On socialized medicine and travel insurance, On rude patients, On boys, monkeys, and simpler days, On relationships
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"When my 65-year-old grandparents left for a long-overdue family reunion in Germany, they spent $120 on a supplemental insurance policy. We thought they'd been taken. Then came the call from the hospital. My grandfather had had a heart attack and was not doing well. He also had an arrhythmia. His treatment? Medical management only. The cost-benefit ratio for a man my grandfather's age argued against anything more, we were told.
Had he suffered the attack while in the US, Medicare and my grandfather's company insurance policy would, together, surely have covered bypass surgery and a pacemaker if needed. But not when he was in Germany, and the German physicians refused to release him. The supplemental policy came to mind.
Amazingly, with a few phone calls, the plan began to solidify. The insurer flew a resident physician to Germany, and the physicians there agreed to release my grandfather to his care. The insurance paid for the physician, the hospitalization, and the two extra seats on the plane needed to enable my grandfather to lie flat during the trip home. Quadruple bypass and defibrillationthree timesfollowed.
That was 12 years ago. In those years, stolen as they were from hospital professionals in a socialized medical system, my grandfather has seen his grandson become an electrical engineer and his granddaughter become a physician. We're all thankful for that supplemental insurance policy."
"I overheard Brenda on the phone. She is one of our calmest, most experienced secretaries and is always anxious to help. But this day, her voice had an edge to it. She was polite, but her tone told me that she was holding back.
Later the office manager told me that Brenda was very upset by the rudeness of a particular patient. It wasn't the first time this patient had been overly demanding and rude to a receptionist. We wrote the patient a letter immediately, giving him notice that he would have to find another doctor. We have a no-tolerance policy on rudenessand that includes patients as well as staff.
Staff members appreciate that we stand behind them if a patient hassles them. We encourage them to tell a belligerent patient that they are here to help, but that they do not have to put up with abuse. If the abuse continues, they have our permission to put down the phone or walk away from the reception desk."
"In 1958, I joined two other South Africans in a practice in Salisbury, the capital of Rhodesia (now called Zimbabwe). Salisbury was known as the City of Flowering Trees, and my first spring there, I discovered that the flowering trees also brought an attendant increase in insect life.
At noon one glorious Saturday, as the office was steadily emptying, a small boy rushed in, crying 'Doctor, come quickly! Billy's been stung badly!' I grabbed my emergency bag and trotted a few houses down to find a chaotic scene. People of all ages were milling around on the lawn, swatting at bees on their bodies and in their hair. Billy's anguished parents led me quickly to my patient, a small boy. He was thrashing in circles on the grass, screaming in pain. The poor child's head, arms, and legs were completely covered in long curved stings, and there were hordes of bees crawling around in his hair. His eyes were swollen shut, his limbs were covered with welts, and his pulse was thready.
After showing the family how to remove the stings without squeezing them, I quickly gave the youngster a shot of adrenaline.
Then I heard shouts of 'The monkey, Doctor, the monkey!' I had, it seemed, another patient on my hands. A small gray monkey lay prostrate on the grass, panting rapidly. Its little body was overlaid with a carpet of angry bees. The crowd on the lawn looked at me and my black bag with such trusting expectancy that I knew I had to do something decisive. So I took another vial of adrenaline, drew up a smaller dose for the monkey with the same syringe I had just used on the boy, and injected it into what appeared to be the monkey's gluteus maximus.
I followed the same routine with Benadryl: a new needle and syringe, an injection for the boy, then an injection for the monkey. Then the same process again with a corticosteroid. There was nothing more I could do. The boy was out of danger, and an air of calm descended on the garden party. I had some snacks, declined the beer, and counted the stings on the two patients. Each had at least 100. The boy appeared to be recovering rapidly, but the poor little monkey was limp and shivering and appeared to be in extremis.
Billy's family became regular patients. I often reminisce about the easygoing way we practiced medicine in those days. Patients were friends, not adversaries. No time was wasted hunting for diagnostic codes or E&M categories. We were appreciated for doing our best with the facilities available. And I somehow felt secure knowing that I would not be sued for malpractice in connection with the monkey's death."
"The practice of medicine involves more than making the right diagnosis. The real challenge is integrating the patient, family, and doctor relationships and making them work. I found out how nice this can be when, a week after a rather puzzling phone conversation with the equally aged sister of a dementia patient, I got a letter from still a third family member. It thanked me for taking the time to speak on the phone with her Aunt Tiffany about her Aunt Gert's condition. Tiffany, it seems, had passed away the day after speaking to me. She'd been worried about Gert, and I'd eased her mind."
Your Voices. Medical Economics 2001;11:101.