Having spent my entire life in the upper mid-west, I knew that moving to West Virginia would be a cultural shift. Food, speech, tempo, I expected all these things to differ from what I was used to. One thing I didn't anticipate was differences in medical treatment. Whereas I had been used to collaborative treatment: my doctor would give me as much information as possible, and then I would make a decision, here the attitude is very much "Doctor knows best," which leads to the assumption that "Doctor's time is more valuable."

When choosing an internist, I carefully examined the profiles of many of the area doctors. I chose a female, educated at Michigan State. Yet rather than tell me what my cholesterol and blood pressure values were, explaining what was normal, and then suggesting a course of treatment, she simply handed me a couple of scrips. When I had the audacity to ask what the numbers were, she mumbled some numbers and told me to take the medicine. Never mind that previous to that day, I had never had a high blood pressure reading in my life. Never mind that I might want to try alternative means, like reduced sodium intake, to control it. When I went back and my blood pressure was normal, she was very pleased--until she learned I hadn't taken the medication. She seemed quite offended that I didn't blindly follow her direction, and more than a little put out that it seemed I had been right.

Around here it is clear that the patient's time is worthless. They don't schedule appointments, they GIVE you appointments. Yesterday I was at the doctor and he wanted to do a follow-up in six months. I was paying my bill and the receptionist handed me a card with the day and time of my next appointment. No, "What will work for you?" or even, "Will this work for you?" Just, "This is when we are available, so it's what you'll take."

Even then, the chances that he'll actually be available are slim. More than once I've gotten letters in the mail saying "The doctor can't make your appointment. Come this other day instead." Again, no concern that it might not work for me. And there's the chance that when you show up for your appointment the doctor won't even be there. Yesterday, I had a noon appointment, and when I got to the clinic, they weren't even open. No doctor, no support staff, doors locked up. By the time someone finally showed up at 12:30, there were eight of us waiting--all with 12:00 appointments. I got in quite quickly (this being a relative term), but by the time I got out at 1:30, some of the people that were there with me at noon hadn't yet been moved to an exam room, much less seen by the doctor. The waiting room was jammed full--every seat was taken and 4 or 5 people were standing, and that's not even counting the guy laid out on the medical stretcher.

The previous time I had been to see this doctor (I'll call him Dr. V), it had been nearly as bad: I waited in the lobby for an hour past my appointment, growing increasingly angry as it became clear that the doctor was interviewing for a receptionist, but instead of making appointments for the candidates, he had told them to "stop by around..." They were taken to see the doctor quite quickly, even though they had no appointment. When I confronted Dr. V. about being made to wait, explaining to him that I, too, have an advanced degree, and my time was at least on par with his in value, he simply said, "Well, we do better than a lot of places around here." Even if it were true (and I'm not convinced it is, because even though I've only been here a year, I've seen quite a few doctors and he has been hands-down the worst), since when is being better than the worst acceptable?

I will not be going back to see Dr. V., and if I can find someone better than my internist, I will drop her too. The question is, can I find someone better than her? She was at least educated in the upper-mid-west. I can only imagine what someone raised and educated around here would be like. (Dr. V. doesn't give a hint, as he grew up in India and was educated in New Jersey--plus, he's one of those guys that's an ass no matter what culture he lives in.)