Here's a rerun from May of 2014. A couple of readers of this blog have written to say it was of value to them so I thought I'd give it another airing. I'll be back later with something new but for now…
For a guy who's pretty healthy, I find that I have an amazing number of doctors. I have my Primary Care Physician, of course, but my phone book also contains the numbers of my dermatologist, my dentist, my ophthalmologist, my gastroenterologist, my proctologist, my urologist, my cardiologist, my podiatrist, my orthopedist and a vascular surgeon who helped me with a circulatory problem relating to my recent knee problems. (I am only listing doctors to whom I will probably return some day. There's also, for instance, the gent who performed my Gastric Bypass Surgery in 2006.)
Generally what happens is that my Primary Care Physician (or P.C.P. for short) refers me to a specialist and I go to see that specialist and I either like that specialist and continue to see him or her as needed…or I don't like that specialist and I go in search of someone else who does that same thing. I went to five dermatologists before I found one I liked enough to call my own. I also went through a couple of P.C.P.s before I found the one I have now.
What made me not like certain doctors? My main complaint has not been their competence as men and women of medicine. I've only left two because of that. Mainly what's driven me away has been not being able to get their attention. When I went to them, they either were in too much of a hurry to get on to their next patient or they passed me on to a Physician's Assistant in their offices.
The worst of the "too busy" guys was a world-famous nutritionist I went to long before 2006, before I had my weight generally under control. I asked my current P.C.P. to send me to the best nutritionist he knew of and he recommended a man I'll call Dr. Occupado. "He's a genius," my P.C.P. said…but he added, "You may have trouble getting an appointment." Sure enough, when I called up, they said the next opening they had was in the middle of May. I was calling the first week of March.
I made the appointment anyway and showed up on time, expecting to spend a half-hour or more discussing my various eating disorders and food allergies and what I should and shouldn't eat. Instead, I waited well over an hour for a whopping five minutes with Dr. Occupado. He gave me some good information before bolting for his next appointment…but how much good can a doctor do you in five minutes? I never even got to tell him about the allergies…and since he charged above 'n' beyond what my insurance would pay, I spent about $100 for those five minutes.
Still, I sensed this was a brilliant doctor who could help me so on my way out, I made another appointment…and I got lucky. He had an opening in June.
In June, I went back and after another considerable wait, got another five minutes from Dr. Occupado. He had, he explained as he walked in, an interview waiting for a very important magazine. I started wondering if any of the magazines I worked for would send me to interview him but at that moment, the only one was Groo the Wanderer and all I would have gotten was nutritional information on cheese dip.
Still, the five minutes I got were not without their benefit and I still thought the man knew his business so on the way out, I stopped at the desk. The woman there asked me, "Would you like to make an appointment for your next visit?" I said, "No, I'd like to make four appointments for my next visit. I would like to book four appointments, one right after another."
This was me trying to outgame the system…which once in a while in this world, it's possible to do. I figured this way, he couldn't leave me for his next appointment because I would be his next appointment. And I had this crazy idea that this "stunt" would make him realize I needed some special attention and maybe he'd see me for as long as I needed, if not that day then someday.
For about thirty seconds, I thought I was so, so clever. That was until the woman said as she paged through her calendar, "I'm sorry but if you want four appointments with him, they'll be in July, September, late October and then there's one open just before we close down for Christmas."
I asked, "Does he have four consecutive appointments open any day in July?" She said, "Yes but other patients have tried this and I've been told not to book them that way."
I left without making even one appointment.
The lasting value of my attempts to actually get doctored by Dr. Occupado was this: Since then, when I meet a new doctor, I try to find a way to work that tale into the conversation. It's my way of telling them up front what I consider lousy doctoring, just to see what they say. Many of them know of Dr. Occupado and nod in understanding…and then they make sure they spend enough time with me. Either that or they show their true colors early on and I can quickly write them off as a long-term relationship.
None of my current specialists ever rushes me but I couldn't have written those words two days ago. Yesterday, I made a change. Over the last year or two, one doctor began going the Physician's Assistant route. It wasn't that I could only see him for five minutes. I couldn't see him at all. I'd make an appointment with him, go into the examining room to await his usually-delayed entry…and instead. a P.A. would come into the examining room, introduce him or herself, and begin doing his job for him.
So, what exactly is a Physician's Assistant?
A physician assistant or associate is a healthcare professional who is licensed to practice medicine as part of a team with physicians. Physician assistants are concerned with preventing and treating human illness and injury by providing a broad range of health care services under the direction of a physician or surgeon. Physician assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, prescribe medications, counsel on preventive health care and may assist in surgery.
In other words, "I'm not a doctor but I play one in a doctor's office."
The bait-and-switch did not sit well with me and the Physician's Assistants — I went through three there — told me so little, I had the feeling they were researching my condition on Wikipedia. That, by the way, is where I found the above definition.
I have no idea how much the first P.A. knew about the particular area of medicine because English was not his first language. It did not seem to be his second, third or eighth, either. I am used to not being able to understand the nouns doctors use but with this guy, I couldn't parse the verbs, adjectives or adverbs, and only the occasional article. After three visits where I felt like I was being treated by Sid Caesar, I specified that my next appointment be with The Doctor himself.
I went to see him, waited in the examining room…and in came a different P.A. He was a nice guy and I could understand him. But my insurance and I were paying full price and I was getting about a third of a doctor.
On the way out of my second and what I'd decided would be my last appointment with P.A. #2, I ran into the real doctor in the hallway. He was all smiles until I told him I was not happy seeing people from a temp agency instead of him. "I supervise them all very carefully," he assured me. "They're giving you the exact same treatment you would get from me."
I said, "Are you telling me that these people who do not have the legal right to call themselves 'doctors' know as much as you do?" He said no, of course not, though someday they might. I said, "Well, it's my health here and I'd kinda like to entrust it to the most knowledgeable person in this office. Every time I come here, there are more and more names on your door. On my way in, I checked for mine because I thought it had to be a list of patients."
He laughed, apologized and promised that my next visit there would be with him…and it was. Unfortunately, there was also this woman there, observing and listening and taking notes. And after ten or so minutes, he turned me over to P.A. #3 and left. So now I've left him.
My P.C.P. gave me a new referral and I got all my records from the busy specialist's office and gave them to the new guy. The new guy isn't a new guy to medicine — he's been practicing for thirty years — but he's new to me. And he doesn't have any Physician's Assistants. When I go there, there'll be nobody there for me to see but him.
Matter of fact, he needed some blood from me and I figured he'd do what every single doctor of my lifetime has done, which is to call in a nurse and have her take it. Instead, he had me roll up my sleeve and he hauled out the equipment and took it himself. I'm 62 years old and I can't recall a person with the title of "doctor" ever taking blood from me before.
His nurse had taken my blood pressure and jotted down my height and weight before I saw him, and I asked him why she wasn't taking my blood. He leaned in very confidentially and told me, "It makes her squeamish." I think I'm going to like this guy.