Maggie's Farm

American patients are just as dreadful as European ones about looking after their own health and expecting their physicians to work magic and save them from themselves. The difference is that, so far, Americans are readier to sue their doctors when bad things happen. Americans have the curious idea that death and disease and defects of development and character are an affront, instead of simply part of our fallen nature. We also have the arrogant notion that we can completely control our own health. Nobody so outraged at a diagnosis as a vice-less agnostic vegetarian!

Greedy lawyers have exacerbated the problem. This leads some doctors to practice defensive medicine, order unnecessary tests, prescribe excessively (even if not encouraged to do so by greedy drug company salespeople).

We Yanks also have a tendency to diagnose and prescribe for ourselves, which complicates our doctors' jobs. We are definitely lacking in humility, and often object to following directions.

The doctors I knew in England were just as smart and just as dedicated to their patients as those here. They probably can't help being creatures of a culture in which everyone, from the drugstore clerk to the high mucky-muck hospital administrator feels entitled to four vacations a year, at least two of them abroad in sunny hollday spots. It is a concept mostly alien to us Puritans.

Their frustrations as expressed to me were about having passive patients who were fatalistic about giving up bad habits, ignorant. But it is more ego-gratifying to be a physician over there, as people still respect your authority. I have a young friend there who was barely out of med school and who positively bridled when I expressed reservations about a relative's meds dosage. "Speaking as a physician..."she sneered, continuing that I couldn't possibly understand such a complicated subject....An American doctor would have expected me to educate myself about the matter, so as to be more helpful to the sick relative.

I think physicians over there have been demoralized by the chains of socialized medicine, being prevented from practicing medicine in the best interests of their patients by bureaucratic guidelines. Nevertheless, despite it, they still make house calls, spend hours on the phone on their own time talking with patients and their families, pay welcome social calls, and seem much lesss afraid of being sued or misunderstood for offering warmth and comfort to their patients. Of course liability suits are starting to plague them now, but it is still much less adversarial than here.

A doctor and nurse there will usually talk with you openly about pros and cons of continuing treatment for a terminally ill patient, will offer advice, will express personal opinions about the character or weaknesses of a patient or family member. THey are not terrified of it coming back to bite them.

How many times in this country has someone desperately needed their physician's advice on something that they knew themselves technically ill-equipped to decide about, and too emotionally involved to decide rationally, but the American physician (liability shy) said "But of course, you will have to decide that for yourself...?." It's rationalized as empowering the patient, but the fact is even the proudest of us faces decisions at times where we need advice, and are not infantile for expecting their professional to give it.