The Customer is Always in Pain

My misadventures in modern medicine, where doctors became vendors and patients became customers.

I think it’s called a Shoulder Impingement, or something. I’m not going to look it up, though; it’s too annoying. Also, I’m absolutely not going to a doctor about it. General Practitioners are expensive. And — can we be honest about this? — not very good, as a rule.

But everyone knows this by now, surely. There are good GPs around — everyone has a friend or knows somebody who has a good GP. Typically, they’re on the other side of town — not that it matters, because they don’t happen to be taking any new patients at the moment. So you grit your teeth and visit the most geographically convenient clinic and hope for the best. And it never is.

When I was twenty, I loathed doctors. Every time I had to go to see one, I came home with a story, and it was never a happy one. I felt individually cursed with bad experiences, and doctors became my pet hate. I learned to watch them like a hawk.

When I was about twenty-five, I’d taken up smoking Dutch cigarillos, and found it difficult to give up. I’d been inhaling them, which apparently you’re not entirely supposed to do. So, I consulted a doctor, and he prescribed me a medication called Zyban.

“Are there any negative side-effects?” I asked.

“Well, if you notice any, let me know,” was my doctor’s reply.

“In other words, you don’t know if there are any negative side-effects,” said I, because I was that sort of patient. “A word of advice, Doctor: it’s perfectly fine not to know a thing. People may even respect you more for admitting it.”

Three weeks later, I returned to his clinic.

“Here’s news for you,” I said to the man. “That medication you prescribed to me has made me entirely immune to the charms of tobacco. On the other hand, I seem not to feel anything at all. Is this the negative consequence you asked me to tell you about? In my current state, I cannot determine if it is.

“Also, perhaps noteworthy, I have not slept in a week. I feel perfectly calm and rested. I have become mildly concerned that I may be, technically, in a state of psychosis. For the past three nights, I sat in a chair by a window and stared at the moon. I have felt nothing for two weeks, now. I could stab you in the neck if you needed me to. Obviously, I wouldn’t without your permission. It would be indecorous of me. Cruelty is so displeasing, and lacking in aesthetics, don’t you think? But I see why some of you become doctors ...”

My doctor considered the matter and suggested I stop taking Zyban. Then he transferred to a different city and I never saw him again.

In general, my impression of General Practitioners was that they were, universally, unhelpful and uninterested. They just impatiently listened to your issue, wrote a prescription, and threw you out of their offices. I don’t believe I’d ever met one that was even personable or pleasant.

And then, I moved to Boston.

One day, I had to visit a doctor, and I came away without feeling provoked or irritated. For the next fifteen years, my experience with General Practitioners became, on the whole, positive experiences. I landed a job at Harvard’s Medical School, and even made friends with doctors.

And here’s something odd. Whenever I went to a doctor, that doctor would ask me detailed questions about my past, my habits, my diet and exercise, my family history. Then — the next time, when I returned — they would know everything I’d told them. It was like a magic trick. I came to realize they were writing down what I said into my file, and then re-reading that file before each visit. Which seemed clever. I wasn’t used to doctors acting like physicians, so much as sales representatives for pharmaceutical companies.

For fifteen years, every General Practitioner I encountered was good at what they did. They’d inquire about, not just my health, but my family’s. They were calm and on top of things. It was as if I was living in one of those unrealistic movies in which people do their jobs properly — which is completely unlike the real world.

In reality, most workplaces contain only about three individuals who know what they’re doing. And normally, they’re completely reclusive. Roughly half of everybody else is fighting over who is supposed to do what, and the rest simply consider it a successful day when they haven’t accidentally stapled their head to the desk.

But from my perspective, I just felt like I was maturing. My animosity towards General Practitioners seemed to be little more than a childish prejudice and one I could easily put aside.

One of my friends went to Georgetown to become a GP. To her, it’s all about helping people. I have all these stories about her being fundamentally nice and helping people. Growing up, I didn’t know such people even existed. These days, she’s a country doctor in Massachusetts. Part of me always thought I should move my family to her town just so we can have an excellent family doctor for the rest of our lives. It would be like living in a Frank Capra movie.

But most of the world doesn’t have excellent GPs. One of my friends who lives in Silicon Valley is faced with the same challenge. The good doctors aren’t taking new patients. Also, Byron, who lives in the woods of Pennsylvania, probably hasn’t seen a doctor for years, first, because it’s expensive, and second, because they offer so little.

Whenever my friends turn up to one of these corporate-run healthcare franchises, they never get the same doctor anyway. It’s always someone different. Not that it matters, because the doctor just stares at their computer monitor, asks what prescriptions they need, then throws them out of their office.

