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hello everyone,

i received many replies from my post requesting that we treat physicians with
the same respect we treat everyone else.  most of them seemed to indicate
that we physicians have not earned that respect.  many had questions about
how to talk to their doctors.  i will try to summarize here.

some posters indicated that i have no idea what they go through.  of course i
do.  i did not become a practicing physician until i was 31 years old.  i
come from a middle class family who uses the healthcare system just like you
do. before that time, i was treated by the medical profession just like
everyone else.  most of my experiences were okay.

i suffered the same pain watching my little angel lose weight with no
explanation.  at eighteen months, she still couldn't walk.  my pediatrician
sent her to a neurologist who checked her out as okay.  i had to suffer the
torture of watching her work with an occupational therapist who tried to
"make" her walk because she was just lazy.  now i know she was too weak.

i had an excellent pediatrician, who laughed and smiled and tried to make me
feel like everything was going to be okay.  when she moved, and i transferred
to another pediatrician, i found out that she had actually been quite worried
about my daughter, but just hadn't shown it to me.  my new pediatrician got
the diagnosis on the first try, after my daughter was pretty severely
malnourished.

i do not fault my first pediatrician.  i feel angry toward her, but the anger
is not justified.  i was in medical training about 16,000 hours.  in that
time, i spent around 10 minutes on celiac disease.  there are hundreds of
other diseases which we spend only a few minutes on.

in medical training, we are taught to look for "horses, not zebras."  if
every patient was screened for every possible disease their symptoms could
represent, our healthcare budget would quadruple, and we would need four
times as many doctors and lab technicians, etc., as we now have.  gluten
intolerance is clearly a "zebra."

doctors did not "ask for" mangaed care.  insurance companies did, and do.
 you cannot imagine the desperation i feel when i am argueing with a managed
care company on the phone to keep a sick person in the hospital, or order a
blood test, that i know they need, while someone on the other end, who has
little or no medical training, is saying they don't need it.  i don't tell my
patients about those experiences..

also, managed care companies keep statistics on doctors, about who orders the
fewest tests, or has the fewest days in the hospital!  if you order too many
tests, the insurance company will not renew your contract!  this is, of
course, an outrage, but what are my choices?  either cooperate with them, or
lose my contract, and know that a less discriminating physician will be kept.
 if my patients are to get the care they need and deserve, i have to play
along.

you should not ever be treated in an insulting, patronizing or rude way by
your doctor.  if you are, you should tell her or him.  if the problem isn't
changed, you should change doctors.  but neither should you treat your doctor
like the enemy.  the partnership between patient and doctor provides the
healing environment.

now, i suggest we get back to learning from one another about cd and dh.

sincerely,

debra, m.d. (melissa's mommy)