; African-American, 2; Afro-Caribbean, 1. Male, 11; female, 5. 

There used to be people who thought a Real Doctor should look like the characters on certain old TV shows: White, male, about fifty, graying hair, domineering personality. I don’t think my generation hold those stereotypes—for one thing few of us would have seen those TV shows. Some providers of medical care who happen to be White, male, and about fifty also happen to be competent.

Personally, I’m more concerned about competence, respectfulness, honesty, and a person's overall approach to whatever kind of medical care s/he provides, than I am about a practitioner’s physical type. Good things come in all kinds of packages but I'm not convinced that good things come in a package of pills that treat symptoms, if they do that, rather than the practitioner taking time to observe and treat the actual disease. 

Allopathic physicians outnumber naturopathic (and homeopathic and "alternative") physicians because a lot of people seem to prefer the allopathic approach. I say good luck to them and let them have it, but I do not intend to let some bean-counter call me a bigot just because I'm not interested in allopathic medicine.