The War Front Between Eastern and Western Medicine is at the Individual

I know nearly nothing about Eastern Medicine or Western Medicine, but I have heard a few comments that reflect a difference exists.  Is Eastern healing more of an art?  Is Western Healing more of a science?  Is Eastern Healing more causal and exact and is Western Healing just a series guesses?  I think that these are interesting questions to explore, as is the question is Eastern Medicine and Western Medicine basically the same.  Are they simply expressions of compassion?

A few weeks ago, I had a discussion with a patient, lets call her Hae.  She was on my list to schedule a routine follow-up appointment in the Specialty Clinic.  I called through a Korean interpreter and greeted the patient.  She sounded glad to talk to someone.  As anyone who works in health care or any social service can tell you:  an illness manifests itself in different ways and you can hear it.  An illness can make a person rude and impatient.  In speaking with them you hear pain sharpening their words.   An illness can make a person feel a sense of entitlement.  You can hear them relentlessly try to take back what pain has taken from them.  Some patients just sound confused.

When Hae spoke she sounded hopeless.  I offered her an appointment and she balked at the timing.  She said that she already had an appointment with another doctor (her primary care doctor)  and she did not wish to return to our clinic.  I thanked her for her time and was about to hang up when she said, “But I don’t like this doctor.  He never does anything for me.”

“OK,” I said.  ” Would you like to come in here for an appointment?”

“Yes, but when was at your hospital last time you didn’t do anything for me.  You only talked.”

This is a common complaint in the Specialty Clinic, especially as people travel from across the state.  They say, “I’m not going to drive 200 miles and pay $150 in gas and another $100 for a hotel and another $10 for parking at your clinic for your doctors to just talk to me.”  The criticism is valid, in my opinion.  A lot of what the physicians do in the Specialty Clinic is simply “eyeball” patient or see how healthy they look and make some basic recommendations.  This is not trivial, however.  A patient can live with a chronic illness for a long time and feel perfectly healthy, then for seemingly no reason at all they fall out of their shell and get really sick really fast.  It is important to see them often to catch them before they shatter.

Hae continued, “If I make an appointment in your clinic will you do something to treat me?”

I stammered something non-committal  like, “The doctors will do what they can…”

“But, I need treatment.  No one helps me.  I go my doctor and he sends me to your clinic.  I go to your clinic and they say that nothing is wrong and send me to my doctor and now you are asking me to come to your clinic again, but you are not offering to help me.  I am in so much pain all the time.  I need treatment.”

I had access to Mae’s medical record and I began reading it so I could understand what the hospital’s interpretation of her problems were.  Mae went on to tell me about her symptoms and her pain.  Her medical records said that she had no diagnosis.  This is very uncommon for me to see.  Usually, by the time we see a patient they have already been diagnosed.  Mae simply had pain.  She had been sent to us because she had an MRI that showed tiny indeterminate nodules that likely had nothing to do with her pain.

I told her, “I can’t promise that the doctors here will be able to offer you treatment.”  I was getting into tricky territory because I’m not medically trained and I cannot get into any thing specific.

She started to sob, “Do you mean there is no cure for me?”

I worried that we were having trouble with the language barrier.  I tried to choose my words carefully and while I trusted the competence of the interpreter thoroughly I had no idea what was actually said to her.

“No, I am not saying that there is no cure for you.  If the doctors see you and believe that there is a treatment that would be good for you they will recommend it.”

She replied, “I don’t understand why doctors here can’t do anything.”

“Well, the doctors can’t treat you until they know what the exact problem is.”

She stated her symptoms again.

“But the doctors don’t know what is causing your pain.  They have to know what is causing your pain before they can treat you.

She started to get angry.  “I don’t understand why doctors here in the U.S. cannot do anything.  In Korea I would have seen someone and they would have treated me right away.  Why can’t they do that here?”

“Because in order to treat you the doctors here have to know what your diagnosis, what the cause of your problems are.  Unfortunately, we just have to wait a while and do another MRI.”

She began to break down again.  “I feel like nobody cares about me.  I feel like nobody cares about my pain.  I feel like nobody cares if I live or die.”

I tried to assure her that I was speaking to her and that I cared about her.  I went on to say, “the doctors cannot give you a treatment until they know what your diagnosis is.  Sometimes in Western Medicine if the doctors don’t know what to do they have to wait a little while and do another test and then maybe they will have enough information to make a diagnosis.  Then once they have a diagnosis they will recommend a treatment for you… if there is one available.”  I was kicking myself for being so honest and transparent, but I couldn’t lie to her just so she would see us.

We went back and forth like that for over 50 minutes with the interpreter caught in between.  Many times Hae would decline the appointment and as I thanked her for her time she would get worked up again stating that she wanted to be seen, but she wanted to also be treated.   I would tell her that we would be happy to see her, but I couldn’t guarantee anything other than talk.   Our conversation was like the Cyclic Universe theory where the big bang is repeated  for all of eternity.

I made one last push, pacing up and down the staff only hallway, “I am very sorry that you are in pain and that it seems like no one is helping you.  I understand that Western Medicine does have flaws, but I assure you that the doctors here do care if you live or die and I do care if you live or die.  If you choose to be seen here  I assure you that the doctors will do everything in their power to help you.  However, they might not have a treatment for you.”

At that point she said that she understood and that she appreciated the information.  She said that she did not wish to be seen in our clinic.  I asked her to please follow-up with her primary care doctor and I thanked her for her time.  She agreed and said goodbye.

Was it a wasted hour of my time and my employer’s pay?  Was it a waste of Hae’s time?  Did I upset her or calm her?  Did she follow-up with her pcp and is there any treatment that will help her?

I hope her body can heal her.  I hope that I helped shrink the rift between her and her primary care doctors and western doctors in general.  I hope that she gave me a greater insight to one of the many barriers in the doctor patient relationship… Or in this case, the patient-scheduler relationship.

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