Physician heal thyself

With all the talk about our healthcare system, we’re missing out on what may be its most pressing problem – the arrogance of some doctors. Awhile back I was referred to a dermatologist for a skin condition. Healthcare being what it is in Canada, it was months before I saw him. He took a few scrapings and said he’d send them to the lab to see what it is. Then he booked me for a second appointment, and said at that time he’d have the results and would examine me again.

This was the dead of winter and on the next visit it was very chilly. I booked the first appointment of the morning. The doctor’s staff was there, along with many patients, but he was not. Some 45 minutes later he waltzed through the door. I asked the receptionist why he was late and she said it was cold outside.

The doctor confirmed the condition, but couldn’t say what type it is. He didn’t examine me as he had promised, and shooed me out saying I should call if things get worse. A wasted visit, at least, for me.

Later I saw another doctor for a different problem. He said he could treat it. He booked me for three weeks hence and, as before, I chose the first appointment of the morning. Alas, I waited 30 minutes for his arrival. He didn’t examine me as he had promised, and only wanted to make sure I had come to see him. I was out in three minutes flat. Another wasted effort for me, another fee for the doctor.

Meanwhile, a small growth had appeared on my chest. My G. P. referred me to yet another dermatologist who said he could remove it with a spray, but it would take three sessions at fifty bucks a crack. It wasn’t covered. And he said he could get rid of those little polyps I had. “I’ll just snip ‘em off. It’s $160. I don’t take debit or cheques. Cash or credit card.”

He talked with the all-business demeanour of a retail checkout clerk, then checked out my earlier skin condition, which he concluded was definitely not what the first doctor had said. I agreed to the polyp removals, which cost $10 a snip. When including the spray for the growth on my chest plus taxes, the total bill was $220 for a 15-minute visit. Add $50 for each of two subsequent visits after that and the guy cost me $320. I realize this was an elective procedure, but the reason I went was to make sure the problem wasn’t serious. Never mind the fact that many years ago I had a growth removed, only then they managed to do it in one visit and it was covered. Strange how inflation infects not only economics, but our biological health as well.

Now let’s move to 2003 when SARS hit Toronto. Where were our leaders? Prime Minister Jean Chretien was golfing in the Dominican Republic. Ontario Premier Mike Harris was golfing in Arizona. Toronto Mayor Mel Lastman, who didn’t play golf, got interviewed on CNN where he asked, “What’s the WHO?” (The World Health Organization had issued a worldwide ban on traveling to Toronto). Over the next few weeks, 44 people died and Toronto was widely seen as a pariah. The perception, especially by US media, was that of a massive outbreak in the community, everyone in masks, people afraid to go outdoors, and “rampant fear and paranoia” on the streets.

The facts were that only hospital staff and patients were in masks, and notwithstanding the media coverage, it was pretty much life as usual. But Toronto’s handling of the situation was a classic in how NOT to do crisis communications. There was no single point of contact with the media. No clear concise messaging. No plan. And no leadership. But one voice of reason did emerge. Dr. Sheela Basrur.

Leadership is tested when times are tough and this diminutive woman – a doctor no less – shone like a beacon when all others failed miserably. She took control. She explained things in a way that people understood. She said to be calm.

Dr. Basrur was a physician who embodied the Hippocratic Oath, and not only during SARS, but during her entire life. After obtaining her medical degree, she visited such places as Nepal and India where she learned first-hand about preventive medicine. So she went into public health. Because of her, restaurants must now post notices in their windows saying if they passed or failed a health inspection. She helped make Toronto’s smoking ban in public places a reality. She developed a plan to tackle bioterrorism. And during SARS she led.

Three weeks ago she died at the age of 51 from a rare form of cancer. Though I never met her, I felt the same way I did when Terry Fox died. As if I had lost a friend.

The Hippocratic Oath, which I once thought all doctors adhere to, says, “In every house where I come I will enter only for the good of my patients.” Today doctors visiting your house has gone the way of the dodo bird. But what’s that about attitude? Like regarding patients as being so inconsequential it doesn’t matter if you show up on time. Or citing your services as if they are a shopping list. Or would you please not dally so I can move on to my next customer. Whatever happened to doctors being people who care for their fellow human beings and, in the process, show a little compassion? A person like Dr. Sheela Basrur. Unfortunately, such physicians seem to be few and far between.