A few years ago, I moved from Boston back to Australia, and ... it’s like being a kid again, in the sense that every visit to the doctor makes me want to punch a wall. It’s also stupidly expensive. It never used to be. Funny thing: apparently, in my absence, a succession of ‘business-friendly’ government(s) started to transform Australia’s (universal) healthcare system into the American healthcare system.

There isn’t an American alive who praises the American health care system. If you think you’ve met one, well — I don’t believe you have. You have merely met a lizard person, going about in a latex mask. Even when I was taking that medication, Zyban, I wouldn’t have thought American healthcare was praiseworthy.

Anyway, for the past month I’ve had this weird Shoulder Impingement injury. My wife says I should visit a doctor, but I don’t want to spend a hundred dollars just to be told by a doctor that I ought to rest my shoulder.

It’s like a dull, and sometimes throbbing, ache. If I move my left arm in a forward-ish direction, it can get bad. If I move too suddenly, it’s like being punched extremely hard into the middle of my shoulder. Sometimes, whilst showering or toweling myself off, I forget it’s there and ... I kinda have to scream.

Most nights, it’s difficult to sleep because I tend to roll onto my left side — and by sometimes, I mean, like, forty times a night. So, sleep-deprived, and stumbling around in pain, I haven’t been able to write any newsletters. In fact, I just got rundown, and caught a bad cold. I lay in bed for a few days. It sort of helped my shoulder a little.

Sometimes, I wonder what a doctor would say about all this. I mean, I could go and ask one, but I’m not in Boston anymore. Whenever I see a doctor, here, I become annoyed with the profession as a whole.

Last year, I went to get a prescription for medication, and the doctor remarked at me, in an admonishing and imperious sort of way: “You know, men your age typically avoid visiting the doctor. You avoid healthcare. You should know that’s potentially dangerous.”

I feel like, if you pay ninety dollars for a four-minute appointment with someone, that individual is professionally obligated not to speak to you like an idiot. Now, the last thing I want to do in any given day is school somebody on etiquette; I have children, and I find the entire topic exhausting. So instead of that, I decided simply to tell the truth.

“Once a man hits his forties,” I said, “he realizes that his sanity depends on avoiding certain kinds of situations, and too often, visiting a doctor is one.

“I mean, does corporate-run healthcare make you happy, Doctor?” I asked in a rhetorical sort of way. “Because for some of us, this is all just ... another way the world has been ruined before our very eyes. And before you answer, please remember that technically I am not your patient, anymore; I am your customer. And my chief complaint, here, is that you, along with your entire profession, seem to not be receiving adequate training in customer service.

“My experience with General Practitioners is that they are rude and lack thoroughness. It doesn’t surprise me that my entire demographic are not happy customers. Perhaps you all should take a look in the mirror?

“As for myself, I sincerely prefer a visit to the dentist, because a dentist, at least, seems to care deeply about my teeth. Obviously, I find that a little unsettling, but there’s no denying that they care, bless their hearts.

“I lay down in that dentist chair, and I feel ashamed of myself. I feel like I’m letting my dentist down badly. And I vow, every time, to become a better man. They’re kind to me, they stuff cotton balls into my mouth and drill my teeth, and ask me lovely questions, and then I walk out of there feeling chastened and determined to live a better, more responsible life.

“I never feel that when I come to see a General Practitioner. This is like ... ordering food in a food court, in the sense that the food is both terrible and expensive, and the server is talking at me like they haven’t been paid enough to be here. Except that’s not the case, is it?

“So, perhaps it’s not that men my age hate visiting doctors, so much as we’re avoiding bad customer service experiences, and potentially stressful situations that will leave us angry and dissatisfied. And who knows? Maybe if you pass that up to your corporate overlords, they won’t replace you with AI Chatbots as soon as they possibly can?”

Anyway, that conversation occurred within a five-minute appointment which cost me ninety dollars. Later, I found out she’d written me a prescription for the wrong medicine.

I think my shoulder is getting better. I am sleep-deprived and run-down but I do feel I turned a corner a few days ago. It’s Christmas, suddenly, and this is my favorite season. I plan to write to you all again in the next few days, so look out for that. If you’ve been awaiting an email from me, I’m sorry I’ve not been in the best of form. A good number of people have written to me this month, and I haven’t responded because I’ve been in such an odd state of mind, and, of course, using a keyboard has been a challenge.

I love you people. With chaste affection,

Kris St.Gabriel