My doctor patient relationship wish

I saw a new doctor last week. My last doctor appointment was five years ago. Both visits were, ostensibly, for the same reason: I needed the prescription on my asthma inhaler renewed. Other than my asthma, which is very mild, I am healthy. I’ve had a fever twice in my adult life. I’ve never had the flu. I’ve never broken a bone. But that isn’t the only reason why I avoid going to the doctor. I simply don’t like doctors. It isn’t fear, it’s dislike. In my, albeit limited, experience, doctors are arrogant, condescending and cold. They don’t find me interesting, they treat me with very little respect. Why in the would would I chose to spend time with them?

In his book Blink, Malcolm Gladwell talks about doctors who tend to be sued verses ones who don’t. (link here) In the end the difference has nothing to do with the competence of the doctor – it has to do with whether the patients like the doctor or not. Kind, sympathetic, caring doctors don’t get sued. Cold, arrogant pricks do. And it serves them right.

I just read an excellent novel, Florence Gordon by Brian Morton. (link here) Florence is an old lady, and at one point in the story she visits her doctor, Noah.

“Florence Gordon,” he said. “My hero. My heroine.”

“You always seem amused when you see me, Noah. Do all your patients amuse you?”

“My patients don’t amuse me. You don’t amuse me.  What you are mistaking for a smile of amusement is a smile of admiration.”

[skipping a few lines]

While they were talking he was listening to her body with his stethoscope, testing her reflexes, pressing on her lymph nodes. He had a knack of making you feel as if you were spending twenty minutes doing nothing but joking with him, even while he was examining you scrupulously.

I often read passages like this in novels where a doctor and patient have clearly known each other for a long time.  They respect each other, care about each other even. But this is only ever in fiction, which makes me think I am not the only one who would wish for this sort of relationship with the person whose job it is to help me maintain my body.

But perhaps this is my own fault: I move, I change insurance plans, I stay healthy. The only doctor I’ve ever seen on a more regular basic was the gynecologist I had for most of my 20s and 30s. After a decade of seeing her at least once a year, sometimes more often when I had issues with birth control, or the occasional irregular pap or whatever, she never once remembered my name. And she was friends with my sister-in-law! She had the bedside manner of a dead fish. Even her hands were chronically cold.

I get the need for distance. If a general practitioner spent the amount of time necessary to truly establish a meaningful relationship with every patient, they’d see only a handful of patients a day, and never make any money. They might as well become therapists.

And there’s another bunch of doctors I can’t stand.  Again, I’m only talking about my own limited experience, but when I, a pathologically honest person, starts making up insane lies just to get a reaction out of the person with the blank expression sitting across from me, you know there’s a problem.

I found a ‘discussion prompt sheet’ on a site called teachwithmovies.com for the movie, Good Will Hunting. (link here)

Here is question 8 from the attachment disorder section:

What does Sean McGuire, the therapist, try to do in the treatment?

Suggested Response: He re-parents Will. Sean tries to fill in the gaps of Will’s development caused by the abuse and the lack of caring. He provides Will with a secure attachment and with an oral history of relationships that worked by recounting his own. Sean told Will about life’s imperfections and that imperfect people could be loved. (Will thought of himself as profoundly imperfect and unlovable. Why else would his caregivers hit him?) Sean talked to Will about what sacrifice means, like a father to a son. Sean hugged Will, giving him the tactile sense of belonging that a child would get from a parent.

Which sounds just lovely, doesn’t it? But it is total BS. Granted, I in no way have any of the problems Will had in that movie, but not one of the therapists I have ever encountered would have committed themselves so thoroughly to solving my problems. They sat and stared and waited for the hour to be over. They did not care about me at all. It is my understanding that they are taught to keep a distance, to do otherwise would overwhelm them. But what I felt was disrespect and the feeling that I bored them.

