Watching Marcus Welby may have led Americans of a Certain Age to expect house calls and long conversations with their doctors. Watching ER may have led younger Americans to expect a lot of noisy rapid action. Watching Grey’s Anatomy or General Hospital may have led many of us to sneak a peek into supposedly empty hospital rooms in hope of catching younger medical personnel in flagrante delicto. Popular culture undoubtedly shapes our expectations of the health care system, for better and for worse.
Age, class, and gender play their part, too. Younger males, especially blue-collar men, want as little contact with the health care system as possible. Real men don’t go to doctors and don’t take meds. Real blue-collar men watch ESPN, which rarely deals with medical issues other than the ingestion of illegal substances by professional athletes. Naturally, this tends to make doctors, when seen at all, the bad guys.
Women generally get stuck functioning as the designated interface with the health care system on behalf of everybody else in the family until they are old enough to need somebody else to handle those duties on their own behalf.
Middle-class, educated, white-collar Americans have higher expectations, because in addition to watching Private Practice and Hawthorne, they read Scientific American and the Health section of the daily paper. Which leads them into the same trap we collectively fall into: losing track of the distinction between what we can imagine being able to do, what science has worked out the how-tos for but not implemented yet, what elite medical care can provide if paid enough for it, what is actually being done in the majority of American facilities, and what poor people can get if they’re really lucky. The popular culture culprit here may not be a hospital show at all, but CSI and other purveyors of gee-whiz technology. In an earlier generation, we didn’t have so much trouble realizing that Dr. McCoy’s scanner was a couple of centuries away. Today, we rarely think about the fact that the various non-invasive technologies for imaging and surgery that we really do have available now are EXPENSIVE. ER was pretty good about discussing the financial facts of medical life where they were relevant to the plotline, but of course, in an emergency room, the law requires every bona fide emergency patient to be treated regardless of ability to pay, so the issue didn’t necessarily come up until much later, usually long after the show was over.
Quite possibly what popular culture and the health care system should be working on together is a medical version of Car Talk. You know, that Public Radio show on which, every Saturday morning, two Italian-American mechanics (both MIT-educated, and one of whom has a PhD, so much for blue-collar credentials) take questions from listeners nationwide about the foibles and failings of cars and mechanics. They have a pretty healthy and realistic attitude toward both. Cars are mortal. All cars eventually disintegrate and die. Mechanics are fallible and sometimes greedy. Car dealers and their repair and maintenance facilities are not necessarily much better. But most of us can keep our cars running for well over 100,000 miles by paying attention to telltale noises (Car Talk makes me wonder if good hearing and possibly even perfect pitch are Bona Fide Occupational Qualifications for a car mechanic), tending to routine maintenance regularly, and not doing Really Dumb Things. Some car problems are Really Dangerous, and some are just trivial or unpleasant. Check with your mechanic to see which is which, and don’t hesitate to get a second opinion when the first one doesn’t sound right. Since most of their calls involve cars over five years old (that’s forty-five in people years), they have no gee-whiz technology to call upon, just basic grease-monkey stuff. [Cars with GPS and rear view cameras are still brand new and under dealer warranty, so the Car Talk Boys never hear about them.]
This is precisely the level of technology most of us need to hear about when our bodies act up, except that we don’t usually give off telltale noises (other than the stuff stethoscopes listen for, which was probably a much larger part of the practice of medicine seventy years ago.) Unfortunately, doctors are mostly too nervous about getting sued to offer medical advice to strangers on the public airwaves (note that the Car Talk Boys never issue any disclaimers about their advice. Is this because so far, most of us don’t sue our mechanics?) There should be ways to work around this. Because, at least until we start heading into the Geezer Years, most of us think of our bodies pretty much the way we think of our cars: we just want to keep them running reasonably well at reasonable cost for as long as possible. We want our doctors to function like good car mechanics. Mostly, we want them to specialize in doing things we mostly think we could do for ourselves if we wanted to take the time and trouble, but it’s easier to let somebody else do it. We want hints on how to do some of the easy stuff for ourselves, and then we just want to leave the complicated stuff to them. If we could drop our bodies off at the hospital and come back for them later, most of us probably would, especially if we could get a suitable loaner in the meantime (Here’s a slightly used Mel Gibson, shouldn’t give you any trouble, but it’s only got a quarter tank of gas, be sure and have dinner on the way home tonight…)
And in the Geezer Years, we probably don’t expect what the medical establishment seems to think we do. We don’t want to live forever. We just want to keep functioning more or less normally for as long as possible. We don’t want to fight as long as possible. Whose idea was it to depict medical intervention in terms of combat in the first place anyway? These days, a lot of patients regardless of gender seem to buy into the model, but I suspect that’s mostly because they are made to think they ought to. I know the denizens of That Other Blog will say I’m pushing euthanasia or assisted suicide or something, but I think if the medical establishment were willing to tell patients it’s okay to give up or give in beyond a certain point, a lot of people would, thereby sparing themselves a lot of unnecessary pain and perhaps also cutting down on the enormous proportion of lifetime health care expenditures that is now spent in the last six months of life. Nurses are often better at talking about these realities than doctors, and maybe they should be encouraged to do it more often. It is their primary job, after all, to care about how the patient feels. Maybe hospital chaplains should be recruited for these discussions too; they are mostly connected with faith traditions that tell us the soul is more important than the body, after all. Doctors, on the other hand, tend to see themselves as the patient’s designated champion in the combat against death.
Well, enough of awkwardly chosen metaphors (a man’s reach should exceed his grasp, or what’s a metaphor?) Now that Obama has started talking about what used to be health care reform as health insurance reform, we will need to start looking elsewhere to change the health care system. Stay tuned for The Body Talk Boys, Mark and David Welby, and don’t eat like my brother.