… do you think baby A’s stork’s beaks marks will fade?’
‘I can’t say: I never make rash promises.’
Now that we know we’re in Chicago for another year, I finally got round to two things: taking baby A for her delayed 9-month check-up, and clearing the backlog of New Yorker magazines that have been building up and plaguing my conscience (notwithstanding my previously recorded reservations about the magazine).
So there is an article that I heartily recommend in the 13th August issue, about how doctors could learn from The Cheesecake Factory. Sounds horrifying, especially since my only previous experience of The Cheesecake Factory is going to one with my mum and managing, between us, to misunderstand everything about the occasion, as if we had never eaten outside our own home before. But anyway, the article is fascinating.
One of the things it talks about is (I am paraphrasing somewhat) the way that doctors in America have almost totally unfettered autonomy about how they treat their patients, leading to a bewildering variety of practices. The example it gives is about the author’s mother’s knee replacement, and how in his hospital the nine specialists all had a different preferred brand of knee replacement joint, with wildly varying costs. Moreover you can’t easily get any information about these doctors’ varying practices, or statistics about their success rates – but nevertheless you are somehow supposed to choose a doctor and then be guided by their idiosyncratic advice unless and until you leave them for another individual doctor whom you know nothing about.
Coming from the NHS this is a bizarre experience. A slightly sneery woman in the Benefits division at Northwestern recommended general doctors for M and me when we moved over here. Except they weren’t GPs – they were specialists in internal medicine, whatever the hell that meant. I have never actually been to see this doctor because I don’t understand what she does, but because of our insurance plan’s restrictions, I had to choose a gynaecologist in the same group. I chose one on the basis of her office location. Then when I had to choose a doctor for baby A, I chose her on the basis of her office location, the fact that I can access A’s medical records online, and the recommendation of my ob-gyn (look, look, I used the American term!).
I know what you’re thinking: this is not a very well informed approach to medical care. Right. But what is? If you read the American What To Expect: the First Year, there’s an entire chapter on How to Choose Your Child’s Doctor. This includes: make sure they’re certified by the American Academy of Pediatrics (everyone is); look for ‘wallpaper with bright colors’ in the waiting room; go to the waiting room and ask patients how long they typically have to wait (as if).
What I now realise is that it’s actually moderately important to choose a doctor whose philosophy is in keeping with your own. So: I was lucky to end up with an ob-gyn (did it again!) who didn’t believe in inductions and was keen to keep me mobile and active in labour. But when I was choosing, I didn’t know the right questions to ask. Similarly, baby A’s doctor (whom we like very much) issues instructions about solid food that are quite at odds with British NHS guidelines. They leave me thinking: nice to hear your opinion – but what is the consensus here? Why would I be guided by one individual doctor on the rights and wrongs of starting weaning before 6 months, egg white, milk, wheat, berries, mango… when every doctor has her own approach, and they can’t all be either right or wrong? Basically: I want a nice NHS leaflet that everyone has signed up to, that is consensused-to-the-max, and I want a whole bevy of NHS staff who know what the leaflet says.
Because the other funny thing here is that you only ever see your paediatrician. Whereas in Britain there would be the hospital doctor, the GP, the midwife, the health visitor and then, I guess, some kind of clinic to go to – here it’s just the one doctor and her gatekeepers. This gives the doctor a borderline divine status. When you go for a visit you don’t go into the doctor’s office – that would be like approaching the holy of holies. Instead you go to a tiny examination room, undress, and sit around while a nurse takes your blood pressure and weighs you (me) or measures your head and length and weighs you (A). Then you wait in there for up to half an hour until the doctor finds time to swoop in, hug you, chat, prescribe as necessary, and swoop out leaving the nurse to do the vaccinations and anything else too messy. The paediatrician leaves us with a print-out that contains anything from three to ten sentences of advice, sometimes helpful, sometimes clear, sometimes neither, like the Bible, I suppose. ‘Your baby may wake more often at night towards 9 months. The best thing is to briefly reassure her and for you all to go back to sleep.’ ‘Wait on table foods for the time being.’ (Table foods?)
An actual audience is quite a privilege. I realised this one time when I called about seeing my ob-gyn and was told she had no appointments for a month. I practically burst into tears and then realised that I was making a strategic error. I did not need an appointment. I needed a phone consultation, which I promptly got, and which involved my doctor prescribing me two quite serious drugs without seeing me, and phoning the prescription through to my local pharmacy. I was delighted, but it all seemed very informal. (As do the paper prescriptions, which look like glorified post-it notes.)
Still. I doubt I will ever be on hugging terms with two doctors at once when we move back to Britain, so I must enjoy it while I can.
The Sceptical Expat 