March 12, 2013
As an employee of the ABIM Foundation, I’ve batted around the phrase “medical professionalism” for several years but it didn’t really hit home for me until I encountered it – and the lack thereof – as a patient.
Over the past six months, I’ve logged a few miles in the frequent patient program. I underwent a 13-hour craniotomy to resect a meningioma and woke up from surgery with nerve damage to my left brachial plexus. I have consulted doctors up and down the East Coast, from some of the most prestigious health care systems. When it comes to finding a good doctor, I do my research. But exemplary skills as a surgeon, as I well know, don’t necessarily translate to practicing “professional” medicine.
I recently had my six-month post-op appointment with the neurosurgeon that operated on my tumor. When I told him I was back at my job as an online content manager, his eyes lit up and he immediately began asking me questions about building a website. He wanted to use the website as a place to put information about what he does, answers to questions he gets asked all the time and “to advertise.” His current health system, he explained, doesn’t allow him to do so and this would be a great way for him to get his name out there. We went on to discuss the challenges of building a website for about 10 minutes. Then, my appointment was over, he shook my hand and I left. I guess I checked out OK.
For some reason, the thought of doctors “advertising” left a bad taste in my mouth. I understand that doctors work in a volume-based system; the more patients they see, the better off they are. But I don’t want to be marketed to or worse, part of someone else’s marketing campaign. I want to be looked after; I want my concerns to be his concerns. Most of all, I don’t want to spend my appointment discussing the best options for him to market himself. I wanted to talk about the dizzy spells I’m having and for him to reassure me that they are just the result of a sinus infection, not residual tumor issues.
Two weeks ago, I was scheduled for surgery at a different hospital for my arm. The doctor performing the surgery is recognized as one of the best peripheral nerve surgeons in the country—I was in good hands. When I got to pre-op, my surgeon was waiting for me. He was ready to go and filling out last-minute paperwork. I felt that my arm movement had improved significantly since I last saw him and wanted to impress him with my new “trick” – a shaky but determined bicep curl, which I haven’t been able to since before my brain surgery. He watched, felt my arm, had me do it a few more times and then said, “Go home. I’m not doing it. If it was my arm, I wouldn’t do the surgery. So I’m not going to do it.” He told me to see him in six weeks (when my post-op appointment is scheduled for) and sent me on my way. Despite the money he would have stood to make for himself and his hospital by operating, he sent me home to let nature do its thing. His inaction to me epitomized medical professionalism. As Daniel Wolfson put it so well, “He did the right thing.”
Reflecting on these two experiences, I know what medical professionalism means to me, as a patient. I know that I respect my arm doctor tremendously and that he has and will continue to put my best interest first (a key principle of the Physician Charter). I feel comfortable putting myself in his hands. As for my brain surgeon, I don’t feel like a patient. I feel like a consumer. And next time I see him, I wonder if he’ll grin at me like a car salesman and ask, “What do I have to do to put you in the hospital today?”
Lisa C. Miller