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Do You Like Your Doctor?
I did. I liked my primary care doctor a lot but couldn't keep him.
I didn't lose him because of Obamacare or death panels or creeping socialism but rather because he left the country with his doctor wife and future-doctor kids to go work for U.S. Embassies around the world for the next four years. He had this notion that his kids might do well growing up in other countries and learning about other cultures. You can see why I liked him; besides which he was an excellent, young, fit, up-to-date doctor who knew how to make things happen for paradise50 when we needed it most.
Wednesday I saw my new primary care doctor, a fellow from Scotland who runs a well-regarded medical group. I just needed to get my thyroid meds refilled and had already run my own labs for him. I figured on a brief get-to-know-you greeting, a glance at the test results and a new prescription, taking 10 minutes at most. This wasn't the lengthier full (and free!) physical you're now entitled to under Obamacare.
So, let me pose this question to you right now: What do you really care about in a doctor? Is it their expertise, their manner, their advice? My views about it have changed. The things I used to care about (a compassionate bedside manner, openness to things outside the evidence-based standard medical model, the ability to carefully listen and empathize) have been replaced by one ruthless imperative: My doctor has to have clout in this medical community. He or she has to be known and respected and up-to-date. When he takes one look at your symptom he doesn't waste anyone's time; he orders the biopsy or gets on the phone to that specialist and gets you in this week, thank you, not 2 months from now.
So Dr. Scots* walks into the exam room where I attempt to greet him by letting him know I've been referring people to his practice for years, a blatant move to ingratiate myself. This sentence, however, doesn't leave my mouth for the first 3 minutes. Within 5 minutes I realize I am in the presence of voluble greatness; I have finally met a man who talks even more than paradise50 (is this is Scottish thing?). It doesn't take long for me to substitute non-verbal responses over spoken ones whenever possible, like waving my FitBit at him when he asks, "Do you exercise? Walk? Bike? Swim?" or, a few times, just letting him just answer his own (correct) medical assumptions about me.
It was a freakin' whirlwind of information, opinions, history and sheer exuberant verbiage.During our 20 minute consult, while he threw out the occasional question, he told me about:
* The history of his practice and the medical group he founded
* His family history in Scotland including his family's role in crucial battles (there are battle pictures and historical timelines posted all over the walls)
* The workings of the medical group's computerized system where I can access my medical records online, view lab results, make appointments and email any questions
* Why his dermatology PA is every bit as good as any dermatologist and doesn't need to go to medical school for 8 years
* His thoughts on Covered California and how he set his lawyers on them to find out what their reimbursement rates are ("It took them 2 weeks-- TWO WEEKS!-- to get back to us and it turns out they pay 3% higher than regular Blue Cross! Why didn't they just say so!")
* The back story of Scotland getting their independence from England after 300 years including commentary on the euro and high-speed rail
* The state of the medical system in Scotland, including what it was like when his American wife lived in Scotland and worked in another doctor's office and how the patients were all worried they'd called America by mistake when she answered the phone and how the dour (pronounced do-er) Scots didn't know what to make of this perky American woman
* The problems with Single Payer systems in Europe
* Why there's a local shortage of new doctors because they want to be employees and don't want to start a practice, ("they're not willing to take the risk!")
* Why only one medical group in town can afford to accept MediCal
* How Covered California hasn't been compliant with reimbursement schedules ("14 days for a clean medical claim!") and will have to pay him fines and penalties
* Why I'm not eligible for an Irish passport
* What free services I'm entitled to under Covered California
* Why the English also think Scotland getting their independence is a good thing and,
* Um, there was more, mostly about the Scots.
During this animated verbal torrent he wedged in a few pertinent questions, electronically transmitted my prescription to my pharmacy, entered me into their group portal, booked me an appointment with the dermatology PA, and listened to my lungs and heart, all the while talking over my brief-as-possible replies. He very clearly prides himself on knowing how to navigate the current medical system, which is exactly what you want in a modern primary care doctor. He has no obvious political take on the ACA (his only politics seem to center around despising the English)-- but takes the pragmatic view that it's a mixture of good and bad and he and his lawyers will hold insurance companies accountable for their end. He is NOT a listener and seemed pleased that I didn't appear as if I would be one to have "too many problems."
Ten, twenty, thirty years ago I would have despised him.
I liked him very much.
He knows how the entire digital medical world works and is happy to bring you in on it, is willing to smack down Covered California itself if need be, and carries on with so much energy he can tell a new patient about the past 300 years' history of Scotland while taking a medical history. I'm unlikely to complete a sentence around him unless I'm in actual agony, in which case we'll see. If some gawd-awful thing comes up he'll make the system work for me.
How about you? What was the best or worst doctor you ever had?
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