The Medical Rites of Spring

Having reached the august age of 61, I find myself at the doctor’s office more often than I’d like. For some reason, these appointments cluster in the spring in a bizarre rite of seasonal self-preservation. In the past three months, I’ve gone for my annual physical, a head-to-toe skin exam with my dermatologist (skin cancer in 2020), my five-year colonoscopy (hereditary risk of polyps), my semi-annual PSA test (prostate cancer in 2018), and follow-up blood work on tenaciously high cholesterol.

The most recent visit to my primary care physician convinced me to change doctors. The fact is I’ve grown impatient with surly front-office people and nurses who summon you to the inner sanctum then head down the hallway without saying hello. Uh, no thank you. I am no longer willing to don a paper-thin hospital gown and wait for an hour with my feet dangling off the examination table. For one, my feet get cold. But I also see it as a matter of principle: Everyone has a right to be treated with respect and compassion.

My previous doctor—a very nice woman in a very bad practice—recently prescribed a medication to bring down my stratospheric LDL cholesterol. I’ve resisted taking a statin for over 20 years but relented when she said, “Maybe you could handle that level of cholesterol as a younger man, but not anymore.” And, to be honest, seeing my cholesterol creep up over 300 got my attention. We talked about statins and how they may have given me peripheral neuropathy a couple decades back; and then she recommended a new injectable drug called Repatha. Though there is less clinical data available on this monoclonal antibody, it can reduce LDL by 60 percent. I agreed to try it out, and the doctor asked that I return for blood work in three weeks.

Three weeks later, having given myself two of the injections (right in that pouch of stubborn belly fat we men get), I returned to the doctor’s office to have blood drawn. Aware of their tendency to run late, I chose the earliest time. So at 7:45 AM I checked in and took a seat in the waiting room. Thirty minutes on, after seeing at least a dozen people arrive after me and leave before me, I asked the receptionist how much longer it would be. “Oh, we were told you went home,” she replied. No embarrassment for the mistake. No apology. “I’ll tell the phlebotomist you’re still here,” she said, as if she’d discovered an old broom in the closet.

At this point, my empty stomach and lack of caffeine took over. I threw up my hands and said to the woman, “Nah, I’m good.”

Then I left.

Of course, when I reached the car I realized I still needed to have my blood checked.

Your Standards Are Too High

Long story short (or is it already long?), I found a new doc who could see me in July. But to have my cholesterol checked, I’d need to see one of his colleagues sooner. That appointment occurred earlier this week. Once again, I chose an early appointment. When I walked in at 7:35 AM (10 minutes early, as instructed), I cheerfully greeted the receptionist, a heavy-set, stone-faced woman of indeterminate middle age. “You gotta give me a few minutes,” she snapped. “I just got here.”

Okay, I thought, someone hasn’t had her Cheerios. So I took a seat in the waiting room, where I spent the next few minutes listening to that same receptionist complain to a coworker about her job. “I just can’t wait to get outa here,” she kept saying to her sympathetic friend. Pretty soon I felt the same way.

Eventually, a nurse called my name, led me to an examination room, and said the doctor would be with me shortly. “I’m just here to have my blood drawn,” I protested, which didn’t seem to register with her.

Moments later, a wiry, red-haired doctor in his 40s or 50s came in and started working his way through a battery of health questions—the same ones I’d answered a month earlier at my physical.

“Do you sleep well?” Reasonably well, for an older guy.

“Do you drink alcohol?” One cocktail a night (well, maybe more, but I’m not telling you that).

“Do your bowels move well?” Sure, but they still can’t figure out the Electric Slide.

Then he listened to my chest and back with his stethoscope. Apparently not discovering anything noteworthy about my lungs, he started in on more questions. The first really threw me.

“Why are you changing docs?” he asked.

My first instinct was to say, None of your business, Carrot Top. But I managed a more civil response, explaining that I didn’t care for the “professional atmosphere” at the practice. He asked if I liked the doctor, and I said that I did. Then he smiled as if he’d exposed my flawed logic. “Well, the front-office people don’t treat your illness, do they?” Before I could respond, he went on to describe a “crisis in primary care,” and how there aren’t enough docs to see all the patients and so forth—as if the healthcare industry’s problems justified my many crappy experiences. More than anything else, his question made me feel like he’d rather I just go away.

That question was strike one.

What’s With the Klonopin?

Strike two came quickly. He asked if I’d had any surgeries; and I explained that I’d undergone a radical prostatectomy in early 2019 to treat stage-three cancer. “Huh,” was his response. He didn’t ask how it turned out or about the infamous physical and emotional side-effects of prostate removal. Just, “Huh.”

Strike three may have been his most spectacular whiff of the day. As the doctor reviewed my medications—a short list, I’m proud to say—he asked, and I kid you not, “What’s with the Klonopin?” Now any doctor knows that Klonopin (clonazepam is the generic name), is prescribed for anxiety. Someone taking the medication is likely experiencing a rough stretch in his or her life. I wanted to ask, Is your bedside manner always this shitty or did you miss your coffee break? Instead, I explained that the weekend before we’d suddenly lost our beautiful Saint Bernard puppy to lymphoma and that the whole family was devastated. My grief generally comes with intense anxiety, I added, for which my previous doc prescribed a 10-day supply of Klonopin. I suppose I shouldn’t have expected any sympathy or concern but, foolishly, I did. Instead, the doctor made a decisive circular notation on his notepad, as if writing, “Head case.” And that was that. He never even made eye contact.

We Can Do Better

In my book Midpoint, I commented extensively on my disappointment with aspects of the American healthcare system—most specifically with the lack of compassion exhibited by many of its practitioners. On the bright side, I noted how impressed I’d been by Memorial Sloan Kettering, where I received cancer treatment. MSK is one large and prestigious institution that has figured out how to institutionalize empathy and kindness. Sadly, at the local level, I often find the opposite: docs who seem slaves to the insurance companies, and front-office people who’d rather be anywhere than helping sick patients. During the COVID pandemic, we were urged to view “frontline” healthcare workers as heroic; and I enthusiastically embraced that narrative. The risks those people took to help their fellow men and women awed me. Consequently I find myself torn by the desire to lionize those who selflessly care for the sick and dying, and infuriated by others who can barely muster a smile or a “good morning.” You might say I’m asking too much—that we should all just be grateful to live in the USA with its miraculous technologies and medications.

Maybe you’re right. Maybe the problem isn’t with the receptionist or the primary care doc, but with the system and its drive to standardize, optimize, and maximize what should be an intimate, compassionate human experience. Whatever the case, I hereby assert my right not to settle for surly or indifferent or condescending care. I’ve seen one of the largest cancer centers in the world deliver cutting-edge care with extraordinary compassion, and it both inspired and spoiled me. I know we can do better, and I’ll keep changing caregivers until I find one who fully honors this line from the Hippocratic Oath:

“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

I meet with my new doc in July, and maybe he’ll surprise me. I promise to be my best smiley self—as long as he doesn’t ask, “What’s up with the Klonopin?”