Thursday, November 22, 2018


This story is true and it bugs me, so though it's kind of indiscrete, I'm going to tell it.  "Doctoring", as we call it here, is a matter of driving.  There is a clinic in town one day a week but it's really more of a dispensary serving people with constant chronic conditions like diabetes, which is common.  I'm pre-diabetic.  I'm also a reader of medical material which makes me a kind of patient who is questioning and from a doc's point of view, a pain in the butt.  More than one has said bluntly, "If you don't do what I say, I will cut off your prescriptions." (Usually it's a female and often a "sub-doc," like a physician's assistant or nurse practitioner, categories that are relatively new.)

So I've been doc-hopping in hopes of finding a "real" and sympathetic doc.  Discovering that a previously unknown man had a new private practice only thirty miles away instead of the hundred-mile distance of the previous one, I made an appointment.  Knowing that the most grievous mistake most diabetics make is messing up their med regime, I took all mine in a box and asked him to reform and stabilize me.  He did that, carefully and successfully.  

But I needed to renew my prescription and he's only at his practise three days a week.  On the other two, his physical assistant (I'll call her Dagmar) sees patients.  I called Monday, was told there was an appointment open that very day with just enough time for me to drive there.  So I did.

The nurse, whom I feel I sort of know from other clinics, took my height (I'm three inches shorter than I used to be) and my weight (I'm a little heavier) and my blood pressure.  140 over 98, a little high, just about at the previous boundary which recently has been moved lower.  Some say so as to sell more meds.  I have not seen scientific evidence for the decision.  It was the same pressure reading on her big sphygmomanometer as my wrist instrument.  Blood pressure, like glucose %, are numbers that move all the time, responding to the environment and internal state.

The intake questionnaire was standard except for two big categories:  "Are you sad and depressed?" and "Are you all alone without support"?  There has been concern about depression and suicide in rural populations, so I wasn't surprised but it WAS more emphatic than usual.  A previous questionnaire was from a doc who had been serving a clinic for females and I was a bit disconcerted to be asked how many lovers I'd had.  Is two a lot or not enough?  It didn't ask gender.  Another woman said she was asked to fill out a questionnaire that had 6 alternatives for her sex.  She didn't know what "cis" meant.  (It's someone identified as one of the two binary sexes at birth and content with that.)

I asked for an a1C blood test to see if my metformin was working and a potassium blood test to see if my hydrochlorothiazide was proper.  She agreed, but then got to my blood pressure.  She wanted me to return to have a new test later.  I said no.

She said, "Do you know any reason why your blood pressure would be high?"  I said, "Coming to the doctor."  She was implying that I was in distress over something.

She said that if my blood pressure were high, I would have a stroke.  I said no.  (The last doc who went to threats said my feet would be amputated.)

She said that I should go by the Valier clinic to get a reading.  I said no.  (The last time we did this, the lab report was lost.  It used to be that a finger stick was good enough -- not a blood draw.  But there's more money in a blood draw.)

She said I should bring in my bp meter to check it against the big one.  I said no.

We were both losing patience.  I leaned forward and hissed,  "Argue argue argue.  I do not want to do these things."  She was taken aback.  Her patients did not balk.  She ended the "encounter" as the bill calls it.  She did not check my feet, but no one ever does though it is supposed to be one of the most important things for a care person to do.  Sometimes I ask them to do it, but I just wanted to escape.

I was a little baffled about what happened and why I came away with a clear vibe of danger, a need to get out of there when it should have been a place of safety and trust.  This has happened before.  I won't go back.

Dagmar was a young woman with no makeup, long unshaped hair. and gaudy but fashionable floral leggings.  She seemed "right wing," that is, accustomed to Lakoff's "strict papa" sort of governance, willing to go to punishment.  Half a dozen sets of patients came, each a woman with a much older man, father or husband who seemed in charge of her and went into the exam room with her.  They seemed like people from the country, Mormon or Pentecostal.  All women had long unkempt hair.  All clothes were oddly shapeless and colorless.  The women were overweight, the men were gaunt.  They seemed almost like Russian peasants.

When I added it all up, my conclusion was that the goal was to attach patients to the medical person.  These people are missionaries for a restrictive Christian position, who had not been to a major medical school where an MD has always been impressed with the high duty of the profession to honor patients and do no harm.  This position of idealism I've seen diminished over the last decades.  Dagmar had been neither exposed nor convinced.  Maybe she didn't know it existed.  

Medical use for political conversion is not okay with me.  I suspect her status is certified by a low-attendance certificate at a correspondence school, many of which are bogus or inadequate if investigated.  I hope she doesn't do surgery.  I suspect she prescribes a lot of psychoactive drugs for depression and painkillers for chronic complaints.  The obvious goal is lack of hurt and sadness -- escape from being human in a harsh place with no escape.  

The under-goal is obedience.   These people are to the right.  I'm far to the left -- I value individuality, originality, willingness to risk.  I'm not here on the high prairie because I'm like them, but because of the land itself, which for me is not a way of getting rich, but a way of fitting into creation.  My impatience with them protects me.  But I worry when I run into them, esp. in a doctor's office or among teachers.

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