I did a bit of research online and found that the idea that doctors should try to develop some sort of relationship with their patients has been in and out of fashion since the beginning of doctors.  I found a paper from 2006 called “The evolution of the doctor-patient relationship” by R. Kabaa and P. Sooriakumaranb (link here) Not too hard a read for a scientific paper.  A lot of it is quoting other sources, so this might be confusing, (links within links!) but I want to quote this paragraph

More recently, Roth and Fonagy (1996), [link in original] emphasized the importance of aspects of the doctor-patient relationship, including (a) the patient’s perception of the relevance and potency of interventions offered, (b) agreement over the goals of treatment, and (c) cognitive and affective components, such as the personal bond between doctor and patient and perception of the doctor as caring, sensitive and sympathetic. [link in original] Thus, a friendly and sympathetic manner may increase the likelihood of patient adherence to treatment.

This paragraph sums up exactly why I will be following my new doctor’s advice to the letter.  a) Because she treated my disdain for certain medications as legitimate – and countered that argument in an intelligent and respectful way – I am willing to believe that a certain drug might be useful for me to try.  b) We agreed that the goal of taking the medication was to make my life easier.  c) Because she was caring and sympathetic and empathetic – and willing to get involved – I am willing to do everything she wants me to do.

“Thus, a friendly and sympathetic manner may increase the likelihood of patient adherence to treatment.”

Absolutely.

I want to be noticed. I want to be remembered. I want the doctor to think later, ‘Wow, that new patient Jill was a trip, I hope she comes back.” I want a doctor who likes and respects me. I want a doctor who sees me as the complex, multifaceted and interesting person I know I am.  I don’t want to be reduced to a bunch of notes on a chart.

“‘Florence Gordon,’ he said. ‘My hero.'”

Take a walk.

It’s easy. Open the door. Step outside. Don’t look left and right, left and right, left and right, over and over before stepping onto the sidewalk. People will think… Look straight ahead. Don’t look down at your feet. Except to make sure you wont trip, or step in dog shit, or strange puddles. Which are different from not-strange puddles, how? Do the normal puddles make fun of the strange puddles? Do they determine strangeness by color or smell? One more block. Don’t frown, but don’t smile too much, either, people will think… Just keep a pleasant expression, a neutral expression, not choosing sides. Not happy, not sad, just invisible. (Oh how I long to be invisible.) Stop it, you already checked your zipper, and besides these are the jeans that you sewed the zipper permanently closed because the flap always looked a little open. People will think… Good thing they are really stretchy jeans. One more block. There is the park, the half-way mark. Don’t stare at the playing children, people will think… But smile a little more, it is normal to be happier around children, and scowls are scary. One more block. The light is red, but there are no cars nearby. That person is crossing, should I cross? What will they think if I wait for the green? What if they are colorblind? Now a car is coming. But the other light is yellow, just go, go, go. Almost home. Half a block, one more house, door, key, don’t look, no one is behind you. Open. In. Close.  Breathe in.  Breathe out.   Home.

I like complicated

Pull apart the moment.

Sort the pieces by weight,
– a curved finger
– part of a whisper
– a sustained glance
– the edge of a hug
– a sigh
– a ‘so?’
– the corner of a lip, upturned.

Shake the box, take each piece out of context.
Inspect for conjecture
With lenses of assumption & fancy.
Find what I want to feel.

Complicated:
Hours spent, pieces in hand, eyes closed, staring at the ceiling,
Inventing clues in texture, taste and tone.
I am my most alive, entombed with this moment.

Frustrated fun, the holiday ends, the picture unfinished.
Pieces swept back into the box.
Until next time.

Random Scottish bits

We just wandered today – with no theme or plan in mind. The overcast sky threatened rain, but none fell and the temperature stayed close enough to 50 to keep us mostly comfortable.

We hit two of the ‘must see’s’ in the guide book though, the graveyard at Greyfriers Kirk, and then Dunbar’s Close Garden. Both are described with words like, green, lush, beautiful. And I’m sure those descriptions are accurate, in the summer. But in the winter… well, cold and muddy would be the words I’d use to describe the graveyard, at least. The garden was still very nice, even if the trees were bare and lifeless.

Despite the mud, the graveyard was fascinating: old and creepy, just the way a graveyard ought to feel. With stones dating from the 14 and 15 hundreds all the way to today. I don’t think I’ve ever seen so many carvings of skulls and crossbones outside of a pirate ship in my life. It was a photographers dreamland20141222_131804.

