Make a mental picture of your doctor's waiting room. There are some chairs, perhaps a couch, and piles of magazines for you to read while you wait . . . and wait . . . and wait until the nurse says: "The doctor can see you now."
If you have ever lived through this scenario--and most people have--you know how frustrating it can be. Of course you have the option of changing doctors. But has it ever occurred to you that your doctor can change, too?
Elizabeth Morgan, a plastic surgeon and the author of "Solo Practice," did just that. Once she ran an office with 30 patients filing through the waiting room on a typical afternoon. She had only limited time for each patient, and even then she was often more than two hours behind schedule. Now she runs a tighter shop. She sees fewer patients, but spends more time with them--as much as an hour with new patients, a half-hour on subsequent visits. Morgan chronicles this change in her latest book, a fast-moving account of a concerned physician starting out in private practice.
After 11 years of medical training, which she described in "The Making of a Woman Surgeon," Morgan decided to open an office in the Washington area, where she had grown up and where her family still lives. She was initially greeted by hostility from some of the older, established plastic surgeons. But much to her credit, Morgan does not cry "sexism" for this. Instead, she points to the realities of the situation: Washington is glutted with plastic surgeons, and any new ones--no matter what their gender--add to the competition.
When most people think of plastic surgery, they think of nose jobs and face lifts. This kind of cosmetic surgery is the money-making side of the business. But Morgan sees her work as being more than that of an overpriced beautician. "Plastic surgery," she writes, "involves reconstruction--fixing the body, putting it back together again--in children with birth defects, teen-agers with maimed legsfrom motorcycle accidents, workers with fractured hands, housewives who have lost a breast in cancer surgery." Although she takes her share of cosmetic cases, Morgan ends up with a large load of reconstructive work too.
Morgan's cases make fascinating reading. But she has a lot more to say about medicine than her tales of surgery. She describes the professional jealousy, borderline incompetency and greed among colleagues who charge as much as the system will bear. And, by way of inference, she tells the reader a lot about what is wrong with our current fee-paying structure.
One case that illustrates this point well involved a child who had a fingertip cut off by a kitchen knife. The top was hanging by a piece of skin. According to Morgan, the finger could easily be stitched back into place. The child would be left with a scar--and a finger that looked more or less normal. But Morgan did not handle this case. She was busy in the emergency room so another physician took it. He cut off the tip and shortened the finger. "Insurance pays much, much more if you shorten the bone and make it a complete amputation. You get nothing for putting the tip back," he explained to the dumbfounded Morgan.
In her book, Morgan describes a range of nonclinical trials she faced during her first year in practice. Outstanding among these events were studying for (and passing) exams that made her a board-certified plastic and reconstructive surgeon, and taking care of her seriously ill mother. She also discusses--sometimes at too great a length--the real problems of being a professional single woman who wants to stay professional but not necessarily single.
During her first year in practice, Morgan came to the realization that the demands of a successful private practice were incompatible with being a good doctor. She was overworked and often irritable, and she wanted--no, she needed--to put some humanity into her practice. And this is when she changed the way she ran her office.
In the old days, she would have scheduled an operation immediately for the patient who came to her office seeking surgery for a cleft lip that had been partially repaired in childhood. But now, with time to explore the motives of her patient, she questioned him about his feelings and found that he was so depressed that he had taken an overdose of sleeping pills recently. She advised him to get counseling for his problems before having the surgery. "If you kill yourself, even if the operation was a surgical success, have I helped you?" she asked. When he came back to her office a few months later, he wanted the surgery for positive reasons: He had a new job and a new outlook on life. Morgan commented to him during a post-operation visit: "The surgery didn't cure the depression. You did it yourself."
Elizabeth Morgan is not the only physician to consider seriously the whole patient and not just the nose, the liver, or the left lung. But she is still part of a relatively small band of physicians who do. Her book, "Solo Practice," is an encouraging sign that, more and more, humanity is returning to the practice of medicine.