The Doctor (and Her Computer) Will See You Now
Autonomy is important to me. Maybe it’s because I am a Gen X-er. Some say we were raised by wolves. I do know that we were raised knowing we had the freedom to explore but also the freedom to fail. Our autonomy taught us resilience.
With autonomy comes responsibility. I need to do the adulting task of scheduling my annual doctor’s visit. I’m dreading it. I’m procrastinating. I don’t want to go. There was a time when I admired those in white coats or those with the education and knowledge that I lacked. I also admired teachers. That changed when I became a teacher and heard what was said in the teacher’s lounge. I held teachers and doctors and politicians and scientists in high regard. Now I’m not so sure. Trust must be earned.
At my next doctor’s visit, I know we will disagree about the new mammogram guidelines. Women my age should be getting one every other year. I disagree. I have no history of breast cancer and the number of false positives make me want to avoid the roller coaster of emotions. My mom just had a false positive and it wasn’t fun. Plus, I hate mammograms.
Will I have an honest discussion with my doctor about the pros and cons? Will my doctor be a partner and an ally with me? Can we agree to disagree? I doubt it. I’m sure I will get the eye roll – one that may or may not be visible but is certainly felt. Or, the heavy sigh. I will feel her disappointment.
It is not actually the doctor I don’t trust. It is not the doctor that I no longer hold in high regard. It is the system that produced the doctor that treats me like a number rather than a person with autonomy. It is the computer that my doctor now taps on during our entire visit. My doctor parrots the information that comes from the consensus of recommendations being displayed on the screen. I almost feel sorry for her. She, too, has lost her autonomy. To be able to function as a doctor in this world, she must hold the medical community and all their guidelines in high regard. But, at what cost?
Our healthcare system is broken. I hope we can reclaim our autonomy and rebuild trust. I hope we can realize one size fits no one. I hope we can fix this. Thankfully, I believe Gen X can speak up and be the adult in the room and move our institutions toward autonomy. We have the resilience from our childhoods to keep trying. I will go to my annual appointment with an open mind and, who knows, maybe this time will be different.
Autumn Miller is a retired educator who fostered a love of learning across ages as a middle school teacher and a college advisor. Holding a B.A. in Humanities from Arizona State University and a J.D. from the Sandra Day O’Connor College of Law, Autumn's passion for lifelong learning extends into retirement. Currently, she enjoys hiking South Mountain and learning how to cook nutritious meals.
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I'm a primary care doc and when my patients disagree w my advice, I say, "Guess whose breasts they are? The guidelines say XYZ and I'm supposed to tell you, but you must do what you feel is right for you." At my workplace, one gets the "quality" points if one hits the metric at around 80% (it's different for each metric). There are some metrics I know I will never get bc I think they are a waste of my precious time w the patient. I happen to disagree w some of the official recommendations and I tell my patients that and why. I also tell them, "If you wish to follow the recommendation, by all means, do," but I think it's wiser to do PQR and here's why.
I do not need to wring every last penny possible out of my med school diploma. I love making a good living, of course, but I also love doing work I feel proud of.
I really enjoyed reading this. I am a gen X female doctor (pediatrician) myself, and I feel your frustration from both sides of the computer. The way we are pushed to “meet metrics” is dreadful. When I see the parent is reluctant, I will often say, this is your child, it is always your decision. Because it is. We doctors are highly trained and well educated, and it makes many of us bossy. We should be educating our patients about why we do things, and listening to their concerns. That takes time, which we often don’t have. Keep fighting for that autonomy. It’s worth the effort. And if your doctor won’t listen to you even after you’ve tried to get explain yourself, find a new one.