I’ve managed to keep up the every other week Friday Reflection for 58 weeks. A very busy month almost led me to miss this deadline, and then my mother came to the rescue.
My mom died 4 years ago. At the time I packed away her journals and albums, unable to imagine getting rid of any of them. During the last couple of weeks, for the same reasons I failed to write a reflection this week, I dove into her files. One thing that I discovered was this piece. I am not sure whether to call it a poem, a prose poem, or a screed but I think it fits in this space.
I am grateful to the commenters on Sensible Medicine for (frequently) reminding me how many people have been disappointed (to put it mildly) by medicine in general and doctors in particular. Anne Cifu was “an insider” — her father and husband were doctors, her mother a nurse — but she could still be appalled by medicine. Anne was also a writer, — she finished her career as a vice president and copy chief of a multinational company — a feminist, and an amazing mom. I think she wrote this in 1987.
Besides appreciating the tone and the message, I love that I can hear my mother in it. I know the friends she is referring to. I hear her love for Paul Simon. I remember how much she treasured long walks — anywhere but especially around New York. I can also picture her hammering this out on her typewriter, in her office, the minute she got back to her desk. I think she’d be happy that it can find an audience, 36 years after she wrote it.
Adam Cifu
The Sexual Politics of Waiting Rooms
By Anne Cifu
What is it about waiting rooms...
waiting rooms where women wait...
that makes them into holding pens
turning the women of America
into so many heads of cattle,
be they captains of industry or
frightened first-time mothers?
Visit your internist and there
are three PEOPLE in the waiting room;
the cardiologist, four; the otolaryngologist,
even in flu season, five or six. BUT
the obstetrician/gynecologist 10 or 12;
the pediatrician 12 or 14;
the mammography suite (filled with fear and) 20 to 25.
Waiting rooms where women wait!
Were a doctor to keep your husband,
brother or father waiting with such arrogance,
poor office management, or lack of caring,
HE would simply walk out or find a new doctor.
Why do WE put up with it? Is it that women
have nothing better to do? Is their time
worthless, meaningless? Or, is it that we
are still crazy after all these years,
still docile children who do what we are
told?
When I re-joined the work force eleven years ago,
changed by motherhood and a raised consciousness
(I thought),
I waged a one-woman
crusade to persuade my friends (architects,
teachers, social workers, a psychiatric
nurse, and a cosmetic executive) not to wait.
"Call ahead", I said. "Say you have a meeting.
Be firm and matter-of-fact. Think of it as
a business meeting, a client, an interview."
Most followed my advice and we all
saved time, anxiety, humiliation, and rage.
Then recently, I returned to my gynecologist
after a long hiatus. Why is that, my dear?
Feeling free and easy about time because I
had nothing else on my schedule, I neglected to
call ahead. I arrived at 9:25 for a 9:30
appointment "like a good little girl" and
the waiting room was wall-to-wall expectant
mothers. Waiting. Two radiantly
pregnant young women sat and read.
One woman looking very close to term
was sitting on the floor because the
elegant little chairs would have been
pure torture. Another, not pregnant,
sat pale and gaunt and obviously
frightened or in pain. No one
reassured them. A simple, "Doctor is running
a little late" would have gone a long way.
At 10:00, another uncomfortably pregnant
woman opened the door and seeing the
full house blurted out: "OHHH, They told me
I'd be the first appointment.”
The 9:00, nine-months-gone (as my mother
would have called her) dejectedly said:
"I've been waiting since nine."
I was infuriated, outraged for them
and angry with myself. Too furious
to speak for fear of making a scene
(and why not?) I grabbed my coat and
left without a word, walking the forty blocks
to my office to cool down.
Back at my desk, I called to re-schedule.
The female traffic policeman of the office
said: (and I quote) "what is wrong with you that you cannot wait?"
Indeed, what is wrong with us all.
I am a retired pediatric specialist. I have several physicians at this point in my life but most have the same problem. They do minimal to zero physical examinations. For my urologist after six years post-prostatectomy and no fear of relapse, it made sense that he did not touch me. However, for each physician, I have the luxury of accessing their official office notes via MyChart. Every one of them filled out a full Physical Exam with phrases like: Lung exam: no visible breathing difficulty and skin: no evident lesions. This is pure and simple fraud. It is dishonest and is a cynical attempt to jack up the possible professional charge. Yes, Medicare screws them paying less than 50% of what they can get from commercial insurance. These doctors include an internist, who spent less than 30 seconds doing a superficial heart and lung exam and did not touch my abdomen but still included it in her documentation, the urologist aforementioned who did not touch me once, the Physical Medicine and Rehabilitation doctors who did not ENT or cardiopulmonary assessment, and the endocrinologist who confined herself to a sensory exam of my feet due to my type 2 diabetes. These physicians work in the Texas Medical Center or affiliated clinics. The insurers are complicit because this documentation is clearly and obviously copy and paste. I suspect that this is common in all of American medicine. When I was in practice, I did an ENT exam, heart exam, full lung exam (I am a pulmonologist), and a thorough abdominal exam on all patients. I got a good exam of the skin, gait, key aspects of neurologic exam, and a screening psychological exam. The standards have dramatically fallen. NO ONE IS TALKING ABOUT THIS!
I have always refused to wait. I’m guessing it was my mother’s absolute affinity for punctuality that gave me that bravery. I arrive at the proper time (ten minutes early) and inquire as to the wait. If it is more than fifteen minutes beyond my appointment I immediately cancel and leave. I have used the line, “What makes the doctors time more valuable than mine” when asked why I’m canceling. I now have a dentist, a GP and an orthopedic specialist where I walk in, register and within minutes am escorted to the inner sanctum. I let the doctor know each time
how appreciative I am of them being respectful of my time by not making me wait. Maybe if we all speak up more of them will change.