Monday, March 7, 2011

Low Expectations, Contracts, and All Types of Feasances


When a patient visits a doctor, s/he does so with a certain expectation. The patient recognizes the schooling and degrees the doctor holds. We pay him/her for his time, expertise, knowledge, and guidance. The patient is not allowed to be late to the appointment, as many offices reschedule the appointment for fear it will delay the already crowded schedule.  If the doctor keeps the patient waiting, so be it. The patient shuffles from room to room waiting for his/her turn.  Rarely do we complain about the time, and rarely do we leave the office in less than an hour, after a 10 minute visit with the doctor, of course. Regardless, it is a system that we all buy into. We accept. We may complain, but we need these people, these doctors. People in many societies have come to accept this modern medical practice. 

In addition, the doctor goes to great lengths to ensure the patient understands our responsibility, our financial obligation to the doctor for his time and expertise.  The patient signs many forms before the initial appointment -- outlining the beginning of this relationship.  The doctor will be paid for his service, whether through the insurance company or the patient.  The patient is paying for the service of a medical doctor. We pay them based on time, not results. In no way does the doctor ever promise to the patient that s/he will resolve our medical ailments. Isn't that a little messed up?

What happens when we patients can no longer get a doctor to listen to us? What happens when we are very clear about our symptoms, request certain testing to rule out our undiagnosed illness, yet the doctor refuses to help us?  It is my strong view that when a doctor who fails to investigate a patient's concerns about Cushing's -- yet we continue to pay them for their time but inattention -- it is a breach of contract.

"When a contract creates a duty that does not exist at common law, there are three things the parties can do wrong:

  • Nonfeasance is to ignore and take no indicated action - neglect. 
  • Misfeasance is to take inappropriate action or give intentionally incorrect advice.
  • Malfeasance is hostile, aggressive action taken to injure the client's interests."

I have heard story after story from my Cushie friends, horror stories of the treatment they receive from doctors who dismiss their concerns, symptoms, and knowledge. It makes me so sad and ANGRY.

Nonetheless, we Cushies have come to expect this terrible treatment from doctors. When were a far enough along, we can even joke about it.

To emphasized this point, my brilliant and super cool Cushie friend Cyndie created this video, which portrays a typical exchange between Cushing's patient and endocrinologist/doctor. LOSE WEIGHT. EXERCISE. Oh yeah, well, that won't get rid of my tumors, you jackhole!  


Now, repeat this exchange at every doctor appointment for 4 to 20 years, and then it doesn't seem too funny.