Monday, August 25, 2008

Every man his doctor

I'm back from vacation to find our main workhorse digitizing computer dead and no way to get scanned images off the two externals currently attached to it. So, in lieu of fun photos, we'll be all text today....

The transcript from the oral history interview with Dr. William Toffler, OHSU Family Medicine, is back from the transcriptionist. Reading through it quickly, I was reminded of one point made by Dr. Toffler near the very end of the session--a very sage point, in my opinion. Having finished up a discussion of his stand against physician-assisted suicide, Toffler related an anecdote with a thought-provoking punchline: if you stifle physicians' personal beliefs and make them all conform to a particular belief system (and we're not talking ethics here, which is a different kettle of fish), then some patients won't feel comfortable with any physician they might see:
Toffler: You know, I had a person from the Center for Ethics come to me once because she had found out that a patient, no, not a patient, it was a nurse that complained that a patient had changed her mind about a tubal ligation after I’d gone in and visited with the patient postpartum. And I said, “Well, what’s wrong with that?” Well, the nurse is concerned because you made her change her mind. I said, “Well, I can’t make anybody change their mind.” Least of all yours, Jim. “But I went in and I talked to her about options, and she chose a different option. Have you talked to the patient?” She said, “Well, no, but we plan on it.”

I said, “Well, good.” And if you find out that the patient did choose another option, I didn’t force her to do anything, which I think is impossible, you might want to talk to that nurse about what view she had about her future childbearing. Was she too poor to have more kids? You might want to talk to the nurse about the rejection that she had about that patient when she was bothered that the woman had not chosen to sterilize herself.
And then she went into other details about what I limit my practice to or don’t do. And I said, “You know, just being up front like I try to be with my patients, so they don’t have any surprises about where I’m coming from.”
She said, “Well maybe there’s still a problem, because people would come to you thinking you do these things, and they’re a waste of time.”
I said, “Well, I tell them that the visit’s no charge, if they had expectations.”
She said, “But still, they have to spend the time. Maybe we could post a sign in the waiting room that says what you do and don’t do.”
I said, “That’s really a good idea. In fact, it’s such a good idea, why don’t we have a sign out in the waiting room for every doctor like that?”
And she said, “Oh, I don’t think we can do that.”

See, I’m for transparency, Jim. And it’s interesting. I shared that anecdote with a writer from the Portland Tribune. All he did was reduce it down to, “Toffler refused to put it up.” I actually didn’t refuse. I thought it was a great idea. I encourage transparency in the house of medicine. And I encourage integrity among my colleagues for whatever they believe, so that their patients know what they stand for and what they don’t stand for.

And there were some patients who wrote when they were bothered by the press hinting that perhaps I took ethical stands that were at odds with the majority view of the institution. They said, “You know, if you exclude doctors like Dr. Toffler from the institution, then I’ll have no doctor that I’ll want with the world view and point of view that he holds. What’s more, you’ll have no future doctors that hold that viewpoint, because you’ll only train people who see the world the way you see it.” And this is a layperson with absolutely more insight, in my opinion, than some of my colleagues who hold ethical credentials and seem to lack the insight of true diversity and true respect for different world views that this particular patient in Hillsboro holds.

1 comment:

bechem said...

Hi your telling is true becuse every man is a doctor your giving this instuctions is very nice...........



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