Column: Just Wondering

Column: Just Wondering

Having never attended medical school (and not really having had the grades or commitment to do so), and having only completed 10th grade biology and freshman year astronomy, and rarely even driven by a medical school growing up, my understanding and/or instincts regarding how a medical professional plans and/or prepares for his day is as foreign to me as sugar-free chocolate (if I’m going down, I’m going down swinging; in truth however, considering the anti-cancer, alkaline diet I’m following, I do need to swing a little less frequently).

Nevertheless, having had multiple appointments with doctors/health care professionals over these last four cancer-centric years, I’ve often wondered how much preparation occurs before each appointment. There’s a schedule certainly, but does the doctor review it daily/weekly – in advance, to determine the course of his possible action/discussion with the patient? And if so, does he review/study/research said patient’s medical chart/history to better prepare for these discussions or does he sort of “wing it,” professionally speaking, and instead wait to hear what the patient has to say? Moreover, if there’s been lab work, diagnostic scans, etc., completed previous to the appointment, does the doctor receive indications – electronic or otherwise, before the appointment, with enough time to evaluate the results/read the reports or does he see it for the first time sometime during the day of the appointment? And while this curiosity exists in my head, is the doctor likewise preoccupied (even a little bit) with my ongoing health situation beyond the 30 minutes or so we spend together every few months or his time too precious, respectfully speaking? I realize he’s busy, but do I rank in his file? And if so, what does he know and when did he know it?

Not that I’ve ever felt unknown or disrespected when visiting either my primary care doctor or my oncologist, but I have felt a little distance when I’ve seen specialists: pulmonary, thoracic, nephrology, surgery, to whom I’ve been referred, who previous to seeing me face-to-face had never met and/or spoken to me. Now I never took it personally; I took it professionally, as in: I suppose this is the process. However, how do they know a patient they don’t know, let alone advise with proper consent?

Over time though, my thinking has evolved. Now I’m thinking/wondering if they are even supposed to prepare for me – and not by reading my file for the first time when I’m sitting on an examining table directly across from them or through study the night before, but at all? Perhaps my situation – as serious as it is to me, is not as serious to the doctor? And by that I mean, he’s not ruled by his emotions – he’s not terminal, that I know of, anyway. It’s just another day at the office – so to speak. I understand that he likely has many patient histories on his mind/in his head and focusing/preparing too much for one somehow has adverse consequences for the others. Maybe the treatment protocols, as complicated as they are to me, are fairly mundane to the doctor and don’t require that much homework, so discussing my chart as he reads it for that first time is no big/complicated deal and standard operating procedure?

I’ve actually experienced this sensation a couple of times with my oncologist. When I was a more frequent visitor to the Infusion Center – every three weeks, occasionally I would see him tending to other patients; he didn’t seem to know I was going to be infused that day (in fairness, the infusion appointment does not directly involve the oncologist), even exhibiting surprise at my presence. Still, I would more often than not ask him a question about my specific health situation. However, if I didn’t have a non-infusion appointment scheduled that day, he wasn’t comfortable answering my questions. He would say: he wasn’t prepared to answer the question. Apparently, he couldn’t pull my information out of thin air. I came to understand and accept that if it wasn’t my day to be examined, it wasn’t a good day to ask him health-related questions about yours truly.

Still, I wonder, as much from lack of knowledge as anything: are my expectations unreasonable? I know, in my head anyway, as concerns my cancer treatment, it’s all about me. But what about in my oncologist’s head? Am I on his radar or am I out of sight, out of mind? And if so, is there any harm in that, or is it just me wondering too much about too much (the bane of this cancer patient’s existence)?