Earlier this year, as various body parts and functions began showing signs of relinquishing their youth I came to the undeniable realisation that age was creeping, or ,perhaps briskly strolling, up on me. The thought occurred to me that I should probably see a doctor for a check up. I tried to ignore the thought because of the experience I had two years ago when I acted on a similar notion and attempted to find a caring, supportive family doctor. In 2015, seized with a sense of being proactive, I made an appointment to see the same doctor my mother goes to. As a family doctor myself, I often see several members of the same family, and knowing the family background helps me provide effective personalised care for the individual members, without violating confidentiality.
Sadly that visit, in 2015, with this particular doctor did not go well. I was soundly reprimanded for not having done all the routine screening tests for a woman my age. I got no credit for being brave enough to do a mammogram and blood tests. She took a quick peek at my varicose veins which were the main medical complaint that I had at the time, wrote a prescription for them, along with a sheaf of test request forms, and ended the visit with the admonishment that if I didn’t go get my tests done she would tell my mother. I thought she was joking….but a few months later, my mother says to me “Dr X says you haven’t been back to see her and she hopes you have done your tests. Have you done your tests?” The confidentiality of the doctor-patient relationship is something I consider to be very sacred, and this violation (on a relatively minor matter, but a violation nevertheless) so traumatised me that two years later, I was still very daunted by the prospect of a check up.
So now, in 2017, in spite of my efforts to ignore it, I knew that ultimately I would have to go and get that check up. This time, I made an appointment with a random doctor at the same health facility where I had my traumatising visit in 2015. I opted to remain at the same location because it was where all my medical records ( since age 6 ) lived. This time I had no expectations of a supportive doctor-patient relationship or good bed-side manners, and did my best to treat the visit the same way I would a trip to the supermarket. I had a list of what I needed and hoped that I would have acquired those items at the end of the trip.
I have been asthmatic since childhood, and over the past few years my varicose veins had become symptomatic. Both these conditions fall into the category of chronic communicable diseases (NCDs), and, in Jamaica, qualify for subsidy on prescriptions through the National Health Fund. In order to get the subsidy, one needs a doctor to complete a form confirming that one is indeed suffering from these conditions. So my list for this visit was the following: 1. General check up 2. Repeat prescriptions for my NCDs 3. A completed NHF application form 4. Requests for the required screening tests for my age and stage in life. With such minimal and specific expectations, I figured I could not be disappointed this time. Any competent physician, even with zero bedside manner should be able to fulfil those expectations right? …
The young lady doctor called me in to her office, and introductory remarks went smoothly. As a long time patient of this health centre my docket, which was in front of her, though not obese, was by no means underweight. I was no stranger to the doctor’s office as a child. When she heard I was there for a check-up and treatment for varicose veins, she glanced at the file, and confirmed with me that I was not diabetic or hypertensive. Presumably she saw when my last check up was. There were no questions about family history, occupation, drinking or smoking habits nor any further inquiry into any symptoms from my varicose veins. She told me there is no need to check weight, urine or blood sugar, and proceeded to check my blood pressure, pulse and breathing rate. I was then shown to the examination couch and instructed to remove my shirt but keep bra and pants on.
I should clarify here , for those who may not know, that varicose veins are a condition that affect the legs, of which mine were covered with very opaque jeans. My bra also was not of the sheer variety. Now I went to medical school over 20 years ago, but I doubt the steps for physical examination have changed much since then. I was taught the following sequence : inspection (look), palpation (touch), percussion ( tap with fingers, where appropriate) and auscultation (listen with stethoscope). So, while I undressed as instructed and lay on the couch, I was intrigued as to how my pleasant young doctor was going to inspect my legs and breasts through opaque clothing. Well, it took all of about 5 minutes for that riddle to be solved. Just as she had decided to omit weight and urine checks, she also omitted the inspection of my varicose veins, and breasts. After palpating my abdomen, she listened to my chest with her stethoscope, and there ended my physical examination.
After I got dressed and returned to my chair, we turned to my prescription, NHF application and request forms. I thought that part should be fairly straightforward, and she certainly was very efficient in filling out the forms . After that, she told me that once I did the tests, the results would be sent to her. If there were any abnormal results, she would call me in for an urgent visit . If the results were normal , then I would be called in for a regular visit…and that was the end of the visit. I thanked her and stepped out of her office, thinking that in spite of the large gaps in the physical examination, I had accomplished what I had set out to do with this visit.
Then, I inspected the papers that she had given me, and came to the sad realisation that, in fact, not even my minimal expectations were properly met. I was given a 3 month prescription for drugs to treat lifelong conditions. So in 3 months I would have to come back for another prescription. A closer look at the NHF application showed that she had indicated I had “mild” varicose veins. Now each NCD listed on the NHF form has a mild or severe rating which determines the benefits one is entitled to . I wondered how she concluded that my varicose veins were mild when she had neither inquired about any symptoms nor actually examined them.
These are the kinds of experiences that make people avoid doctors. As a physician myself, I fully appreciate and understand the importance of seeing a doctor for maintaining good health, especially with the scourge of the chronic non communicable diseases. Even with that knowledge though, my experiences with 2 doctors in pursuit of that “check up” have been singularly discouraging and disappointing…and I don’t think my expectations were that high. Confidentiality and competence should be bare minimum requirements for a doctor treating patients. Our health services in Jamaica are in very dire straits if the general practitioners that I encountered are representative of the majority of physicians that are expected to provide health care for the general population.