I went to physical therapy on Monday for my messed-up shoulder, and was a little disturbed when the receptionist said, Dr. X will see you now. A part of my brain said, I haven’t come to see a doctor — I’ve come to see a physical therapist. And then the other part of my brain remembered: Physical therapists all now have PhDs, and all are entitled to be called doctor. That’s also true of pharmacists. Psychologists. Social workers. Nurse practitioners. And even some PAs (who have been relabeled Physician Associates, instead of Physician Assistants)
Now everybody is a doctor, which is kind of wonderful, but also kind of confusing. Wonderful, because it means many health professionals have more book learning than they used to. But it is also confusing, because it is hard to know who is who, just from the way they are addressed. I’m an MD kind of doctor, so perhaps I have some chauvinism about all this, and perhaps I miss being special. But I don’t think that bothers me as a person, because I’m also the sort of human who doesn’t care what you call me, as long, as the old joke goes, as you don’t call me late for dinner.
What’s crazy about all this is that has developed part and parcel of a mushrooming health services market that is focused on profit, one that has turned away from serving communities. Once upon a time, you knew who the doctor was and who the dentist was and who the banker and the lawyer and the accountant were, and all those people were part of communities in which people took care of one another, communities in which the professionals felt a sense of responsibility and stewardship for their communities. It wasn’t perfect, back then. Too many people were kept out or down, judged by the color of their skins or by their faith or lack thereof or by their incomes or professions or family connections. Back then, once upon a time, most of us knew who was who and what the rules were, and all lives and jobs had a certain dignity because everyone understood how each of us contributed to the communities in which we lived or associated.
Now, everyone in healthcare is selling something. But no one is taking responsibility for keeping you, your family, and your community healthy. We’ve left that up to you, as we turned you from a citizen into a consumer. It’s up to you to figure out when you need a specialist and which one to see. It’s up to you to figure out if and when you need the hospital. And it’s up to you to figure out when you need a physical therapist, a psychologist, a social worker, a pharmacist, a nurse practitioner or a PA. Since all of those guys are doctors and all doctors are equal, you can pick one or more, and because they are all doctors, your insurance will pay them, and everything in this new reality is hunky-dory.
Except. Except in the real version of this new world, many people feel abandoned, anxious, alone, especially if and when they get sick. Your health care is now up to you and your computer or phone. Instead of talking to someone who knows you, you end up talking to a chatbot, or a person in a cubicle in the Philippines or in Jamaica, reading from a script from which they can never deviate. Or sitting on hold. Which is what life is like if you are a consumer and not a citizen.
When you need something and can find a human to talk to, that person is too often someone you are meeting for the first time, someone you’ll see for a week or two and then never see again.
We used to have relationships over time with people we trusted. But now we have reduced health care to a set of commodities and billable encounters.
Who is a doctor? Many people have doctorates, and that is a good thing, because more knowledge is better than less knowledge. But maybe the better question is, who is my doctor? Who knows me? Who can I trust to help unselfishly with my health and the health of my family and community.
It’s crazy to think that the degree matters. The degree helps. But it is the person who matters, the person who listens and then takes responsibility for being there for you, your family and your community. That person may be part of a team – but no degree and no team can replace the one person who knows you and cares.
