JP has strep throat–fun, fun, fun. Nothing beats a miserably sick child with a high temperature for bringing out certain primal parental reflexes.
This played out with me when I took him to the pediatrician. We just changed doctors recently because the docs at our previous practice never seemed to be able to get their act together. Any appointment short of a verifiable emergency meant being consigned to an hour or more in waiting room hell.
The new folks are a fast-growing medical practice in New York that has only recently begun expanding into my part of Brooklyn. The offices definitely give me pause. Shopfronts dressed up like a cross between a health clinic and hair salon; call me old fashioned, but I think I prefer my doctor to have bad taste in interior design.
Anyway, before I went in for the appointment, I called my uncle, an ear, nose and throat specialist. He told me that if JP had strep the doctor was going to recommend amoxicillin, and that I should refuse it and ask for a stronger antibiotic, whose name now escapes me. JP was then for strep (he puked after they jabbed the sample stick down his throat; fun!), and it came back positive.
Now, I should point out that the doctor, as it turned out, was on vacation. I was seeing the nurse practitioner (not that there’s anything wrong with that). She recommended amoxicillin, I said no, and…she looked dumbfounded. It simply never occurred to her that I might have a medical plan already in place.
“But amoxicillin is our first protocol medicine,” she said.
“That’s nice,” I replied, and parroting my uncle, added, “but it’s over-prescribed and not particularly effective. I want this” and asked for the other drug (whose name escapes me; downfall of writing at work and not home).
She seemed stumped and left the office for a few moments to poke around on her computer. When she returned, she said that against her better judgment she would offer me a different drug–still first protocol but not the one I asked for. Or, if I didn’t like that, I could ask my uncle to phone in the prescription.
Now, I’m going to keep my choice of drug to myself. That’s between me and JP. What I would like to point out is the nurse practitioner’s reliance both on rigidly defined protocols for treatment and her use of the computer to tell her what the options were.
Does this strike anyone as poor medical care? Shouldn’t the nurse at least pretend that she’s making up her mind based on experience, training, and a bit of black magic?
At work after the appointment, I was scolded by one of my coworkers. There were, he said, real public health policy issues involved in those protocols, and I was undermining the broader efficacy of the drugs by trying to insist on a non-first-protocol treatment. My desire to benefit myself at the expense of greater society was a prime example, he said, of the “tragedy of the commons,” which I learned was a societal danger caused “not by malicious outside forces but by the apparently appropriate and innocent behaviors of many individuals acting alone.”
In short, I was lousing up society by insisting on specific health care for my child rather than a cookie-cutter simulacrum. My response? (and I would like to hear from people who either agree or disagree)
Fuck the commons.