I get a lot of comments hostile to doctors, and I’m OK with that. Going to a doctor can be comforting, painful, humiliating, frightening, or all of the above. Doctors can be saints, assholes, and everything in between. But there are two phenomena I find puzzling. One is the act of “punishing” the doctor by not taking care of yourself, the other the idea that the doctor should take care of you for free.
We pay doctors for their professional expertise. We hope that they will behave as compassionate professionals, but as human beings, we often fail. I strive to be compassionate, and teach that to my residents and students, but we all have our bad days.
Compassion does not mean doing whatever the patient asks. Being a doctor means telling people every day things they don’t want to hear. I frequently see patients who refuse to take medications, won’t follow a diet, or avoid vaccines because (they say) they are mad at their doctor. I have news for these people: doctor’s don’t lose a lot of sleep over patients who choose to go their own way. While I certainly prefer that you take good care of yourself, if you choose not to, there is a danger that my focus may shift to people who want to get better.
Digging a bit deeper, when I hear, “I’m not taking that pill because the doctor’s an ass,” I think of two different things. One is an immature hostility that harms no one but the patient, but on another level, I hear someone who may be more frightened than they are letting on, and are in denial about their disease. If I am very lucky, I can reach this person.
The other odd thing is people who think doctor’s should work for free. I don’t just mean those who think we need a new health care system, or who expect us to magically diagnose them over the phone—I mean people who think that we should write prescriptions, administer vaccines, or give advice without charging a fee. Folks, this is my livelihood. This is how I feed my family. My education wasn’t free. My office isn’t free. My supplies aren’t free. My time and expertise aren’t free. You pay me because you want my services (and out of simple respect). I don’t come to your restaurant and expect a free bowl of soup, so don’t expect a free flu shot from me. Of course, unlike a restaurant owner, I’m unlikely to turn you away if you walk in my door holding a bloody appendage.
Finally, a note on professionalism—no, not professional behavior, but the nature of professions. Doctors have a special knowledge and skill that we pay for. If we could all do it, that would be great, but we can’t. It’s easy to deceive ourselves that googling “high blood pressure” makes us knowledgeable enough to take care of ourselves, but it doesn’t. Every seemingly small decision we make every day is backed by years of study that inform us of the correct course to take, the risks, the benefits—-there are no simple decisions in medicine, or at least damned few.
Primary care docs may not get rich, but we are privileged to have a profession that allows us to study something fascinating and use that knowledge to help people. Like anyone else, we hope people follow our advice, and we hope they pay their bills, but neither is certain.