Health-caring relationships

I was sitting on an examining table, waiting to meet the new doctor my insurance company had assigned me to, when she blew in the door, offered her hand and shook mine energetically.

Then the new doc sat down on a chair in the corner of the room, put her feet up on the seat of another chair and clasped her hands behind her head like somebody who planned to be there for a while.

“Tell me about your life,” she said, and suddenly a routine physical became a cross between a job interview and a high school reunion.

“Um. Aren’t you kind of busy?” I asked.

No, she said, because whatever illness or physical complaint brought me into her office in the future would be a direct result of whatever kind of life I was living. She wanted to know what she was dealing with.

I started with the husband who traveled for work, the two small children, the full-time job, the hour commute and, oh, that I worked until 1, 2 or 3 in the morning on a newspaper copy desk. Then I added the Step aerobics classes and the bad ankle.

And we were off.

That was some years ago, but I had found the kind of general practitioner they are saying we all need now.

One who listens. One who knows enough about us to understand the potential lifestyle origins of what ails us. One who is into preventing trouble. A physician for whom a shrinking compensation formula does not mean she has to see a patient every 15 minutes.

I bundled up my toddler daughter and rushed her to the pediatrician’s office, the panic rising like bile in my throat. Her high chair had collapsed and, as she flew forward, she struck the bridge of her nose on the edge of the kitchen table.

There was blood everywhere. Stitches, I knew.

But that didn’t scare me as much as the fact that this was the third time I had bundled her up with an injury. The first time, she had scooted her walker down the basement steps and banged her head. The second time, she had crawled up on the kitchen table for some crackers, fell off and broke her collarbone.

It was an alarming pattern and one that might have brought me to the attention of social services.

“Why didn’t you report me?” I asked my pediatrician weeks later when all the injuries had healed. “I mean, didn’t you wonder about me?”

No, he said. “Your explanations were perfectly plausible. And besides, I know you.”

Again, I had found myself in health-care heaven. Where the relationship between parent and pediatrician continues until the child’s high school graduation picture is on the office bulletin board.

You can argue that this kind of care is a thing of the past. Like the time Dr. Kinsel came with his black bag to my mother’s house (she had no car while my father worked) to give me an injection after an alarming allergic reaction to strawberries.

I have plenty of anecdotes like these. And I can gather plenty more with just a couple of phone calls. The kinds of doctor-patient relationships they describe are not a conceit. They are not a luxury or a throwback to another time or an example of pampering Western medicine.

They are an economy born of relationships.

My doctor rarely needs to send me to a specialist or for a battery of tests to figure out what is wrong with me. She knows me well enough. There is real savings there.

And my daughter’s pediatrician knew me well enough to trust me.

We are beginning what they are calling “a historic, summerlong debate” on the reform of health care, a system lawmakers have been trying to fix since FDR failed to get health care included in his proposal for Social Security 70 years ago.

This time, unlike President Bill Clinton’s attempt in 1993, all the players — hospitals, doctors, insurance companies, drug companies — are at the table because, as one wag said, they don’t want to be on the menu.

On that table are proposals that each will find completely distasteful: mandated coverage, the federal government as insurance provider, cost controls, taxes on employee health benefits. To continue the food analogy, this is sausage no one wants to see being made.

People love to talk about their health problems, so one more story.

When yet another health insurance change required me to leave the doctor who knows me so well for a year, I found myself in the care of a health care giant and assigned to a doctor based on my home address.

During my time under her care, we communicated through e-mail. Appointment requests, referrals, medication refills, medical questions, test results. My records were at her fingertips — via the computer keyboard — when we “talked.” The speed of her reassuring communication was a wonder.

Going back in time may not be the only way to improve health care.

— Susan Reimer’s e-mail address is at susan.reimer@baltsun.com.