I have to mention two interesting bits of J.K. Rowling lore I’ve run into here in Edinburgh. (I read the books and enjoyed the movies, but as I was not a teenager at any point during the Harry Potter ‘thing’ I would never call myself a passionate fan, but these are interesting nonetheless.)

First of all, just down the street from our hotel is a little café called The Elephant House. Apparently J.K. Rowling wrote the first few books in of the series in that café. The place has a line almost out the door every time we’ve walked past it. Now, I understand on some level, it gives me a little thrill every time I see a sign that reads ‘Boswell and Johnson ate here’ or ‘Sir Arthur Conan Doyle walked this way’ but even for those literary giants I wouldn’t stand in line for two hours to get a glimpse of the chairs they sat in. Maybe they’ve bronzed the crumbs that fell off a biscuit that touched her lips. OMG! Let’s Go!

The second weird bit was in the graveyard. Now the whole place was muddy, but not too bad over all, until we came upon one section. I saw some people (late teens, early twenties people – that should have tipped me off) having their picture taken in front of a certain gravestone and the way leading to it was ankle deep in mud. When Will and I squelched our way close enough to read the marker we saw, ‘Thomas Riddell, Esq.’ I turned to Will in confusion, and he said, “She must have gotten a lot of the names in the books from this graveyard,” as it is located so close to the Elephant House. Right, Rowling again. Of course.

We walked the whole of the Royal Mile today (a Scots mile is apparently a bit longer than a regular mile.) The whole length is mostly just shops selling tourist crap, with the odd pub, museum or ghost tour tucked in here or there for variety. At the very bottom is Holyrood Palace – where the royal family stays when they’re in town. From near the entrance to Holyrood house, you can see the path up to Arthur’s Seat. We have plans to hike all the way up there on Christmas Day. Oh boy. I hope my legs can take it.

I don’t have an opinion on the idea of Scottish independence. I can understand both sides of the argument, and they seem equally valid to me. Having said that, I am aware that I come from a country that tore itself away from England, once upon a time, by “hiding behind trees and shooting at the English till they got tired and left,” as Will puts it to every person we talk to here. But there is a huge difference between our situation and theirs. It is called The Atlantic Ocean. I think from Edinburgh to London, it’s like a three hour train ride.

The Scottish take a huge amount of pride in being Scottish, it’s everywhere you look. Even our cab driver the first day said something about being a Scottish veteran, and resenting the fact that his discharge papers say he’s British.

Most Americans still take more pride in their European heritage than in being American. Would we act differently if we were still tied to England, and needed to emphasize our differences?

There’s no crying in Scotland!

I cried twice today.

The first time was upon entering “Game Masters – The Exhibition” at the National Museum of Scotland. The first part of the exhibit, called Arcade Masters, looked just like a real arcade from when I was a kid. And there was Space Invaders and Pac Man and Missile Command, all the old favorites. I saw moms and dads holding up their kids, showing them how to play, saying, “look this was my favorite when I was your age.”

I almost sobbed. Why? Oh, maybe I’m PMSing and tired from two days straight of walking, but I think it might be something deeper than that.

Will and I played a few games, I totally crushed him in ‘Elevator Action,’ but he’s generally better at all of them than I am. We moved on to the next section, I think it was called Modern Masters, showing the games from the last decade or so that have made their creators millionaires and have added the word Industry to the word Gaming. The room was full of Xbox’s, PlayStations and PC’s, all loaded with titles like Sonic the Hedgehog, Rock Band, all the Lego games and, my personal addiction, World of Warcraft. (I lost most of 2006 and a fair portion 2007 to that game.)

It was in this second room that I started to understand my emotional reaction. Along with the games, there were pictures of concept art and diagrams of game levels. There were videos of interviews with the designers, programmers, writers, with all the whys and hows of what they did. The creators are almost all like me, born in the 60s and 70s and grew up with the games. The loved the games so much, that they made their own, or found ways to get hired by the new companies that were popping up all over. All the games in that room represent creativity and passion and dedication and hard work. In other words, art. But the game isn’t removed from us, the audience, it isn’t hung up on a wall, it isn’t something we passively listen to or watch. It only lives when it is played, when the audience interacts with it, and through it, with each other.

