Saturday, May 20, 2006

"Your doctor" - experiencing a false myth

I was called away last weekend, after completing ‘moving out’ activities to help my father with a medical problem. His periodic medical crises (as those of my mother before him) are always bringing new facets of
America’s dysfunctional health care system to my attention as well as some facets that seem to work well.
What struck me on this visit was the degree to which patient care is almost entirely the province of women, nurses and lower caste caregivers, assistant and aides.

To be sure, the aura of ‘your doctor,’ that high caste authority figure who is the ultimate medical arbiter, pervades the system. (“Your doctor has ordered this transfusion…” “your doctor will let us know when you can return home.” “your doctor hasn’t ordered these tests that he promised he would order.’) But this mythic figure – predominantly male, preoccupied and distant – is rarely seen. Indeed the oft repeated phrase "your doctor" (implying that there is a physician with whom the patient has some personal relationship) mostly describes a myth, not what is actually experienced. (Foucault would understand this social construct well).

This is an unacknowledged paradox of US medical care – perhaps of medical care in other systems as well. Virtually all important decisions must be made by “your doctor,” but the reality is that “your doctor” is, by and large, a distant figure who has little contact with you, is inaccessible, and may have been assigned by some random process over which you had no control.

I believe that many – perhaps most – young men and women entered medical school motivated by high ideals and a commitment to be of service. I grieve for many of the physicians I see, whose ideals and fundamental humanity seem to been eroded by the institutions within which they function (professors are not immune from this, incidentally).
‘Your doctor” like his patient is, all too often victimized by a institutional structures where myth and reality bear little reality to one another.

Thank God for nurses. For the most part, they care and they are there.

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