There are age-old dilemmas in choosing a doctor, aren’t there? Choices often have a way of seeming problematic, even insoluble, when considered in the abstract and all the more so when they have to be made for real. Theoretically, I suppose, they should be made after due-diligence, as the lawyers would say. One merely sets out a series of criteria and then assesses whether or not they have been satisfied. We all do this, to some extent, but often the only criterion that has to be met is whether or not a friend liked the doctor, or perhaps had a good result from him or her. What her scar looked like -never mind what went on underneath it?
But even considering it like this suggests further and more contentious questions: should one choose on the basis of personality -bedside manner, if you will- or results? After all, you still need to interact with the doctor, explain your problem, have it considered and assessed in a sympathetic and respectful manner. A skilled surgeon may be only that – and as I’ve pointed out in previous blogs, surgery isn’t always the answer, but often merely one of many options. If you’re not given the choice, how would you even know there was one?
Do you choose the academician, or the clinician? Knowledge isn’t always translatable into skill. My senior residents usually have the academics down pat -they need to write exams to prove it, after all- but it takes time for them to master the skills that enable them to put it into practice, especially under pressure at three AM or in an emergency where conditions may not be text-book clear. Knowledge is the possession of facts about something; wisdom -skill- is the ability to contextualize them. Use them, in other words.
Oh yes, and then there’s gender -a particularly vexing problem for the male gynaecologist. It seemed especially so when I first started in practice, but I was younger then -more naive. A female colleague and I opened an office together soon after we achieved our specialist fellowships, and I remember feeling hurt (is that the right word?) that our new patients chose -insisted- on seeing her. Finally, and after what seemed like months of empty day-sheets for me, she became so busy that new appointments, even emergencies, had to be deflected. I began to get what I used to call the left-overs: patients who were initially angry that they too had been given a left-over.
Eventually, however, things settled a little and people began to choose on the basis of other criteria than merely gender. Quite simply, males often see things differently. Things that my partner had less patience for -perhaps because she had lived through some of the problems she was being asked to solve and saw them more as complaints than issues needing a solution- I saw through inexperienced eyes and from a different perspective. I could sympathize with someone having debilitating pain that returned like the moon month after month, year after year. I could understand the need to find a contraceptive that didn’t engender mood changes, or headaches, or intermittent bleeding, or require strict adherence to a schedule so as not to forget to take it. I could sense the tiredness that would be brought on by the demands of breast-feeding, of needing to be constantly alert to the infant, or child’s needs, no matter what else my life required.
But a choice is just that: singling out one from a line up of often similar faces where even the criteria require yet other choices. I suppose if the difference between them is truly small, the choice is even more difficult, but less likely to result in later self-recrimination. One does not -one cannot- choose retrospectively, so any choice could be argued to be the correct one under whatever circumstances it was made. The fact that choice is even possible is a luxury not afforded to everyone, everywhere.
Obviously I have no answer that transcends personalities and specific needs; I would not presume to speak for someone who sees the world from a different background or a different culture. I can only suggest that respect is something that I would look for; that is usually evident on the first encounter. It is in the eyes, on the face and in the gestures. It is woven into the cadence of speech, the words chosen, the smile that, unbidden, lights up the interface between two individuals who are no longer strangers.