Practicing Cafeteria-Style Medicine

My patient Ester has reached the point in her life where her age is described in words, like octogenarian, as if by now the exact number isn’t that important. She calls me Hon, and sends me cards at Christmas. During her visit she tells me her little brother died of influenza. “The doctor came to the house. He tried, but in those days they couldn’t do so much. Not like now.” Her chin shakes. Her gray hair stands up, still curled from her regular Tuesday hair appointment. “He did his best.”

She says it with certainty, with absolute trust. He did his best.

The bleeding that’s brought her back to my office has scared her. We talk - or at least I do - about her options, about biopsies, or maybe a D&C. She listens, smiles, waits for me to finish. “What would you do?” A question I link with gray hair and loose skin and wrinkles.

To her, I’m the expert. Ester will do whatever I suggest. She treats me like a superhero. Makes me feel like she sees me with my white coat billowing out behind me, some bright Superman’s cape fluttering in the breeze as I rush off to deliver another baby. If she doesn’t see the pens and the gift shop Tootsie Rolls that spew out from my pockets as I round the corner, who am I to point them out to her?

She’s a holdover from a time when people trusted the experts in their lives: their butchers to recommend the best cut of meat, the waitress to tell them “what’s good here.” Was it that long ago?

The woman in the next exam room is younger. She’s texting when I walk in. Her cell phone never leaves her hand. She calls me “Nance,” and lists what she wants without bothering to tell me what’s wrong. Why would I need to know her symptoms? She’s already done her research. She tells me she has read all about her options on the Internet. Somehow I don’t think she has limited herself to WebMD.

“The black cohosh doesn’t work and that hormone replacement kills you,” she says. I can’t see her eyes. They’re still on her phone, watching her thumbs flick back and forth. She’s already decided. She tells me what she wants. Just runs down the list.

That’s cafeteria-style medicine. She’s here to place her order. She reads it off the menu as if I have it all lined up behind the counter and ready to toss on the grill. I can almost feel the hairnet on my head.

I wish I could have it all ready, just to pull out and place on the tray. It would be worth it. I really would wear a hairnet to have that. Could we list Painless Labor in Column A and Perfect Baby in Column B for the Family Meal Deal? These scrubs aren’t that different from some of those polyester uniforms.

This is definitely not what I dreamed of when I was playing doctor as a kid - when I wanted people to hold me in the same regard that Ester does. OK, so that was more than 20 years ago now. Long enough that the “girl’s toy” was a white nurse’s kit. My mother’s friends pressured her not to get me the doctor’s kit, the little black box with the red cross. That was for boys, they told her, but she gave it to me anyway. I listened to hearts. I pounded that plastic hammer, and wrapped friends in red ribbons for bandages. I wanted to pull it all out, to heal everything.

Being a doctor is not as much fun as playing doctor. But I think we have it better than physicians in ancient Greece. Wasn’t that where they punished doctors whose patients didn’t get better? Where the patient’s family might kill the doctor if the patient died? Maybe I would rather be sued.

Bing, bing. A chirp from her cell phone brings me back from my daydream.

“I’d like the special, a hysterectomy with two oophorectomies for the sides.”

I whip out my pen.

“Would you like fries with that?”

Nanci Hawkins is an OB/GYN. She works with two midwives and a great staff at Wise Woman OB/GYN in Watertown, N.Y. She can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the May 2009 issue of Physicians Practice.