Wednesday, May 29, 2013

You Can't Always Blame Other People

read the article in the NYTIMES
There's an interesting story in a recent New York Times about the treatment of people with disabilities by physicians here in the United States. Here's an interesting segment:
The researchers then called more than 250 doctors’ offices in four major cities across the country that offered care in areas like gynecology, urology, psychiatry, endocrinology and orthopedic surgery. The researchers presented themselves as the doctors that they were, and tried to make an appointment for the fictional patient. 
One out of five offices refused to even book an appointment. Some explained that their buildings were inaccessible to people in wheelchairs, but most refused simply because they had no equipment like height-adjustable examining tables and chairs, specially designed weight scales or trained staff members to help move the patient out of the wheelchair. 
But even the offices that agreed to see the patient were not necessarily offering appropriate care. When pressed, some acknowledged that they had no plans or equipment for moving the patient. Others said that they would complete only the parts of the exam that they could — and forgo the rest. Fewer than 10 percent of these offices had appropriate equipment or employees trained to help patients with disabilities.
It's a shame, obviously. Every person should have access to decent medical care. That said, it's a naive crip who doesn't get this at the first visit with a new physician.

Doctors are trained to return the damaged to normal. And truth be told, there are few doctors who see disability as anything other than an impairment of normal. A physician can sometimes not understand that disability is normal.

Secondly, a person with a disability should be very wary if a physician's office does not have adequate equipment or staff—or staff with the wrong attitude toward disability. I have never met this sort of attitude, other than an odd response to a telephone call to a Lenscrafters, one in another state. I requested an eye examination, and the response was "We don't do people in wheelchairs."

That's minor, but speaking personally as someone messed up by polio, that ugly old killer and maimer, I find most physicians younger than me are often entirely unfamiliar with the disease, its effects, and most especially with the subsequent effect called post-polio syndrome. 

This is complicated by the fact that I am ventilator-dependent, and most physicians only encounter ventilators in a hospital setting. The combination of these factors means that too often I find myself part of the diagnostic team.

I accept that. I accept the situation because it gives me a greater sense of security. I begin accepting that about two decades ago when I begin occasionally encountering a physician who would argue with the fact that I am here, alive, a half-century after being inoculated by the Salk vaccine and ending up in an iron lung a week later.

"Oh, that's not possible," has been the response I've heard more than once.

The one thing that it has taught me—which is a lesson applicable to anyone who walks into a physician's office—is to never acquiesce automatically to every decision that a physician makes. Or a nurse, or medical technician, for that matter. 

Ask "why." Ask "how." Ask about alternatives.

It's a shame that people with disabilities must do this, but then again it isn't.  Everyone should do this. We are responsible for ourselves. Anyone who doesn't believe that may encounter far more problems in life than a visit to a physician's office that goes wrong.

However, the news story was about access, and an example was given of a man in a wheelchair who had diabetes. 
In his 60s, overweight and in a wheelchair, the patient had been seeing doctors and nurses regularly for his diabetes. Only recently had they discovered a pressure sore after someone had finally, as he put it, “wanted to examine at my backside.”
That's fine. I have no quarrel with criticism of the doctor or his facilities in this case.

I have a greater quarrel with this patient's desire to place all of the blame on the physician. When was it time for him to say, "I need to be checked for pressure sores?"

Physicians generally have a god complex. And why not? A physician tinkers amid the blood and guts, bones and electro-chemical reactions that keep us functioning. That's enough to inflate anyone's ego and generate a sense of entitlement to a house on a golf course and a new Mercedes-Benz. 

True enough, a good physician knows in a general sense he or she is smarter in the ways of the human body than the person being treated, but a good physician is also humble and open-minded.



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