3/6/2014 13:57

Playing decisively at the healthcare specialist's office

Being referred to a medical specialist could be good for a patient, I suppose, but I can't attest to that from recent personal experience. Since I started from feeling that my primary medical office hadn't provided the attention and treatment success that I had been hoping for, a new physician with a different point of view seemed a logical next step.

As is the custom, the nurse was to set up an appointment for me before I left the referring medical office. This is done less as a convenience to the patient than because of the low rates of compliance when the patient has to make the appointment. I've sometimes wondered about the causes of this non-compliance, but I'm less puzzled today than I was last week. In any case, the nurse came back with the phone number written on a piece of paper.

"You might as well call them yourself," she said. "All I get is a message to 'leave your name and number and we'll get back to you'." That seemed odd.

Before calling them myself, I looked at the specialist's website. Everyone has to have a website now. How you present yourself on the web should be a helpful indicator of your business and professional style. This website says, "We care about every aspect of your experience from your initial phone conversation". I cringed. But, I thought to myself, it is always possible that this is meant sincerely. Perhaps, as a small practice, the web page has the words of the physician himself. That is not how the game is most often played, but who the real players can affect how best to respond.

So I went ahead and called. A live person answered. I was lulled into a more hopeful attitude.

A few days later, a computer called me to confirm the appointment. I am not (as you might already be able to guess) a fan of robo-calling. I normally hang up on computers, often wishing that they could be offended.

My expectations now dulled, I arrived for my appointment. When entering the office, the very first thing I noticed was that the examination rooms all open directly to the front desk and the reception area.

I did not turn around and walk out. In retrospect, I think I did not play the game decisively enough.

"We care about every aspect of your experience," the website had told me, "from your initial phone conversation with our reception and scheduling team, to your interactions with our nursing staff and dermatologists during your visit." They had said nothing about interaction with other patients and their families, clothed or otherwise, so I hadn't thought to consider this before I arrived. That's not good enough as an excuse.

After half an hour waiting in the waiting room, a place where I was not visible to the reception area and was beginning to wonder whether perhaps I had been totally forgotten, a nurse came to take me to an exam room. She then rushed mindlessly through a rote list of health history questions, grouped abitrarily into unrelated triads.

Then she stood up and, pointing, said, "There's a hospital gown. You can probably leave your shirt on." I was beginning to doubt the assurance on their website that they "take great interest in you as a person".

I was closer to walking out after that. But I was still indecisive. I even considered whether I was willing to sit nearly naked in plain view of the front desk when the door opened, but compliance was not within the range of behavior I was willing to tolerate. In the event, I was standing in the middle of the room (fully clothed) when the doctor walked in.

It may be that we started off on the wrong foot, as the saying goes. Even so, I did not think it was necessary that their thoughts and plans be kept from me, hidden by half phrases and references to observations made (quite literally) behind my back. This is not the attitude which I had hoped for when I read that they "take great interest in you as a person".

Surely if that were true there would have been some attempt to provide me with information in addition to instructions in Basic English. Perhaps not. In order to play the game well, do I need to know precisely what test the physician intends to perform on the bit of tissue he extracted from me? I may have been wrong to inquire. The doctor must have thought so, anyway, since he jumped from the elementary past the helpful and into the technical. Instead of saying, "I will prepare the tissue for easier viewing and then look for fungus under the microscope", he snapped back, "a periodic acid - Shiff base assay." (That's per-iodic acid, not period-ic; the iodine colors the various human and non-human cells differently.)

Then he asked, "Is that something you are familiar with?" It seems an odd way to play out a strategy of "interest in you as a person". Odd, and not the most effective tactic to implement that strategy. I'm still wondering whether the statement of strategy is blatantly false or the skills of the major player are astonishingly lacking. These possibilities may not be mutually exclusive.

However this physician arrived at the manner in which he plays the Actual Reality Game, his playing brings to light a weakness in my own play. My strategy is to play as if the other players are all honest and intending to play rationally. To do that successfully, I need better skills in changing tactics when individual players chooses not to accept that role.