I recently changed my eye doctor, despite officially being a “suspect” for a nasty little eye disease that eventually leads to blindness. I was going to the same doctor at a big multi-function eye clinic for over 15 years. I can’t say that he ever did anything that was technically wrong; I just got tired of his attitude that “I’m the miracle man and you are the poor victim, I’m always right and anything you believe outside of what I tell you is wrong; and hey, I’ve already been here too long and have to get on to the next patient, so if there are no further [futile and stupid] questions on your part, then have a great day”. <\/p>\n
This fellow has been cited in various local magazines (including New Jersey Monthly<\/a> — look under ophthalmology) as a “doctor of the year”, for many years running. At first this seemed impressive; but it finally dawned on me that these “super doctor” magazine nominations aren’t exactly made<\/a> by the Nobel Prize committee. This is more of an old-boy network<\/a> judgement than an assessment based on ultimate benefit to the patient.<\/p>\n I finally decided to change to the eye doctor that my mother used when she was alive. He is a few years older than my former “doctor of the year for every year”; actually, the new guy is roughly my own age. He is not featured in any magazines and has a very different kind of office. My former doctor was in a group practice with several other eye specialists, in a large facility that was fully equipped with all kinds of high-tech gadgetry, including the latest laser eye surgery stuff. They didn’t just treat eye disease or do annual eye exams, but marketed their services for vision correction and a variety of other “discretionary” procedures, such as an out-patient operation to increase the volume of flow from your tear ducts. No more dry eye!!! These guys could do it all. (And wanted to do it all on me; despite my “suspect” problems, they tried several times to sell me on vision correction and tear flow surgery, out of my own pocket. Obviously I always said no to my doctor — about the only refusal or disagreement that he would allow me to voice, however grudgingly.) <\/p>\n And do it all they did and still do to a wide swath of the public. The clinic was always packed with people, who were continually herded back and forth between various exam rooms and waiting areas by a staff of mostly young assistants and technicians. The whole operation was designed for maximum efficiency; the doctor only saw you at the end, after you finished all the question and answer sessions and eye drops and laser scans and eye chart readings. You would sit in a room alone for maybe 15 minutes, until the door would finally open and in would walk the great man with his assistant ready to jot down his every word. This is it, time to proclaim judgement upon me, right in front of a stranger to whom I am nothing more than the subject of the file she was keeping. But don’t worry, this judgement will be proclaimed quickly, as the next patient(s) are already in similar rooms, waiting alone in the creepy isolated solitude for their own judgements.<\/p>\n Hey look, I know that doctors have to sometimes give patients bad news, things that the patient just doesn’t want to hear. But a highly efficient and highly impersonal setting like the eye clinic I had been so loyal to is just not a good place to get such news. Not that there really is a “good” place for bad news, but a slower, more private and more humane setting where 2-way communication flows naturally certainly might minimize the angst.<\/p>\n My new eye doctor, incredibly enough, seems to maintain such a setting. His office is something out of the past, the way that doctors used to practice medicine. His receptionist is at an open desk, not behind a sliding glass door in a business-like office complex. You speak to her face-to-face when you walk in; you don’t see a poster saying “SIGN IN WITH TIME OF ARRIVAL, TAKE A SEAT, AND WAIT FOR CALL FROM STAFF”. You see the same faces working in the office over many visits, and not an ever changing blend of mostly young people fresh out of school. There is not a bank of TV screens on the walls with stupid shows or health infomercials playing non-stop. There usually are other patients waiting to go in, or coming out, but things are much less hectic and noisy than at the clinic. When it’s time to start the exam or procedure, the doctor himself comes out to get you from the reception area, not a 20 year old technician half-heartedly saying “follow me, how are you today”. The new doctor himself performs some of the procedures that are farmed out to technicians at the big clinic (although some other things are done by his assistant, reasonably enough). You have a fair amount of time to talk with the doctor, and he isn’t hurrying you out the door. <\/p>\n And what’s more, he takes your questions seriously, and even acknowledges that there might be something legitimate to whatever your idea or concern is regarding your eye conditions. He does not immediately and implicitly dismiss the thoughts behind your question, as my friend at the big clinic always did. He may well disagree with what I would be thinking and will make that clear, but he doesn’t just rattle off a rote explanation that anyone could get from a public health web site. <\/p>\n This is the health care of the past. I’m really surprised that I found this guy, that he’s still in business. I don’t see how he survives in the present medical economic environment (especially with the full implementation of Obamacare right around the corner). Perhaps in the future there will still be offices like this available to the very wealthy, those not dependent upon health insurance or government payment plans (mostly Medicare). But the rest of us will surely be herded into expense-minimizing high volume clinics so as to keep the costs to the government and the insurers under control. You will still have a few minutes face-to-face with your doctor; but use that time wisely, as it will be strictly limited. And don’t expect much in-depth discussion of your own fears and concerns. Just state the symptoms plainly and succinctly, listen to the doctors instructions, and off you go!!<\/p>\n Obviously, I do believe that a lot will be lost (and already IS being lost) as “old fashioned” medical practice goes the way of the vinyl record and postage stamp and typewriter. Medical practice will become more impersonal and more uncomfortable for most of us. Computerized records and text messages and even instant monitoring of health conditions from home are great, but will not make up for the deterioration in personal relationship and communication between doctor and patient.<\/p>\n I will admit that there is one down-side to my decision to leave the big clinic for an old-fashioned solo practice. My possible eye condition today is often diagnosed and monitored by high-tech laser scanning equipment that allegedly has the ability to detect even the slightest changes in the eye that would indicate the start of a real problem. The proponents of these machines say that they are a big advance over the kinds of tools that my new doctor still seems to rely on to monitor my eyes; that they would allow responses to a problem months earlier and thus could allow medications or other therapies to be implemented earlier, thus decreasing the chances of eventual blindness or significant sight loss. <\/p>\n