The Right Month for a Pink Slip, I Guess

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I mentioned a few days ago that I'm in the market for two new doctors, one of which is a cardiologist.

The second isn't so much a new doctor as a replacement. And that's because after 17 years, I've decided to fire my internist.

When I started seeing him, he and his partner had a small, quirky, patient-friendly practice. They had funky art all over the place. They held monthly "salons"—discussions about politics, art, and current events. They were whip-smart but also funny and interesting.

They stressed preventive care—the reason I have annual physicals is because they got me into the habit. And they made life a little easier if you needed a routine Rx or a straightforward question answered—because they had lots of baseline information from your physical, you could call with minor issues or questions and have them addressed over the phone.

And they answered the phone. You'd call and ask for the doctor, and a minute or two later, you'd be talking to him. A few minutes after that, he (or his nurse) would call in a prescription to your pharmacy or tell you to come in that same day or give you the name of a very good specialist he knew personally.

During the physical, he'd talk to you about your life—what you did, where you were from, what you were interested in. He took notes by hand on plain white paper. He told you stories and established a rapport. He got to know you, and he remembered you from visit to visit.

As the years went on, the practice grew larger and larger. It was harder and harder to get through on the phone, even just to make an appointment. The waiting room got more and more crowded, and the care became less and less personal.

Still, I thought I was in good hands. I got what I needed from my doctor, harried though he might have been. And inertia worked its magic on me: the longer I continued as his patient, the less inclined I was to make a change. He knew me, I thought. He had a decade's worth of my medical records. Why should I start over with someone else—someone facing the same managed-care pressures as he was? I was healthy. I could afford some extra wait time on hold or in the waiting room.

And then suddenly I wasn't healthy.

All at once I needed a lot of medical care. And here's where that decade-plus relationship paid off. I got a great referral to my fantabulous surgeon. I got in right away for my pre-op physical. I got reassurance from someone I knew and trusted—and who happened to have trained at a brand-name cancer center.

My appreciation carried me a long way. And it allowed me to overlook some things that I would not have tolerated from a doctor I'd just met.

For one thing, Zach began seeing the same doctor—on my strong recommendation—many years before, and he'd had some negative experiences as the practice grew and became a more impersonal place. He talked for years about finding a new doctor, but I was never tempted to make the switch. I had too much invested in the relationship.

The initial fissure in that relationship came after my first breast-cancer diagnosis. For whatever reason, the doctor volunteered his opinion about my prospects for motherhood. It would be "suicide" for me to become pregnant, he said. The spike in hormones that would come with carrying a child would be "like laying a banquet" for the cancer to return.

He said all of this to Zach, who was in for an appointment of his own. I wasn't even there.

I was furious, but I let things lie. I was busy with other things—surgery and chemo, to be precise—and I didn't have the mental space to address what I felt was a serious lapse in judgment and protocol and respect. After the last of my treatment in late 2001, I continued to see the doctor for routine physicals, cholesterol checks, and the odd sinus infection. But most of my internal-medicine needs were handled by my-oh-so-wonderful-oncologist, whom I adored, and I didn't have much interaction with my internist.

Then I went off to grad school a couple of years ago, and suddenly my primary-care physician was the university's student-health service. Even if I'd wanted to see my internist, the school's insurance plan wouldn't have covered the visit. I was lucky enough to see a wonderful nurse-practitioner at the health service, and she became my go-to professional. Once diagnosis number two happened, of course, MOSWO was back in charge, so I was completely covered.

Now that I'm off the school's insurance plan and MOSWO has moved on, I gravitated back to my old routine and scheduled a physical with my internist. My appointment was last Wednesday.

I went in with a clear agenda: I needed a flu shot, I was overdue for a cholesterol check, and I wanted to talk about diet and nutrition and exercise. And, of course, I expected to have a complete once-over.

Things started off well enough. We sat in his office, and he pulled out a sheet of plain white paper and asked me what I'd been up to. I gave him the very abridged version: "I'm finishing grad school." He asked what I was studying, I said journalism, and then he said something like, "How soon before you become a blogger?"

I told him that I already had a blog and what it was about. For reasons I cannot fathom, he went on a long jag about suffering—how he was all for it if there was a purpose or benefit (i.e., a cure or a longer life) but completely opposed if it was in vain. Then he told me how strongly he favored euthanasia and that that's what he'd be doing if he had his druthers. He concluded by telling me that I should really write about suffering. Here.

I tried to explain that I write from my own experience, and that—so far, at least—that hasn't been my experience. This did not persuade him. Fortunately, he returned to the subject of the physical and started asking me for an updated family history. Did any of my relatives have cancer?

I gave him the history, which—aside from me, of course—runs mostly to great-uncles and first cousins, once removed. Among the exceptions—those more closely related—none had been diagnosed before age 75. It's true that one of my grandparents did have cancer (of a smoking-related kind), but not until age 95. The doctor sketched this all out in a family tree, then said, "Well, I guess you know what you're going to die of."

I must have blanched—wouldn't you?—because he said, by way of explanation, "There's no cancer in my family, so I know I'm going to die of heart disease."

Perhaps that was meant as a comfort.

It wasn't.

"There's heart disease in my family, too," I said.

It was at about this time—shortly after 8AM—that he pulled out a brownie from his desk drawer and began eating it.

"Don't you have a Ph.D. in nutrition?" I asked incredulously. (He does.)

He said something like, "That's what my wife keeps saying."

Then he told me that the brownie had come from a patient, which I suppose was intended to mollify me.

It didn't.

At that moment, "Talk about diet and nutrition" dropped off my agenda for the physical.

We moved from his office to the adjoining exam room, where he gave me the extended version of his elevator speech for the book he is currently writing. We had gone from conversation to monologue, and I mainly tuned out. Meanwhile, he gave me a flu shot and drew my blood for routine lab work. At least I had gotten the rest of my to-do list covered. I just needed to get through the rest of the exam.

I'm already getting seven clinical breast exams per year, so it's not like I needed another one. Still, if you're going to do it, do it right. His was a halfhearted effort, and he seemed to lose interest partway through. I have to wonder how diligently he would have done it if I hadn't already had breast cancer twice.

The physical ended with my slightly abnormal EKG. By then I was so disgusted that I didn't focus on the details of what he said, and for once I didn't have my notebook at the ready.

When I called the next day to get a clearer description of the problem, he must have thought I was obsessing about the results. (I wasn't.) I have to assume he was trying to reassure me when he said, flippantly, "You're not going to drop dead tonight."

He didn't.

I want very simple things from my doctors. They need to be excellent clinicians, and they need to know how to deal with people. Of the two criteria, you'd think that the first would be the tougher one. It always surprises me when physicians fall down on the second one.

In this case, "fall down" doesn't begin to cover it. "Plunge precipitously" seems far more apt.

But I guess I should be grateful that my soon-to-be-ex-doctor flunked the test so spectacularly, because it leaves me no doubt that I need to let him go. Any awkwardness I might feel about firing him after so many years is trumped by the memory of the careless, thoughtless, even callous things he said and did last week.

He's not a bad person. But he's no longer right for me.

As with any long-term relationship, it's hard to let go and move on. But I demand—and deserve—much better than this.

And I'm going to find it.