washingtonpost.com  > Opinion > Columnists > Marjorie Williams

The Doctor Factor

By Marjorie Williams
Wednesday, December 31, 2003; Page A19

At long last, the revelation I've been waiting for: the reason why -- beyond the prospect of epic, McGovernesque defeat -- I feel so uneasy about Howard Dean.

The man is a doctor. This is the least-examined chapter of his career. But suddenly it all makes sense: Where else but in medicine do you find men and women who never admit a mistake? Who talk more than they listen, and feel entitled to withhold crucial information? Whose lack of tact in matters of life and death might disqualify them for any other field?

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As it happens, I've spent almost two decades observing politicians, whom on balance I quite like, and more recent years observing doctors, who . . . . Well, let's just say that mine is a grudge tenderly nurtured over two and a half years of illness, encompassing roughly 32 doctors in six hospitals, plus scores of the medical students, fellows, interns and residents in whom we can see the doctor in larval form.

A doctor who has told you one thing at Appointment A might propose an entirely different course of action at Meeting B. Fair enough -- except for the pretense that nothing has changed. It is the very rare doctor who will say, "I've changed my mind," or, "Sorry, I was wrong when I said X at our last meeting." Usually, what he said last time has simply become . . . inoperative.

Now let's turn the clock back to September, and watch Dean answer George Stephanopoulos on "This Week" about his 180-degree turn, over the years, on the North American Free Trade Agreement:

GS: "On NAFTA, you used to be a very strong supporter of NAFTA."

HD: "George, you're doing it again. I supported NAFTA and wrote a letter to President Clinton in 1992 supporting NAFTA. That's different than 'you used to be a very strong supporter of NAFTA.' "

GS: "You were a strong supporter of NAFTA."

HD: "I supported NAFTA. Where do you get this 'I'm a strong supporter of NAFTA'? I didn't do anything about it. I didn't vote on it. I didn't march down the street demanding NAFTA. I simply wrote a letter supporting NAFTA."

Dean was not in the least abashed that he had described himself on the same show, eight years earlier, as "a very strong supporter of NAFTA."

Now, we patients rarely dare to have such pugnacious dialogue with our doctors. George Stephanopoulos doesn't have to wear one of those demoralizing gowns with all the confusing snaps, and if you're sick you have more important things to do during your tiny portions of face time than bicker with your doctor.

(A disclaimer: Naturally, all the doctors who are presently treating and advising me are paragons of sagacity and compassion, nothing at all like the men and women I am so broadly lampooning. You know who you are.) The odd thing is that most of Dean's unacknowledged shifts in position are of the kind any other half-good politician, with some vaporous wording, could explain away in his sleep. But even when Dean makes what is clearly a blunder, it takes him days to make the apology that a rival campaign would instinctively produce before the next news cycle.

Which brings me to the irrationally strong impulse, shared by doctors and politicians, to hoard information. Consider the high-handed way Dean has tried to shield great portions of his gubernatorial records. Similarly, doctors seem bent on ensuring that you not read the runic scribblings they have made in your chart. During one hospital stay, as I sat in a wheelchair outside Radiology waiting to be pushed back to my room, I began idly flipping through my chart. A young female doctor-in-training I had never seen before stopped in front of me and said, "You know, you really shouldn't be reading your chart." I thanked her for her advice and continued reading. She repeated her admonition. I explained that I was 43 and couldn't possibly read anything worse there than I had already been told by five real doctors. Upon which she actually wrested it from my grasp. (From this I learned always to go to a stall in the ladies' room when I want to read my chart.)

Finally, let's turn to what newspapers delicately title "the temperament question." Dean's been called arrogant, angry, condescending, prickly. He has gotten this far by playing his chesty irritability as a sign of honesty and integrity.

But I have enough brusque, irritable doctors in my life without sending one to the White House. My most memorable brushes have been with an eminent surgeon whose method is to stride into the examining room two hours late, pat your hand, pronounce your certain death if he can't perform an operation on you, and then snap at your husband to stop taking notes, he can't possibly follow the complexity of the doctor's thinking. Dr. X swats away questions like flies. He spends five precious minutes swearing at the wall-mounted phone, which decades of surgical experience have not equipped him to operate, and then finally pronounces that he can't perform the surgery. "Unless you want me to. But there's a 50-50 chance I would kill you."

Why is it, I ask my husband on the way home, that I'm the one who's sick, but they're the ones who are allowed to have the big, operatic personalities?

I have the same concern about Dean. Why should Democrats choose to stand around all spring and summer holding their breath against the moment when Dean says something arrogant or impolitic? (Think Southern guys with Confederate flag decals on their pickup trucks.) We're the ones who are supposed to be allowed to go on with our temperamental little lives, while our major-party nominees are the poor chumps who have agreed to adhere to the rigid, Ken-doll theater of politics.

And so I bring to my assessment of this year's Democratic candidates one requirement that never crossed my mind before. First, do no harm.

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