If we are going to provide health care to everyone, the system has to change. One change that is expected is that primary care givers can no longer only be those who are M.D.s, as there just aren't enough to go around. My wife happens to have a couple of minor health issues, but both of which affect her eyes, causing some dryness and increased ocular pressure. So, when she had "something in her eye" a foreign object causing discomfort, I encouraged her to get it attended to right away even though it was a weekend and our doctor was off.
I want to share this experience because things worked out well, but it almost didn't. Ironically as we were waiting, and waiting, and waiting, the person next to us who had emigrated from Scotland many decades ago described how she was taken ill a year ago during a visit. She described how she was cared for without any cost since she retained her UK dual citizenship, but she also pointed out how long the waits can be, sometimes over a year to see a specialist in her small town outside of Edinburgh. All is not perfect in the world of socialized medicine.
As I was waiting I had time to think about the fact that the person we would see was not a Physician but a Physician's Assistant, but without the four years of Medical School and internship, which includes a rotation in Opthalmology. The wait was long, longer than they told people who called before coming to the facility. I wondered if they can distort the waiting time, what else are they doing. I specifically asked whether they had the diagnostic tools, a dye that shows abrasions or foreign objects in the eye, which I was told that they did, but I was not about to ask about the specific experience of the practitioner whom we would see.
I could see I was getting confrontational, so I asked my wife whether it would be better if I didn't go in with her, as I didn't want to become a problem. She was willing to leave, if I felt it was a mistake to have this treated by someone with this background, but we agreed to go in together.
When the P.A. came in she was not only professional, but personable; and after she described how she would proceed, I explained my concern that because of my wife's history, this could be difficult for her, even more so since she was not an ophthalmologist. or a physician who would have had a rotation in eye care, whimsically citing my own experience from watching E.R. on television for half a decade.
Within a few minutes my fear that I would poison the atmosphere with my overbearing demeanor was gone, and she proceeded with the examination. Using the die, and having me hold the light over my wife's eyes, she did not see an abrasion or a foreign object.....which was not good, since the pain Sheila was feeling was real. At that point as she was packing up, I suggested that she look under the lid to see if their may be a growth that was causing the pain. Then she saw it, an eyelash nestled in the crescent where the lid meets the orb of the eye. It took a bit of lid contortion but she was able to go in and get it out, and the problem was solved.
As we walked into the sunshine, after the three hours of waiting, with increased aggravation on my part, and then treatment, I felt good that it had worked out well. I was most pleased that my wifes problem was solved, but also that we had found a sweet spot of medical care that could be a way of providing widespread medical care. The other option, had the lash resulted in an infection, would be an Emergency Room which goes for a couple grand in our town as opposed to the Urgent care that resolved it for eighty five dollars.
But I had not been completely wrong about being concerned about the more limited experience of a P.A. as she was about to send Sheila home with the foreign object still there. The next person who comes to her with something like this, whether in a year or a decade, will have the benefit of this experience, but I didn't. What I had was my personality, often the source of conflict, but in this case because of the chemistry of the three people in the treatment room my active participation worked to everyones advantage.
This is the message of this posting, that as medical care changes we must bring with us our own resources, our scientific knowledge and ability to do our own research to become partners in treatment to the degree possible. And from the other side, medical providers must develop the openness to work with those who bring real knowledge into the treatment room. Actual scientific knowledge is the key, which implies the ability to know the difference between the hype that is polluting all channels of information and real information.
That's a subject for another diary, one that starts with our local paper publishing in their health column a gushing description of the wonders of vitamin D, and that everyone should take supplements. I'm in contact with the editor of the paper and the president of the hospital the writer is identified with. Either there will be a retraction or I will be doing what I can to prevent such exaggerations, by naming names. I let you all know how this works out in the next few weeks.