Games are the perfect art form.

The third and final room held the Indie Masters. Angry Birds, Machinarium, Braid, Minecraft, etc. Some so brilliant in their simple playability, and others, well, more like a bit of modern art that leaves me scratching my head, huh?

I looked, but I didn’t find my game, Halloween Candy Capture, or my sister’s game, Mix Match Draw, among the games in this room. Ah well, someday.20141221_121407

Will and I spent the rest of the day in the museum, exploring Scottish History and eating in the amazing Tower restaurant there. We both feel that the museum is worth a return visit.

Later that night, after fish and chips and mushy peas, we turned on the telly and watched ‘Scrooge’ – The 1970 Albert Finney musical version of A Christmas Carol, which I’d never seen before. Will says the movie was an unfortunate part of his childhood, as his mother watched it every year around this time. I’m a sucker for a musical, even a bad one, (this one is really bad) and I watched the whole thing.

And it made me cry. A lot. But I will blame that on being exhausted.

Flying to Edinburgh

It is hard to explain my dislike of flying. Yes, I have those typical moments of fear, or rather, lack-of-control anxiety, during take-off and landing, but that goes away quickly, and is non-existent when I’m reading/listening to a really good book. (In other words, not paying attention.) My dislike is more about… feeling trapped in an uncomfortable seat for hours, hours that cannot, really, be counted on, as they are in constant flux, determined by weather and the whims of air-traffic controllers. It is about being surrounded by strangers when one has no social skills. It is about having to follow illogical and outdated rules, enforced by idiots, explained by no one. And that no one else seems to care that the rules make no sense.

Unfortunately, that is going to be the memory I take away from the flight from London to Edinburgh this morning. The memory of almost getting into an argument with an incurious, rule-following, high-heel wearing flight attendant. (Seriously – is showing off your calves really worth ruining your feet? Now, I love the way a pair of heels make my legs look as much as the next girl, but I don’t work on my feet all day. You do know that heels were invented to keep feet in stirrups, right? You can take that anyway you like.)

Anyway….
It was raining when we landed, and I realized we didn’t bring an umbrella, but it was ok because it feels like it ought to be raining in Scotland in December. Will was crabby and tired because the seats on the plane to London from Philly sucked and he didn’t sleep and he hadn’t had a cigarette in 14 hours. I only slept because I drugged myself up like someone going into major surgery.

So, neither of us were at our best when we got the funny-looking play money from the ATM then got into a cab. But our moods swiftly took an upturn. The first moments of being on the wrong side of the road in the UK are always thrilling/scary, like roller-coaster rides, where you know it is all fine, but it feels so dangerously wrong. The cab driver talked about the weather and about the failed attempt at Scottish independence, (“The people voted with their fear, not their dreams.”) and told us a funny story about the dysfunctional tram system the city of Edinburgh has (sort of) installed.

His brogue wasn’t too heavy, so I only missed one word in five, but the story goes that to get the local populous happy about the years long project that would make a mess of the city, they would start it off with a grand celebration: they’d roll a trolley down a small section of track, and break a bottle of champagne, make speeches, that sort of thing. Well, the big day arrived and the trolley was brought in, only to find the track was the wrong gage, the trolley wouldn’t fit. Apparently the people in charge of procuring the trolley never spoke to the people laying down the track. Head shaking and finger pointing ensued, and no champagne was drunk. (But probably lots of whisky later.)

The story is funny, but being told that story by a true Scotsman with his rolling brogue in a British cab, on the wrong side of the road, in the rain, in Scotland… well it was a wonderful moment. And that is why we are here, on the other side of the pond at Christmas. To have those little moments, to add to the story database. So that next Christmas, we can sit around with friends and family and say, ‘Remember that cab driver in Scotland…”
Hopefully I’ll forget all about the idiot flight attendant.