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Trapped in Family Medicine. Can This Marriage Be Saved Act I: The PCP Encounter

Last week, I introduced the key characters in the parody of family medicine which I entitled, Trapped in Family Medicine. Can This Marriage Be Saved.

As the scene opens, we see a typical day in the waiting room of a family practice: the primary care physician (PCP) is 45 minutes behind schedule. The room is packed with frustrated patients who glare accusingly at the receptionist, transferring their feelings of resentment to her for this routine and expected predicament.

Every few minutes someone storms to the front desk, demanding: “How much longer will it be before I’m seen?” … “My time is valuable.” …“I’ll send the bill for my time to PCP and see how he likes it!”…“What makes the PCP so special?”… “This wait happens every time I come and I’m not waiting anymore!”

The door separating the PCPs’ exam rooms from the waiting area open. Everyone turns their head expectantly towards the nurse who stands, enjoying the moment of power.  “The next patient is Mrs. Doctor.”  Mrs. Doctor stands, and trudges through the door, her look downtrodden amidst the hot glares of her fellow waiting room sufferers.

After a lengthy wait in the exam room, her PCP finally arrives and the following conversation ensues:

PCP: “Good to see you. It’s been a long time.” (The irony not being lost to either of them.) “How can I help you?”

Mrs. Doctor: “I’ve explained the problem to your receptionist, your scheduler, your nurse – along with the rest of the waiting room – and you still don’t know why I’m here. I’m exhausted, can’t sleep and need something to fix me!”

PCP: (taken aback by this assault.)   I think we can fix you up. (A brief exam ensues.) This should be easy. I suspect you’ve an atypical bacteria; let’s give you an antibiotic and see how it goes.  You should be back to normal in 10 days.
(takes prescription pad out and writes quickly)  Anything else I can do for you?
( He’s excited to be done quickly and to move to the next patient.)

Mrs. Doctor: Well….

PCP: (Thinking: Oh NO!  Here we go again! I’m an hour behind, and here comes another “Oh by the way…” The PCP sits, resigned but concerned)  What’s really bothering you.

Mrs. Doctor:  My marriage is in trouble. I work like a dog — really long hours – and always feel stressed and never have enough time. You must know what I mean.  I never feel appreciated no matter how hard I work and every year there are more demands and the same old frustrations that don’t get settled. My husband is a jerk! I’ve been thinking about leaving him for a long-long time.

PCP  Tell me about your husband.

Mrs. Doctor: I didn’t change my last name when we got married; his last name is Insurance. He’s conservative, and likes to be called Mr. Insurance – even by me his wife!  He’s so proud of that stupid name. I’m glad I kept my maiden name “Doctor” so that I’m not always associated with Mr. Insurance. It’s a little consolation.

PCP:  So what’s the problem?

Mrs. Doctor: We don’t get along. We fight constantly, don’t see eye to eye. He questions my judgment.  He’s demanding, and thinks I should do his bidding with a budget that gets stingier and stingier.  It’s hard and time consuming to keep up the household with so little. He’s always meddling in things, saying I’m not worth much and puts me down!

PCP:  What about marriage counseling?

Mrs. Doctor:  I’ve tried. Mr. Insurance says he doesn’t need help, and that everything is my fault. He claims I’m a spoiled brat, expect too much, and that I can’t discipline the kids or keep my house in order. Do you know how it feels to hear that when you work so hard and for so little.
(Mrs. Doctor breaks into tears.)  It’s not fair. If I leave, he’s got all the power and money and would even turn the kids against me.

PCP: Well I’m not a therapist, but I think you have four alternatives:

  1. Leave the marriage and find something else;
  2. Start antidepressants and hope that keeps you’re stable enough to remain in this unsavory condition.
  3. Stay with Mr. Insurance and keep a stiff upper lip. You know the kind of support the American Academy of Family Practice or the American College of Physicians keeps doling out, or the kinds of rah-rah articles we read in the practice management journals that say, “this ain’t so bad … I’ve seen worse…Things are just Hunky-Dory” I mean there’s still food on the table and you’re not out on the street, and the kids seem to be thriving. No one needs to know what you’re really going through except you and me.
  4. Seek counseling, even if you have to go by yourself.

What do you always tell patients when you see them in a marital crises? I know you’ve heard your same story several times a week from your own patients, Mrs. Doctor.  What do you tell them?

Mrs. Doctor: Alright, I’ll get some counseling even though I don’t think there is anything that they can tell me that I don’t already know.  Who do you recommend?

PCP: I’ve got someone who is a great marriage therapist — here’s his phone number. Personally, I’m not far from needing some therapy in my marriage too; I’ll look to you as a pioneer on that front and let me know how it goes?

And the curtain drops.

Until next week – and Act II, I remain sincerely yours in primary care,

Alan Dappen, MD

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