Article Comments Trapped in Family Medicine Act IV: The Choice — Grow Or Pay More To Stay The Same

ntroduction: As we pick up with this ongoing series, here’s a synopsis for those of you new to the story: Mrs. Doctor, a primary care physician, has been going to marriage counseling alone since here husband, Mr. Insurance, has refused her pleading to attend the sessions together. He claims she is too spoiled and is threatening to find a new partner and a happier union, not to mention to find someone new who can help take care of their children (Patient 1, Patient 2, Patient 3 …).

Previous therapy sessions went well — until the last one, when the therapist seemingly accused Mrs. Doctor of being to blame for her marriage crises. At this point in time, the therapist asked her to return explaining why she should be at fault, and this is where we pick up:

Mrs. Doctor: I’m upset with you. I don’t know if I’ll continue therapy.

Therapist: I’m sorry you feel that way. Let me get this straight, you can’t decide whether to stand up for your kids (Patient 1,2,3) or abandon them … or whether stand up to your husband, Mr. Insurance, or abandon him … or whether to stay with therapy or not.

You still need my help. I’m not here to save your marriage if it shouldn’t be saved, rather I’m here help you decide how you can continue forward on a self-determined path instead of muddling along in a stupor of indecision.

Mrs. Doctor: Sometimes I think Mr. Insurance paid you off to take his side.

Therapist: I’m not taking Mr Insurance’s side; as a therapist I work to remain neutral. Because you pay my bill doesn’t mean that Mr. Insurance doesn’t have valid points of view, he’s just doesn’t feel the need to change. Think of the quote “There is a truth of life so cruel, so just, that a person must grow or pay more for staying the same.”

Today it’s your turn to face this truth. Mr. Insurance doesn’t think he needs to change. You, on the other hand, are ready for change. You showed up today, and I congratulate you.

Mrs. Doctor: Why?

Therapist: When I pull that “finger of blame shooting yourself” trick, nine patients out of ten never come back. The tactic isn’t very good for business, but it does separate the wheat from the chaff. Those 10% who do return mean business and are ready to make meaningful change.

Mrs. Doctor: But I’m not the one that needs to change — my husband, Mr. Insurance, needs to change. I can compromise, but he refuses to see what he’s doing wrong. I have no power.

Therapist: No power! Who holds the professional title of Doctor you or M.r Insurance?”

Mrs. Doctor: I do, but –

Therapist : Let me finish.
Who went to medical school, you or Mr. Insurance?
Who has the training to make an accurate diagnosis and treatment?
Who understands the science of disease and recovery?
Who has can prescribe medications and other treatments?
Who can order labs or x-rays?
Who must follow up on how well your treatments are working?
Who has the legal authority to make medical decisions for your patients?
Who has both the legal and moral authority to care for your patients?
Who best knows each individual patient and their needs?
Who do your patients trust the most?

Since the answer to every one of these questions is YOU (pointing his finger at Mrs. Doctor), I’d say you have more than enough power. Let’s get back to that pointing the blaming finger again; the one you keep leveling at Mr. Insurance. You see yourself as a victim and understand how burdened you are with Thidwick’s horns. But for a person with so much power…

Mrs. Doctor: I may have power, but Mr. Insurance pays all the bills. This trumps all of mine powers. When it comes to deciding which parent they’d rather live with, the kids might know me better, trust me more, know that I’m good at what I do, understand that I make their lives better, but in the end they take their chances with Mr. Insurance and his new mistress as long as he pays their bills.

Therapist: So it’s like the creatures in Thidwick’s horns, despite the eleven powers of yours that I just named, Mr. Insurance’s power over the kids is the ultimate veto. That’s quite the conundrum. Thidwick was in the same situation; he’s trapped and has limited choices because of all those creatures in his horns and the hunters have him cornered when …

Mrs. Doctor: He sheds his horns (she smiles as if a light bulb is turning on.)

Therapist: Precisely. Now you need to get to work. Considering all your amazing powers, why are you trapped by the coders, billing and negotiating specialists and the menagerie of other creatures Mr. Insurance insisted on? They all tell you, Mrs. Doctor, how to do your job and take care of your kids, who they don’t even know?

Why would your kids (Patient 1, 2, 3) rather stay with impersonal, uncaring Mr. Insurance — who they aren’t even sure they trust — over you? The question of the day is: What must you do win back your kids’ loyalty? I refuse to believe that your eleven powers leaves you helpless to Mr Insurance’s one.

Think about it.

Until next week next week, I remain yours in primary care,

Alan Dappen, MD