How to Be a Good Doctor

Update: It was pointed out, correctly, that part of this post contained a statement that made a generalization based on age. That statement has been removed and the post updated with this message. It’s not feminist, and it doesn’t belong here. I’m sorry.

I actually had a really good experience with a physician recently. Like outstanding. With a specialist even — an endocrinologist, so if anyone in the northeast Texas general area needs one, I can recommend him without hesitation. I was kind of nervous; I’d seen an endo before when I was starting my transition but stopped because he was a really huge jerk. (My GP wasn’t entirely comfortable with writing scripts for hormone replacement but has been willing to for a while now. She’s also recommended and trans- and queer-friendly.)

Accessibility was poor to okay: I could have done with a chair by the reception window while waiting for them to copy my ID and insurance card. To get from the curb cut by the reseved parking to the front door, one has to go down the sidewalk across the front of the patio to where the ramp up the patio is. At least three cars were parked so that their noses stuck out over the sidewalk. If you couldn’t squish down to 18″/46cm wide, you couldn’t get through there. The doors were all unpowered and the front doors were on the heavy side. I didn’t see Braille signs at all. There was, blessedly, no music and no TV in the waiting rooms. The exam room was freezing; fortunately for me I’m tall and the ceiling was low and I was able to close the air conditioning vent but that’s not a widely available option. There were wide spaces around the furniture in the waiting room that looked like they’d easily accommodate wheels and other assistive devices. Some of the furniture was squishy but some wasn’t and the non-squishy furniture had arms to push up with.

They got to me right about when my scheduled appointment was. They weighed me, measured my height — 202lbs/91.5kg and 5’11 3/4″ (yes, they really measured me to the quarter inch ((sheesh)) and yeah I’m that tall — people comment constantly on how nice it must be which it kind of is except when I’m trying to buy clothes: for all that they love models my height designers apparently don’t believe women don’t come my size and shop at Target)/182cm — with my boots off, and they did bring me a chair for getting them on and off without my having to ask for one.

We waited in the exam room less than ten minutes. Maybe five. The office had mailed me a new patient packet with all the usual stuff to fill out (and the usual uninclusiveness of gender- and sex-variant people on the form, sigh *tick* F). The doctor apparently had spent the five minutes reading and absorbing it because he came in and introduced himself and greeted the wife and me as Mrs. and Mrs. Brown. It felt really good because NO ONE DOES THIS even the people who know we are legally married. Holy shit. The wife explained that I had an autism spectrum disorder and was not having a good day communication-wise. Also that even though I was not talking much today I was plenty smart (which is a construction I’m unfond of) and could understand doctor jargon (this I’m fine with — it’s a skill, not a definition of a person). He told us that on Mondays he had a resident following him around and would we mind if he joined us for the exam?

I’ve had doctors ask this badly before. Often it’s with said resident already present so refusal is an explicit personal rejection and difficult for even a lot of neurotypical folks, never mind those of us with moderate to severe social anxieties. This doctor asked it with the resident on the other side of a closed door. It really actually felt like I could have said no and it would have been okay.

He liked that I had typed up a list of all my surgeries and meds, the dosages, the schedules for taking them, and what they’re for — it’s a long list, twelve prescription meds total — and expressed sympathy that I needed them all. Even though my wife was helping me communicate, he mostly spoke with and to me. Once when he was looking at his notes he missed that I was nodding in response to his question and he apologized for not watching to see my response. When he was working out what labs to order, he noticed what insurance we had and apologized that we couldn’t use the lab in his office but would have to go to the one (not far away) that our insurance company had a contract with or we’d have to pay for the lab work. A DOCTOR. I’ve never run into one that noticed this stuff before, never mind knew what to do with our insurance company.

In short he seemed to be respectful of all the ways I was different: physically impaired, neurologically variant, queer, trans, everything. And genuinely respectful, too, not in that fake-ass “I don’t see the ways people are different from me” bullshit. [Age-based generalization removed by the author.] It was a really nice part of what’s been a string of mostly crappy days.

