Doctor, Doctor, Where Art Thou?

Shilo Zylbergold | Best Medicine
Doctor, Doctor, Where Art Thou?

image by: Com Salud

Never go to a doctor whose office plants have died - Erma Bombeck

What do you do when your family doctor tells you that you’re not wanted any more? Who do you turn to when retirement or relocation forces your doctor to ask for a divorce? Is there life after being set adrift from the person who knows all your secrets?

It’s been months already and I’m just now beginning to heal. Breakups are never easy but when you get dumped by your doctor, the feeling of rejection can be overwhelming.

It started with those words no patient wants to hear: “There’s something I have to tell you.” Immediately I went into panic mode, wondering what part of my body had now gone into total rebellion.

She sensed that I had drawn the wrong conclusion and tried to break it to me gently. She told me as compassionately as possible that she would no longer be able to see me.

I immediately went into guilt mode and blamed myself for the breakup. I scolded myself for not being a better patient. Perhaps I should have not made as many appointments and relied more on a healthy life style (or more likely, self-medication). Then again, maybe I should have gone the other direction and booked a complete physical every week or each time I had an “owie” on a finger or toe. After all, a doctor has to make a living.

I reviewed our entire relationship in my mind, wondering where I had gone so wrong. Memories of hours spent in the waiting room flooded back to me. Why had I been so uncaringly selfish not to have returned the magazines back to their proper places on the rack? How stupid was it to have torn a quiche recipe out of the July “Good Housekeeping” and stuffed it into my pocket with nary a thought about how that would impact the other patients?

And what about all my trivial complaints once I was called into her office? I knew no doctor likes a patient who pulls out a long list of symptoms and ailments, and yet I always brought one with me because I knew my failing memory would cause me to forget the main reason I had made an appointment. Why, oh why, did I have to mention my night sweats on my last visit? That must have been the final straw.

I pleaded with her. I begged her to give me another chance. Maybe the spark had gone out of our patient-doctor relationship, but I was certain we could bring the magic back. I suggested we go for counselling.

“It’s not you; it’s me,” she explained. “I have to get on with my own life”. She told me how a doctor has no private life any more. When she’s not in the office, or making rounds at the hospital, or taking her turn on call at the emergency ward, she’s still a doctor to everyone whose path she crosses during normal day-to-day activities. A simple trip to the grocery store for milk and eggs turns into two or three “mini-consultations” from patients who feel that anytime is a good time to “talk shop” and ask that she have a look at a suspicious mole or check out an erratic pulse.

I suppose I should have felt better with the knowledge that it wasn’t just me she was dumping. All the patients in her entire practice were being cut loose. This must have been the same sense of utter abandonment that the thousands of followers of Krishnamurti, the Indian mystic and world-famous Theosophist, had experienced in 1929 when he set them adrift with the words that he no longer considered himself their teacher and guru. In short, he told them to “piss off” and find their own path to Truth and Enlightenment.

This also must be how the bird in the proverbial “gilded cage” feels when the door to its luxury prison is left propped open and it is told that it is free to fly off into the wild blue yonder. The euphoria of total liberation is immediately offset by concerns of who will now be filling up its cup of bird seed.

I didn’t want my doctor to set me free. I wanted her to think about our long medical history together. She knew me inside and out (especially inside). How could she just walk away from all those lab reports, blood tests, and referrals to specialists? Where would she find another chart half as interesting as mine?

I was having a personal health crisis. But it wasn’t just me and it wasn’t just here on Salt Spring Island. In the city of Vancouver, one out of every six residents does not have a family doctor. It gets worse. Rural areas have half as many doctors per 100,000 population as do urban centres, so the percentage of people without a family doctor is much higher.

Are there any solutions out there? Most larger centres have walk-in clinics (perhaps they should more accurately be called “limp-in” or “crawl-in” clinics) where patients don’t have to make appointments and can be seen by a doctor without waiting a long time. The disadvantage, of course, is that the patient doesn’t have a choice of which doctor will be doing the examination, and the doctor usually has no medical history of the patient and usually must treat only the most recent complaint instead of the whole person.

Smaller regions, Salt Spring for instance, don’t have these type of open clinics. A person who has no family doctor is often forced to turn up at the emergency ward of the local hospital in order to be seen by the doctor on call. Unfortunately, this kind of activity tends to clog up the emergency room and make it more difficult for patients with real trauma symptoms to be treated immediately.

Another possible solution to the family doctor shortage is the implementation of nurse practitioners to help lighten the caseload on GPs. As the name implies, nurse practitioners are registered nurses who have received special training which allows them to treat and care for many of the cases that are presently seen by medical doctors. Of the more than one hundred thousand nurse practitioners licensed in the U.S. in 2010, more than fifty per cent were practicing in primary care (the rest were in subspecialty care). There are over 3000 of them in Canada and every province and territory in Canada has legislation in place for them to practise their skill.

Obviously, there is some inertia in place resisting the greater implementation of nurse practitioners. From a patient’s point of view, the question arises of why one would want to be seen and treated by someone who has less training than a medical doctor. Some GPs, on the other hand, may be reluctant to cut the medical funding pie into more pieces by letting nurse practitioners in on the action.

This health crisis has not gone ignored by the powers that be. A partnership between provincial doctors, the health ministry, and community services have set up Division of Family Practice (DFP), a body dedicated to “organizing community-based groups of family physicians working together to achieve common health care goals”. You can think of this body as a type of support group for medical practitioners to help them cope with the pressures of running an overstocked practice before they burn out.

Under the umbrella of DFP, a more specialized body called “A GP for Me” has now been formed to connect patients looking for a family doctor with GPs who have room for a larger clientele. I have no idea how the whole thing works, but I imagine it must be kind of a glorified on-line dating service like Lavalife or Plenty of Fish except you don’t have to tell lies to make your profile look better (or maybe just disclose a few of your 450 complaints so the doctor won’t reject because you’re too high maintenance!)

Nobody asked me, but I think I’ve survived the four stages of grief and am through to the other side. I’m ready to commit again. Luckily my previous doctor was able to smooth my transition to a new physician, but it feels like I’ve been returned to “Go” on the medical Monopoly board, starting back at the beginning all over again. Now where’s that list?

Shilo Zylbergold lives on a small island somewhere in the southwest corner of British Columbia, Canada. He grows vegetables, teaches math, and is a columnist for a local paper. Send complaints to [email protected]

Shilo Zylbergold

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