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Checking Into Doctor Hell : When You're Really Sick, the Last Thing You Need Is a Health-Care System That Makes Things Worse

March 08, 1992|Bob Secter | Bob Secter is the chief of The Times' Chicago bureau.

On August 2, 1990, Saddam Hussein sliced into Kuwait. On August 3, Dr. Edwin Kaplan of the University of Chicago Medical Center sliced into me, or more precisely, my right groin. He removed a couple of puffed-up lymph nodes and sent them to a pathology lab for analysis.

If everything that followed had gone as smoothly as Kaplan's knife, I wouldn't be writing this. He was gentle and considerate, pausing often to make sure that, fortified by local anesthetic and Demerol, I was feeling no pain. Afterward, when I was in the recovery room, he raided a refrigerator to perk me up with cookies and juice, and we sat around talking baseball for half an hour. As a surgeon, Kaplan proved quite deft, leaving me with an unusually unobtrusive scar.

Weeks later, lying on an examination table at another hospital, I was being looked over by two doctors of the female persuasion. After probing my body for telltale bumps, they turned their attention to the scene of the crime, my exposed groin area. "My, that's a small one," the junior of the pair cooed.

"I beg your pardon?"

She, of course, was referring to Kaplan's handiwork. I, of course, was not.

Perhaps the sickest part about being sick has nothing to do with the malady itself. Suddenly, miscues and miscommunications can come to dominate your life even as you struggle to save it. A few might make you laugh. Considering what's at risk, however, too many others can be terrifying.

Just a few weeks after my 39th birthday, a lump in my groin sent me to my internist, who sent me to Kaplan. The result--a cancer diagnosis--forced me into a crash course in both my illness and the shortcomings of the system deputized to deal with it. What I experienced, what all too many other patients have experienced as well, was truly a Doctor Hell. It's a twilight zone of bureaucracy, nearsightedness and detachment that can defeat or at least complicate even the best efforts of the most sincere and dedicated medical professionals, of whom there are many. Even if it doesn't end up harming patients, which it can--Doctor Hell produces needless anxiety, frustration and bitterness at a time when the last thing an ailing person needs is added stress.

Reviewing my case a year later as a reporter, I got a far more detailed look at behind-the-scenes hospital work than most patients ever get. With that perspective, the reason for some of the confusion and apparent missteps becomes clearer. No matter how many high-tech gizmos and wonder drugs have been developed, medicine remains more an art than a science--with few concrete answers.

But that doesn't account for the avalanche of medical fallibility that should be preventable but often isn't. Diagnoses are presented definitively, then suddenly reversed without any explanation. Tests are misread and treatments misapplied. Doctors can be arrogant and evasive, and patients are made to wait like supplicants, expected to pay exorbitantly, forced to navigate a stupefying bureaucratic maze and--cliche of cliches--are even misplaced on occasion. (More about this later).

"There are problems for patients in the form of a hassle every step of the way," admits Washington internist Charles P. Duvall, immediate past president of the American Society of Internal Medicine.

Charles B. Inlander, president of the People's Medical Society, a consumer group based in Allentown, Pa., agrees. "You (the patient) are helpless," he says. "You're in no physical condition to ask the right kind of questions, you're sick, you're feeling horrible, you're scared, you're grasping at straws for information. You're dealing with a bunch of docs who treat you as a condition, not as a real person." Little wonder that 69% of those questioned in a survey conducted for the American Medical Assn. agreed that "people are beginning to lose faith in their doctors."

A woman named Barbara sure is. Two years ago, her father spent nearly two months in a major Chicago-area teaching hospital after suffering a serious heart attack. He recuperated for several days in intensive care after an experimental heart-regulating device was implanted in his chest. One time, Barbara's mother came into the unit and found him gone. She was told he had been sent back to surgery, an ominous sign. For more than three hours, she sat in the waiting room, sobbing. Finally, a stranger waiting to see another patient took pity on Barbara's mother and started asking questions. Barbara's father, it turned out, was just fine and had been moved to a regular room hours earlier. The man sent to surgery was the next occupant of the intensive-care bed.

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