The practice of medicine is the practice of fear
When I was pregnant I was severely traumatized repeatedly. Every week was a new set of tests, dozens of vials of blood taken from me, and numerous consults. Based on that you would be led to believe that when my son was born there were numerous things wrong with him. Thankfully, he was perfectly healthy upon entering this world. However, everyday of my pregnancy I lived in some state of anxiety due to how scared my medical providers were.
I loved my doctor. She is one of the top doctors in NYC. However, these days doctors out of a precaution of abundance over-monitor one to no end. My friend was also pregnant near the same time that I was and she did not go near anything that I did. That is because she was pregnant while in Germany. When she got morning sickness they gave her medicine. When I got morning sickness (extreme at that and every for 7 months), i was told to take No-Doze for it has the same active ingredients that are in the anti-nausea medication given to pregnant women in Europe. In the US, we are not so lucky. My last four weeks of pregnancy I had to come in every week to have my water level and heart rate monitored. Did I mention that I was perfectly healthy and I did not have much weight gain. As evidenced by the fact that I was able to hide my pregnancy till the 6th month or so at work (I didn’t care to share with my co-workers). Despite all this it was constant vigilance. I asked about this and I was told by the medical professionals they are often scared of something going wrong and being sued.
Which brings me to the malpractice insurance. Now that I, in part, run a clinic I am constantly being asked (whenever I talk to possible new providers or longstanding ones) what about malpractice insurance. who handles that? Am I fully covered. I do not blame the doctors for being concerned. I then make sure that they are fully covered and I provide proof of coverage etc. What drives me crazy is the need to focus on that. Some doctors order tests that may not be needed in order to make sure they are fully covered in the “due diligence” department of things. And, of course, we all want our doctors to do their due diligence. But let me note that over 65% of the time doctors are guessing as to what the diagnosis is. And there is no such thing (other than at NIH in a small, small section) as a medical specialty in “Diagnostics” despite the worldwide popularity of the television show House.
I personally love my own primary care doctor and truly am at a state of denial that I can no longer see him as he is in NYC and I am in California now. He told me when he was perplexed or when there wasn’t a straight answer. He wouldn’t order tests just to quiet me. But as an employer of doctors I do see the other side-that side of fear and the need to order those tests.
An angry patient can really put some providers into a state of hiding and anxiety. Of course, no one likes being yelled at. However, what I have seen is that the medical doctor anxiety is more around the part of being sued. I believe most people know this. Now while I am grateful that I had a healthy baby boy, admittedly due in part to rigorous monitoring, I was not a happy pregnant woman. I was fearful, due in large part to rigorous monitoring and warnings and consults. Its a catch-22 all around. Sigh.
Going forward, how do we change our encounters so that fear is not a driving force for either party?