Posted by utopizen on December 13, 2007, at 21:29:57
What do folks think about this who see psychopharmacologists?
November 7, 2000
CASES; On and Off The 'Best' Patient List
By ABIGAIL ZUGER, M.D.The first thing my patient Debra did when she got out of prison was change her name. She then went on systematically to change every single other thing about herself that she could. Now, six years later, there is not a trace of the old drug-using, prostituting, generally messed-up Debra in the whirlwind of achievement she has become.
She got a job, a promotion, another job, another promotion, and now a third job, a good one. She got her B.A., her M.A., and is just a few credits and a thesis short of her Ph.D. She got her learner's permit, her driver's license and a car. She got married, got pregnant, moved to the suburbs, got a mortgage, had a shower, had a baby. She is too busy to sit down.
I never see her anymore.
From my point of view, in fact, as far as Debra is concerned things couldn't get much worse. She may have changed from a social liability to a social asset, but she has also changed from a very good patient to a very bad one, and when I think about her these days I don't know whether to cheer or to grieve.
Debra the social liability would come in for her checkups right on schedule. She kept her medicines filled, took them on schedule, did her blood tests, watched her diet. Her enormously capable intelligence had little else to focus on back then but herself. Now, even a rattle in her car's muffler takes precedence over her health.
Last time we saw each other she tried to look contrite as I spouted the usual platitudes (take care of yourself, make time for yourself, etc.), but I knew that she really wasn't sorry at all; she was as proud of herself as she had every right to be, and among all the other sources of her pride was the fact that she is way too busy to be a good patient anymore.
What does it really take to make a good patient? Every time I run into one of those ''Best Doctors'' articles, I mentally review my own personal Best Patients list, a work in progress unlikely ever to see print, but one that gives me a certain pleasure to maintain.
Unlike the Best Doctors, those highly polished products of the best training who are able to perform in a reliable, reproducible fashion year after year without missing a beat, the Best Patients are, frankly, a pretty ragtag lot.
A few are just nice, capable, competent people -- Best Doctor types -- who never cause a moment's worry. When I give them a pill, they take it. They never get side effects from anything. When they are sick, they get better fast. They are extremely organized and write everything down.
Most of the Best Patients, though, are quite different. They take nothing because they get side effects from everything. They live through long, operatic bouts of health and disease, which they then recount at enormous length, with brio. They follow no instructions, they always know better than anyone else, they sample pills meant for others, they lend out pills meant for themselves, they disappear and reappear at odd intervals.
But each one of them has a personal take on health care with which I happen to agree, encompassing the principles of avoiding most interventions unless they are absolutely necessary, of bowing gracefully to the inevitable, of taking nothing and nobody at face value and of wasting no time in the event of real emergency.
As a group, the Best Patients lack the technical know-how of the Best Doctors, and their smooth social skills. My bet is, though, that in their wise and elastic understanding of the peculiar ways of human health, they have many of the Best Doctors beat cold.
My patient formerly known as Debra has made it on and off the Best Patients list a dozen times. I keep changing my mind about her. Each dazzling accomplishment gets her back on the list. Then comes another missed appointment without even a phone call, another lapsed prescription, another failure to take care of something small before it turns into something big -- and off she goes again.
It doesn't matter that half the high achievers in the world behave just like Debra, or that I have been known to do so as well. Sympathy votes count for nothing on my list. What I look for is a kind of a medical I.Q. that I am beginning to think is born, not made -- either in doctors or in patients. No degree of education, intellectual achievement or common sense in other realms of life seems to correlate with it. In fact, sometimes all those other attributes just get in the way.
Debra missed another appointment last week. I think she was studying for her Ph.D. oral exams. But since she didn't call, like a good patient would, I don't know for sure.
poster:utopizen
thread:800680
URL: http://www.dr-bob.org/babble/20071213/msgs/800680.html