Only a few were physicians. Although I had entered the hospital as an emergency case and had been tested for lethal disorders, I didn’t see very many doctors inside the building, either. During the first half day, in an emergency department hallway, I had seen one doctor for three minutes; she gave me a nice sense of the spectacular death that my symptoms might presage. I saw a second doctor during my spinal tap, if being on my stomach with a needle in my back counts as seeing. Radiologists did read my scans, though I saw neither them nor their reports. One hospitalist talked to me for five minutes and another for four, and I saw a neurologist for fifteen minutes over Skype (the nervous system cannot be examined over Skype). This isn’t much, but it is typical. In American hospitals, no one doctor ever seems to be responsible for a case, and patients strain to talk to anyone with authority.
We have an imbalance between the technique of tests and the technique of conversation. Of course, it is possible to err too far in the other direction, as Germans and Austrians sometimes do, and righteously avoid tests and medication (especially antibiotics) that really are necessary. My son had bacterial pneumonia in Vienna last spring, and it was a real struggle to persuade the doctors to test him for a bacterial infection. Like me, he did not complain enough, and male doctors did not take his mother seriously enough, so a system based on talking failed. That said, once the diagnosis was made, he was kept in the hospital as long as necessary, with attentive and superior care from doctors and nurses, and with no charges to us. He was admitted on his ninth birthday to the hospital where he was born, and the nurses and doctors made a fuss about that.
When I got sick in Munich last December, I also needed to complain more, and the doctors should have relied more on technology. If the German doctors had ordered a CT scan they would likely have seen a swollen appendix, and proceeded from there with antibiotics or surgery. That said, if I had been treated in Germany, I would have stayed much longer in hospital, been given appropriate antibiotics, and been observed. The cut-rate American disaster of being expelled right after an appendectomy without information about a second infection would have been impossible and indeed unthinkable. It was that scenario which brought me, ignorant of my own condition, to the hospital in Florida.
Although physicians were in short supply, what the Florida hospital did have in impressive numbers were elderly volunteers in khaki shorts and baseball caps. They were always ready, with a friendly wave, to drive patients from one pastel structure to another on speedy white golf carts. They also visited the patients in their rooms and asked how they could be helpful. It turns out that my default mode during medical treatment is polite and accommodating; when a volunteer asked about my experience at the hospital, I said that everything was just fine. The one thing I might mention, I said, was that I had hardly seen any physicians. I added that the nurses and the nurse assistants never seemed to know when doctors would make their rounds, or even who was on duty.
“You’d be surprised,” the nice old gentleman said, “but that’s what everyone says.”
* * *
The problem is not that doctors do not want to work with patients. As we see during the coronavirus pandemic, physicians can work extraordinarily hard and risk their own lives trying to save the lives of others. The problem is that doctors have very little say in what happens around them, and waste their time and energy pacifying greater powers. They no longer have the authority that patients expect and need. Every day, physicians have to pretend to patients that they matter more than they do. If patients understood how enserfed doctors have become, they would be less likely to come to hospitals, and less money would be made. American doctors are becoming props in advertisements, the front men and women whose coached smiles are meant to cover the gaps in our ragged patchwork of competing hospitals.
The pandemic was a moment when the cover dropped, when we could see that doctors do not matter in society and politics. The coronavirus was a financial bonanza for people with unrelated economic interests, such as owners of commercial real estate. The floodgates were opened for firms working for the Trump presidential campaign and companies whose owners donated to it. The richest zip code in America was granted two million dollars for no very clear reason. Insurance companies and private equity firms had a voice in policy; physicians and patients had none.
Though the economic crash of 2020 was actually a public health crisis, no doctors were convened to make recommendations. When the bailout was negotiated, we saw very few doctors and nurses on television proposing how the money might be spent. Our federal government managed to spend two trillion dollars without purchasing what we actually needed: tests, masks, gowns, and ventilators. Into early March it was actually the policy of the Trump administration to export masks made in this country to China. Not a single shipment of medical-grade N95 masks arrived on American shores in March 2020.
I am still in treatment and undergoing tests, so I see some of the consequences of this. It made me nervous to undergo an ultrasound carried out by a coughing, maskless technician. If doctors had been in charge, there would not have been such scenes. There would have been no plague in the first place, since we would have made testing a priority from the beginning. If doctors had authority, they would not have been trying to fight a pandemic without the necessary equipment. If doctors had sway, they would not have been wading into rooms full of infectious disease, day after day for months, without an appropriate number of masks.
A neighbor across the street, a physician with three small children who was treating covid patients at the local hospital, used our block email list to ask if anyone could spare masks: “the hospital is out of small N95 masks (my size).” Even in the better-equipped hospitals, of which hers was one, doctors were getting a mask per week, when a mask is supposed to be disposable. They put their masks in brown paper bags with their names on them when they went home, and picked them up again the next day. Doctors in South Korea looked like they were coming from a science fiction movie; ours looked like they were coming from the Salvation Army.
Throughout the country, people working in hospitals were exposed to the virus far more than they should have been. Without testing and proper personal protective equipment they faced risks they could neither estimate nor avoid. They could not speak openly about these dangers, because the owners of private hospitals protected their brand. In commercial medicine, doctors are supposed to be flat smiling pixelated faces on billboards and in-house promotion videos, not real people with real concerns about patients’ bodies—and their own. Doctors and nurses were fired for bringing their own protective gear to work, since this revealed that hospitals’ stocks were inadequate. Commercial medicine halted free speech. We heard much less than we should have about these outrages because doctors and nurses were under gag orders from their employers. The president of the American Medical Association had to plea for “physicians’ freedom to advocate for the best interest of their patients.”
When I was very sick I spoke often with my father-in-law, a physician. In addition to his private practice, hospital rounds, and teaching rounds, he is also the responsible physician at a nursing home in Pennsylvania. He caught the disease there; a caregiver in the same facility died of it, as did eleven patients. His wife had a debilitating stroke—a result, it seems, of a blood clot related to covid-19. She could not get a test, so it is impossible to know for sure. What I can say for sure is that she no longer remembers the names of her grandchildren.