Finding One’s Way Amidst the Many Available Types of Medical Care
A friend’s experience illustrates how hard it may be to find appropriate medi- cal care. She had minor gastric problems from time to time and initially sought help from a family physician. He was unable to treat the problem adequately;
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therefore, she decided to go elsewhere. However, for many reasons— including anger, embarrassment, and fear of reprisal—she chose not to tell the family physician that she was dissatisfied with his care, nor did she request a referral. She was essentially on her own in terms of securing an appointment with either a gastroenterologist or a surgeon. She very quickly discovered that no physi- cian who was a specialist in gastroenterology would see her on a self-referral. In order to get an appointment, she had to ask her own general practitioner for a referral or else seek initial help from another general practitioner or internist. Since she had little money to spend on a variety of physicians, she decided to wait to see what would happen. In this instance, she was fortunate and has had few further problems.
As a teaching and learning experience, I ask students to describe how they go about selecting a physician and where they go for health care. The younger students in the class generally seek the services of their families’ physicians. The older or married students often have doctors other than those with whom they “grew up.” These latter students generally are quite willing to share the trials and tribulations they have experienced. When given the freedom to express their actions and reactions, most admit to having a great deal of difficulty in getting what they perceive to be good health care. A number of the older stu- dents state that they select a physician on the staff of the institution where they are employed. They have had an opportunity to see him or her at work and can judge, firsthand, whether he or she is “good” or “bad.” One mother stated that she worked in pediatrics during her pregnancy solely to discover who was the best pediatrician. A newly married student stated that she planned to work in the delivery room to see which obstetrician delivered a baby with the greatest amount of concern for both the mother and the child.
That is an ideal situation for members of the nursing profession, but what about the average layperson who does not have access to this resource? This question alerts the students to the specialness of their personal situations and exposes them to the immensity of the problem that the average person experi- ences. After individual experiences are shared, the class can move on to work through a case study such as the following.
Ms. B. is a new resident in this city. She discovers a lump in her breast and does not know where to turn. How does she go about finding a doctor? Where does she go?
One initial course of action is to call the American Cancer Society for ad- vice. From there, she is instructed to call the County Medical Society, since the American Cancer Society is not allowed to give out physicians’ names. During a phone call to the County Medical Society, she is given the names of 3 phy- sicians in her part of the city. From there, she is on her own in attempting to get an appointment with one of them. It is not uncommon for a stranger to call a physician’s office and be told (1) “The doctor is no longer accepting new patients,” (2) “There is a 6-month wait,” or (3) “He or she sees no one with- out a proper referral.”
The woman, of course, has another choice: She can go to an emergency room or a clinic, but then she discovers that the wait in the emergency room is
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intolerable for her. She may rationalize that because a “lump” is not really an “emergency,” she should choose another route. She may then try to secure a clinic appointment, and once again she may experience a great deal of difficulty in getting an appointment at a convenient time. She may finally get one and then discover that the wait in the clinic is unduly long, which may cause her to miss a day of work.