Unfriending your physician

Are you Facebook friends with your doctor?

If you are, you are in the minority. Results from a recent survey of a few hundred French doctors who have profiles on Facebook revealed that most are reticent about having you as a friend and in fact, 85% of them would automatically deny a friend request from a patient.

Good for them. I don't think social networking is the place for a doctor and a patient. I don’t even need to like my doctor, much less follow her status updates. And who's to say I won't get bent out of shape when I see she's Facebooking like a maniac but can't seem to get around to calling me back?

I don't even think doctors should make an email address available.

My doctor should be allowed to not always be a doctor; but under the watchful eye of her patients, can she ever let down that persona?

This isn't to say that the existing doctor-patient paradigm is a healthy one, although it's better than the paternalistic one that it used to be.

Still, three times this week—in two blogs and a book—doctors have gone to some length to tell me the reader that hey, they are people too.

"No shit" was my response the first two times. The third time I got it.

PATIENTS …

We patients, we're a delusional bunch. It's awful how we unknowingly get together and fool ourselves. As we all sit in adjoining exam rooms, we're entertaining a narcisstic fallacy. Because we have one doctor's appointment we think that our doctor might have just one patient appointment. The 3-15 minutes he or she spends in our presence is, presumably of great importance to them because, well, because it's in OUR presence, concerning OUR health.

But I don't think most doctors give us more a second thought the moment they leave us behind in the exam room. I think they're mentally on to the next one before the door shuts. That means they've devoted all of a scattered few minutes to my health and welfare.

"REALLY SMALL BUSINESSMEN"

The patient-doctor relationship ….It's important to our mental health to regard this relationship in a light that's more bighearted and philanthropic than it really is, and that's because we look up to doctors and we believe they hold our lives in their hands.

Pfff. At a basic level, we pay them to provide a service. It's a transaction we do all day, every day, with plenty of professionals who provide services. But we don't fire lousy doctors nearly as often as we should.

It's time to end this altruistic notion, even if there's a kernel of truth in it.

The pioneer behind the war on cancer, Mary Lasker, referred to doctors as "really small businessmen", which sounds more scathing and belittling out of her original context . But because they look after our health, we tend to regard them with awe and admiration, as well as apologies and excuses mixed in, like "yes he makes a lot of money but he puts in 70 hour weeks and he studied for a decade and he'd be doing this even if he didn't make much money because at heart he cares about keeping people healthy."

Sure, they're out there. But not in the numbers we imagine them to be.

REALLY BIG LIARS

I caught this little MedScape article on physician reimbursement from Medicare for discussing end-of-life care. It says that busy physicians are more likely to broach the subject [of end-of-life care] if they are financially rewarded for it.

That statement is only as repugnant as it sounds under the old paradigm of doctors-as-altruists. Under a new one, of doctors as service providers (the way health insurance terminology refers to them), they are entrepreneurs with a business plan and whose primary interest is in the bottom line. And why shouldn't it be? What's so wrong with that?

This gets to one reason why people in the market for a new doctor should skip on asking friends or family. Think about it: if asked whether someone should go see their doctor, who would answer with, "Hell no, my doctor sucks. He'll kill you." People are bound to these decisions because they reflect on their character, which reminds me of the old saying about the only people who lie more often than quacks are their patients.

LOWERED EXPECTATIONS

I guess my point is that your health is best protected by lowering the expectations you have of your doctor. Yes they are well-educated, and well-trained. But not one of them is a white robed ubermensch. And in humanizing your doctor—i.e. by keeping in mind that they are business men and women first and foremost—you allow yourself a greater role in determining the direction of your health and treatment.

Just don't send them a friend request, if for no other reason, you really shouldn't be friends with them in the first place.