I’d really rather not have anything endocrinologically jacked up (and given the pattern of other Stuff that has been tested for, I’m not expecting that anything will be very wrong here either). But if I have to have something like that, I’m glad I know who to go to. ‘cos expertise is one thing. Respect like this — on the first time seeing me, on one of my bad days? — is rare. I wish I could drag all the bad doctors I’ve been to and gritted my teeth through seeing to make them watch this young man do brilliantly with a patient who is admittedly not exactly the most conformative person ever and yell “See? This is how you do it! This is how you make all your patients feel like you care about them.”

Cross-posted at Impermanent Records.

6 Comments

  1. That’s thrilling, when one meets a doctor who gets it. Warning you about the insurance-co.-specified lab is lagniappe.
    .-= Jesse the K´s last blog ..Quoted for Truth: Loving One’s Disabled Body =-.

  2. “I could have done with a chair by the reception window while waiting for them to copy my ID and insurance card.”

    I love the ones that keep calling you back up to the desk for that stuff.
    .-= Virginia S. Wood, Psy.D.´s last blog ..National Novel Writing Month =-.

  3. I love my endocrinologist.

    This great doctor was willing to talk to my stubborn father about my illness. (I was just lazy, according to him, but at the same time, he told me that if I went to Tae Kwon Do, I would die because the heart only has so many beats. Still puzzled over that one.)

    I’m so glad you found a great doctor – it’s great when anyone does, no matter what their situation – monthly(bi-weekly) checkup or yearly physical.
    .-= Kaitlyn´s last blog .."Responding to your message" =-.

  4. Endocrinologists seem to be the one speciality getting good press in fat and/or disability blogs lately! I’m very used to the fat-phobia of medical professionals (apart from my GP who I have well-trained!), so it was a great relief to be weighed and measured with respect, for actual medical purposes, rather than to ramp up the fat-related abuse. Some medical records were missing, and I couldn’t remember what happened to them (thanks, cancer brain!) but he asked me where I had had particular biopsies and surgery done and said he would track them down himself. When I had cranked myself up all ready to deal with a new doctor who would have to weigh me, it was *such* a relief to be treated like an actual person. But it makes me sad that this is such an unusual experience.

  5. (yes, they really measured me to the quarter inch ((sheesh)

    Oh, this is so true. I am five four and three quarters, dang it!

    And I wouldn’t know without my endo visits.

    Which have thankfully been about twice a year now for a few years, with a couple exceptions. It’s good that that issue is under control, but sad because he is my most favorite doctor ever!

    Maybe endocrinologists treat patients with more respect re: weight because their whole field deals with it, in a way. Take the thyroid. (My problem.) Too little, you gain weight. Too much, hello fashion world! Endocrinologists, of all doctors, should know that weight (loss or gain) is often beyond our control.
    .-= Kaitlyn´s last blog .."Responding to your message" =-.

  6. Jesse the K, it really, really, really is.

    I so hear you, Kaitlyn. My GP had been giving me a hard time about my weight when I was fifty pounds heavier. She’s happier that it’s mostly come off and I keep pointing out that I haven’t done anything except change meds. Her thing now is my blood lipid profile which is admittedly scary-looking. But it’s always scary-looking. Even when I’m not eating meat and drinking coffee with soy milk the LDL and triglyceride numbers don’t move. And I won’t take a statin to lower serum cholesterol because I either wouldn’t be able to feel if I were having the really scary muscle-damaging side effects or they’d make the fibromyalgia pain worse. That and I can read a journal article as well as anyone and I know the number needed to treat for improved cardiac event outcomes is something like fifty treated for one patient who doesn’t arrest or arrests later. Serum cholesterol levels are a surrogate target.

    Virginia: I know, right? I’m sure they don’t actually watch to see when you’re just getting settled down to call you back but sometimes it feels like it.

    I’m really glad you found such a good one too, lilacsigil. 🙂