By Barbara Berkeley
I’m trying to remember just when it was that people started to develop doctor-phobia. When I was a kid, my doctor was someone who was slightly scary, but mostly because he was from a different social class. He had nice suits, looked rotundly well-fed, and drove a Cadillac. Doctors were different then. They played golf and were off on Wednesdays, while our fathers worked in stores, factories and offices and always seemed short of cash.
On the other hand, my doctor was loved. I remember lying in my bed, hot with fever and waiting for the doorbell to ring. Dr. Shapiro would burst into the house full of a jovial bluster. “I’m coming, monkey!” he would shout as he bounded up the steps. Then he would smell like rubbing alcohol and his hands would be clean and slightly red from washing. His round face would be even larger and pinker than it seemed in the office with big tortoise shell glasses that covered most of this face. His magnified eyes, a watery blue, would peer at me excitedly. All would soon be well, his very presence shouted. After a bit of poking and prodding and a peek at my eardrums, I would get a shot of penicillin and be gifted with a little rubber monster with wiggly hands that could sit over the eraser on a pencil. Within a day, I would certainly be cured.
Dr. Shapiro did not simply make house calls and give shots. When I broke my leg in five places at the Roosevelt Stadium ice skating rink, it was Dr. Shapiro who set the bone. Months later, it was Dr. Shapiro who cut off the cast, got me off crutches and helped me to start walking again. Dr. Shapiro was the cardiologist who diagnosed and treated my father’s heart attack. He was the psychiatrist who dealt with anxiety and depression. He was the gynecologist who did PAP smears. He was the radiologist who read xrays. And, perhaps more than any of that, he was the calming, reassuring presence that confirmed that, yes, we were in good health once more.
Where has Dr. Shapiro gone? His kind of medicine has been erased and we all miss him. To some extent, his demise was inevitable. Our knowledge of the body has become so vast that it has become nearly impossible for any one person to treat all of its parts. Yet in dividing up our bodies into the tiny territories of specialists, we’ve lost the overriding personal relationship that once defined a patient’s connection to his doctor. We need to be whole, to be taken care of as a whole being. And something deep within us rejects being cared for as if we were a bunch of disconnected provinces.
Another problem has arisen as a result of advanced medical technology. In Dr. Shapiro’s day, you might expect to be sentenced to the dreaded “shot,” but that was about the worst outcome of any visit. Today, we live in fear that doctors will tell us that we need to spend an hour and a half in a claustrophobic, noisy, magnetic tube or to undergo cardiac catheterization or have this or that body part biopsied. We fear the result of our yearly mammogram, the report of our PAP smear. A visit to the doctor seems to have become a moment of judgement in which an often distant figure decides our fate. Drugs? Tests? Diagnosis? It all seems pretty frightening coming from someone we may not know very well anymore.
But there’s another side to this story and that’s the doctor’s side. As much as patients have lost, there’s just as much missing for those of us sitting behind the desk. A doctor’s power has always come more from the laying on of hands than from any specific knowledge, and in order to heal, a doctor has to have a patient’s respect and trust. When fancy tests replace the stethoscope, the gentle hand, and the listening ear, there is no room for a healing relationship to develop.
From the doctor’s point of view, there has also been a change in the very profile of illness. So much of our modern disease, particularly as we live longer, is tied to the way we live. Suddenly, doctors find themselves in new territory. They can either add drug after drug or they can try to counsel patients about changing the way they approach life. Medical school has ill prepared them for this task and thus many doctors are stuck giving the stilted, uncomfortable advice our commenters have described.
So, what to do? For the patient, I would suggest that good medicine, well-practiced, remains enormously valuable to your health. There is no reason to be afraid of someone who has your best interests at heart. So your job is to find that person. Since you are the consumer, I would suggest that you interview a number of doctors before you choose one. Make sure that wellness is as important to your physician as it is to you. Make sure, too, that your doctor will do everything possible to treat you as naturally as possible. Drugs are terrific, but only after lifestyle interventions have failed or when there are no other choices.
For the doctor, well…I can only speak for myself. I try to spend as much time with my patients as I can. I try to remember to touch them, to find out about their families and to worry about them. I try to keep in mind the fact that practicing medicine is an incredible privilege because of the access it gives you to people’s bodies and emotions. And I try to remember that facing a doctor can be scary at times.
On balance, I guess I’m grateful that I can rely on the latest CAT scan, the best MRI, the most detailed digital mammogram. But how I miss the jiggly little monster that used to sit atop my pencil.
