The Mail

Note: I attempted to place this in the "Comments" section of "Nov.30 Ways & Means", as it was written in response to a writer's commentary on that posting. I was unable to do so, initially because of technical difficulties, but ultimately due to length. And so here it is as a new post. To whoever posted their response to "NANDA" (which was really a response to "Nov.30 Ways & Means"), I did NOT delete your response, I just moved it to Nov. 30. Thanks! -N.H.

Dear writer,

Thank you for your response to my posting; I have relocated it from “NANDA” to this post, on which it comments. You raise a number of excellent points which I will try to address.

First, thank you for the reminder that I am writing, as a family physician, from a position of both power and responsibility. It is my hope and aim to never abuse either. I am, at the same time, human. I make mistakes. I do not always live up to my hopes and ideals; I nonetheless try, and I see your response as an opportunity for reflection. My path is always, I hope, one of learning. It should also be noted that the views and opinions expressed in my blog are mine alone and do not necessarily reflect those of my employer or of anyone else associated with me.

I am also aware that I am writing not in a vacuum but in the context of a small town. As such I am constantly reminded of the importance of relationships with all people. To this end my goal in interactions is no different than it has been my whole life, which is to say, to treat everyone with respect.

To whatever degree I have treated you in a way that you saw as disrespectful, I apologize. I do ask that if you would like to address this further with me, you do it in the context of our relationship as doctor and patient in the clinic, as this appears to be the source of your anger, and not in this blog. Out of respect for your comments I have left them as they stood, with the exception of the deletion of your use of profanity.

Secondly, thank you for the chance to point out something I should have stated explicitly: each patient example I gave represents a composite of multiple patient stories from my practice over the last five years in Seattle, Auburn, and here. As such, while any one patient might be based mostly on one person, there are always details that I have changed or borrowed from another patient to avoid identifying one person.

Thirdly I would like to address your question of why I and/or the clinic do not simply give our most needy patients the financial help they need. While I have and will continue to make individual donations to patients, the reasons that I cannot make this the mainstay of my efforts are many. One, I would go broke. Recognizing, again, that as a doctor I am in a position of great power, my resources are still finite. I have a family to support. With me already six years out of medical school, we still have over $100,000 of student loan debt. I rent a 2-bedroom house, drive a used car, and do not own a television. If I were to help out every patient who needs money—which is virtually everyone—I could not carry on what I hope to be a lifetime of service. Two, I would happily pay higher taxes to support a more just and moral healthcare system. As I pointed out in my blog, our current taxation system promotes gross inequality. Three, it is this system of inequality which I believe is doing our patients and our world the most harm, and which I have and will continue to devote my efforts to try and change. Not on behalf of one person, but for us all.

This brings me to the fourth point you raise, which is a very valid one: why on earth am I taking time away from clinic to go to Olympia and speak out?

You should know that my activist efforts are done on my own vacation time, at my own expense, and that every time I leave town for whatever reason I face a sizable stack of back-logged work when I return. So I do not do this lightly.

The reason that I still do it is that I believe in fighting for a more just system for everyone. Because I understand that I have power as a family doctor, I see part of my responsibility, as stated in my address to the legislators, as speaking out on behalf of those with no voice.

Is this effective? I cannot say. But I can tell you that one Senator on the Ways and Means Committee, to whom my efforts were addressed, found it compelling. Here is the link to her site:
http://blog.senatedemocrats.wa.gov/keiser/health-care-needs-exist-across-washington/

Finally, you might ask, if my efforts are addressed to the State Legislature, “why don’t you keep it to that, and not post in a public blog as a member of this small town?” The answer to that is that I hope to raise awareness amongst my own friends and contacts. While I do not promote my blog in any way to patients, I recognize that anyone can search my name and find my blog, as you did. I welcome that too. I aim to foster open discussion amongst anyone who takes these issues seriously.

As such, I also aim to enter into such discussion with an open mind, the awareness that I may be wrong on any issue, and always with respect. I ask that you do the same.

. . .

p.s. If your dissatisfaction with me had anything to do with me running late or not spending enough time with you (and if it was something else entirely, I again ask that you address this with me in clinic), first I apologize, and second I encourage you to speak up. I tend to run behind because I try to listen to patients; I would love to work in a system that allowed me to give you the time you deserve. Even before the budget cuts, we are under pressure to see more and more people in less time. Speak out! You as a patient have a voice—use it! Call your local representatives and let them know your concerns!

. . .

Final Note: To see the comments to which I was responding, please see "Comments" under "Nov.30 Ways & Means". Again, I moved the comments by "Little Cat" from its original location under "NANDA" to there, as this was the post it deals with.