rules of engagement

I just returned from the dentist. It was six months since my last cleaning- what a good patient I am. Um, not. I suppose I get credit in the "good self help" category for making a cleaning appointment before having a infected tooth pulled - which I'll do in two weeks. But I should have had that done last winter when it first started. Pain is what usually drives us to the doctor, dentist, emergency room - but I had the luxury of a disgusting little fistula along the gum line of that tooth, where the pus was draining all this time. So there was no pain, and despite being a medical provider myself, I put it off - for a year. The apex of the irony here is that my partner fears the dentist the way small children fear the dark or things that go bump in the night. That there is lurking probability that there will be tooth decay, cavities and perhaps root canals laying in wait. That going to the dentist will result in pain, so while pain-free, why go? And did I say "oh, I know, I don't like going either. Put it off?" No. I encouraged (harassed) her to go get a check up and tend to her teeth; why? because I love her. Does this mean I love myself less? Hardly. So why didn't I go sooner.

We do not live in a culture of preventive care, of healthful living, or self care. Certainly in the current healthcare system that the US has (for some), many people do little or nothing until they have to because they can't afford it. Certainly I delayed my own treatment knowing it would cost me almost two thousand dollars for this one tooth to be completely and well repaired. It's not small thing. In fact I had a family member recently spend two days in the ICU after a bad fall, a five minute bout of unconsciousness and a bleed on his brain. Can you even imagine what that cost? Out of pocket? No small surprise he didn't go for the follow-up head CT, but even when I recommended he see the Neurologist to evaluate his headaches and functional ability, he agreed that would be a good idea. Do you think he went? Nope. Why?

Why do people wait until the last minute? Why do they wait days after an injury, a first sign of illness, a leaking wound, a sure sign that there is a problem, a serious problem, a life threatening problem? Replies to this question I have heard:

1. I am afraid of hospitals/doctors.
- translation: I afraid something might be wrong with me and yet when pain or a sense of impending doom strikes, people find they fear death more than the doctor or hospital and they still end up there when they need to, and perhaps could have been (better) helped sooner.
2. It's inconvenient. I don't have time to go. My doctor never has appointments.
- translation: I can't be bothered to take care of myself. Now, doesn't that sound stupid?
3. I can't afford it.
- ok, this is the only good reason I know. Which is why I feel hopeful with Obama about to take office and why I advocate for affordable healthcare besides just being a clinician.
4. I didn't want to know.
- that doesn't make it go away, though facing ones mortality to even the smallest degree can sneak up on you and freaks out plenty of people. Still doesn't make it go away - deal with it.
5. They'll find something wrong with me.
- um, if you're getting medical attention, you already knew that.
6. My (insert family member here) was killed (insert hospital) here.
- you're family member was probably already on their way out, or maybe they wouldn't have died (yet) if they'd seeked medical attention sooner.
7. I was ok (until I wasn't).
- well duh.
8. I didn't think anything was wrong.
- denial anyone. Oddly, it doesn't stop the illness or injury from getting worse. If you get some care when you need it, maybe you can sleep well at night knowing this is actually true.
9. I don't want to see just anybody, I want someone good. How do I find someone good?
- this one takes effort, maybe some education or at least some sense of entitlement, but it can be done, and if you want to live a healthy life, it just might be worth it, no?
10. I already know there's nothing anyone can do for me.
- ah yes, the know-it-alls. Even you will end up in a doctors office or hospital. Or there really is nothing wrong with you, stay home. Or you don't care of western medicine, ok, don't dial 911 when you have that sense of impending doom. Or get over yourselves, those people that spent 6-10 years in medical school might just know more than you about your health. Really.