Many years ago, I wrote this essay in which I wondered why I receive so few gifts from my patients in the holiday season. I was prompted to write the essay by the memory of my father, an orthopedic surgeon in solo practice, whose patients showered him every December with foil-wrapped bottles of booze, tins of cookies, and all manner of goodies, including a "World's Greatest Doctor Figurine." I speculated that perhaps dad's speciality, his age (I recalled only his 50s and 60s), his gender, his cozy office on the ground floor of an apartment building, and the era in which he practiced explained his patients' relative generosity. When I wrote the piece I was a young woman caring mostly for other young women in a large internal medicine group housed in a mega-sized, late 20th century hospital. These factors, and not my patients' lack of affection, surely explained why I went home every night with the physician's equivalent of a lump of coal, right?
All these years later, most of these factors remain the same, though a few have changed. I'm older, and so, on average, are my patients. My group has doubled in size and the hospital in which it is housed is now part of a multi-hospital health care system.
And so far this season, I'm still coming up empty-handed. No booze, no cookies, no figurines.
I'm not complaining. I know how expensive health insurance is, how costly the co-pays are, not to mention the parking fee, the babysitter, the time off work, the time wasted in the waiting room...I've experienced all these as a patient, myself. And, to be honest, though I love my own doctors, and appreciate them greatly, I've never given one a holiday gift.
But, if you were thinking of getting me something, here's what I want:
Real health care reform: The passage of the Affordable Care Act was a step in the right direction, but is not the same as universal health coverage. In the richest and most powerful country in the world, basic health care, like education, should be a right and not a privilege--and a healthier population, like a more educated population, would benefit everyone. I come at this as a doctor, not a politician or an activist. I see people all the time who've skipped mammograms, left prescriptions unfilled, or deferred mentioning a symptom because they're unemployed or have poor coverage. It's just not right.
More Time: I wrote in this column that perhaps the most gratifying period of my 20+ years in practice was the three weeks when I returned from medical leave after shoulder surgery and was required, by my hospital's occupational health department, to take double the usual time to see patients. I'm convinced that longer visits would make for healthier and happier patients (and doctors) and fewer costly tests and medicines. Unfortunately, as this article reports, "slow medicine" is not coming soon.
More health, less health care: According to the World Health Organization, the top ten causes of death in the developed world are mostly conditions that could be prevented or ameliorated by changes in lifestyle including diet, exercise, injury prevention, and stress management. But "lifestyle medicine" is still not quite in the American medical mainstream--not much taught in medical schools, and not much practiced in clinics and hospitals. I'd love to see diet and exercise prescribed as frequently as "the little purple pill," but that takes time, and a change in how health care is financed (see above).
Oh, and if none of these are available, and you can't find that figurine, there's also a coffee mug.
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