When Physicians Get Flustered in the Doctor's Office...and Junk Food Cattle
Last evening my short-story group got together. We’re ten guys who meet roughly once a month at each other’s homes to discuss three or four short stories we’ve assigned ourselves. We’ve been doing this for six or seven years. One of the stories we read early on was “Brokeback Mountain”, which, of course, was eventually made into the big movie.
We sometimes joke about the fact that six of the ten men are health care practitioners—four psychiatrists, a psychologist, and a family practice physician--and that the four of us non-medical types are part of the group’s “diversity.”
Usually the host assigns the stories, and last evening the host was the family practice doctor. Very occasionally, the host includes an essay among the short stories, and there was one in this batch, with the intriguing title, “Jazz and the Art of Medicine: Improvisation in the Medical Encounter”, from the Annals of Family Medicine.
It cleverly uses jazz as a metaphor to encourage physicians to view each patient as a special individual and learn to “communicate in a style that is in harmony with (the) patient’s style…” It’s an intriguing, if highly idealized, vision of the physician’s technique, in a world where many patient visits are limited to ten or twelve minutes.
Anyway, what was most intriguing about our discussion, at least to me, was to hear the physicians in our group confess to their own difficulties in communicating with their personal physicians. One of the psychiatrists described how, after consulting for two years with an internist who always appeared reticent about answering questions, the shrink finally got up the nerve to demand a frank discussion of several of his health concerns. “Then we had a wonderful conversation. I think this physician was just shy.”
Another physician member of our group wondered, “How do you react when your physician asks, ‘Do you have any more questions,’ and has one hand on the doorknob?” And a third said he often can’t remember the questions he wants to ask, when the time finally comes.
The conclusion of these experts? Patients have to put aside any sense of intimidation they might feel in visiting their doctors, and be prepared to not only ask questions, but follow up with tougher ones if they don’t feel they’re getting good answers.
While it’s reassuring in some sense to know I’m not the only one who sometimes feels flustered in the doctor’s office, I can’t help but sense that the pervasiveness of the problem of unsatisfactory doctor-patient relationships ties in to the larger issues described by Dave Milano and others—the physician as chronic-disease detector and treater, and as insurance company subcontractor. In a time-intense environment, the physician’s focus isn’t necessarily on the problems of primary concern to patients.
Like Steve Bemis (commenting on yesterday's post, I was intrigued by the article in today’s Wall Street Journal about the waste and fatty snack foods being fed to cattle and pigs because of rising corn prices. Many of us have bemoaned that cattle are fed too much corn and too little grass, and now we learn they’re being fed ever less corn and junk food instead. What especially struck me about the article was that there was no consideration given to the nutritional effects of the diet downgrade on the meat from the animals, except for the observation that “too much fat and salt from foods like potato chips can depress animals’ appetite and cause them to eat less. That isn’t good for producers, who want to pack as many pounds as possible on their animals.” Then again, maybe a little extra junk food mixed into the McDonald’s hamburgers shouldn’t be a huge problem.
As the major media explore the problems of contamination of our food supply, no one seems to want to address the fundamental problems of the industrial food system—even on NPR, where Tom Ashbrook’s “On Point” program today devoted time to the food contamination issue. I heard bits and pieces (unfortunately I can’t find it on the NPR site). At one point, a representative of the National Family Farm Coalition (I believe) called in to try to raise the issue, but Ashbrook could only wonder if the issue of food contamination isn’t “ideological” and “political,” and then move on to questioning a Nader-type consumer group rep who returned to the theme at hand: we need more FDA inspectors.