The Doctor's Office

I’ve always tried to avoid the doctor’s office.  By justifying I am young and healthy, I rarely make yearly check-ups and only schedule appointments if my pain tolerance reaches above a 7.  You see, aside from never really having enough money for the co-pay (note to self: Being a professional student will NOT pay the bills), I really dislike the doctor’s office and all the rules that come along with it - from the signing of paperwork that you never read because anything more than five minutes at the check-in counter will generate exaggerated sighs and whispers from others waiting to check-in, to the awkward gown that you hope to God you put on the right way.

Unfortunately, my avoidance of the doctor’s office has been halted.  Pregnancy and now, a one-year-old daughter will do that to you.  In the past 21 months of being pregnant, going through childbirth, and raising an infant, I think I have been to the doctor’s office more times than my high school and college years combined.   As there is no way around this (as least I feel there isn’t), I grit my teeth each time and pretend, for my daughter’s sake, that this is one of the most exciting places we get to visit that day.

With my daughter’s one-year checkup around the corner, I got to thinking, “Why do I wear a gown?  Why do I need to arrive 15 minutes early?  Why all these rules and what is their purpose?”  Deciding to put my education and student loans to good use, I utilized my Social Geographies class to explore this question further.

Rules:

The Waiting Room:

1.     “Arrive fifteen minutes early” [eti]

2.     “Health insurance is necessary” [con]

3.     “Don’t linger and chit chat at the check-in area” [eti]

4.     “Don’t ask other patients why they are visiting the doctor’s office” [eti]

5.     “Don’t clip your fingernails or do anything that you would normally do at home in your living room” [eti]

6.     “To be seen by the physician, you need to fill out paperwork” [con]

The Examination Room

1.    “Strip down to just the gown” [con]

2.     “Don’t question the doctor’s recommendations/orders” [con]

3.     “You don’t have the option to refuse to answer a physician’s question” [con]

4.     “Look but don’t touch” [eti/con]

5.    “The physician decides what the patient needs”  [con]

6.     “Don’t ask the physician/nurses any personal questions” [eti/con]

Adopting Cresswell’s (2004) straightforward definition of place, “a meaningful location” (p. 7), I made a list of rules attached to the doctor’s office, recognizing that rules are often what give spaces meaning and value.  As Wood and Beck (1994) put it, “Without the rules the home is not a home, it is a house, it is a sculpture of wood and nails, of plumbing and wiring, of wallpaper and carpet” (p. 1-2).

Thinking of issues that applied to me (the patient), I came up with rules that ultimately served two purposes: etiquette (eti) and control (con).  As Anderson’s (1987) example of Chinatown portrays, societal constructs and norms are often dependent on place and space and in which the rules (both spoken and unspoken) are mediums in which these constructs and norms are defined and sustained (Wood & Beck, 1994).  In the context of the doctor’s office, I see rules of etiquette as ways in which the “normative” is maintained.  In public places certain appearances and decorum are expected, hence, the rules of ”arriving fifteen minutes early” or “clipping your fingernails exclusively at home”.  In addition, only certain individuals with personal ties are privy to your personal information, thus, the rules of “abstaining from asking others about the reason of their visit” and “avoiding questioning physicians concerning their personal lives”.

The rules of control, on the other hand, are utilized to maintain certain power differentials tied to, amongst other things, class, race, and gender.   For example, the rules of “filling out paperwork” and the “requirement of health insurance” speak to the privileging of health care.  Only those who can afford health insurance and who can read, write, and understand a certain language, are able to receive health care with relative ease.   “Stripping down to a gown” and “accepting the doctor’s orders as law”, on the other hand, are rules used to maintain the power differential between the doctor and the patient. 

In thinking about the rules listed above, I came to the conclusion that these rules are solely for me (the patient) and as such, I (the patient), along with other patients, are the ones who suffer repercussions when rules are broken.  In contrast, physicians not only break these rules but also operate within a completely different set of rules.  Thus, even though I cannot ask my physicians about their families, they are able to probe into my life, asking very personal information.  Now please don’t misunderstand me here.  I realize that some of the rules maintained are because of patient assumptions and not because physicians necessarily want it that way.  I also recognize the need for certain information to be shared in this specific setting and I am not saying physicians are egotistical power mongrels plotting harm to their patients.  Rather, I am merely pointing out that it is the breaking of rules and operating within a different set of rules that unveil the power differentials and norms being maintained. 

These power differentials and norms in the doctor’s office made me think of another issue of healthcare I heard about from The Diane Rehm Show on National Public Radio.  Approximately a year ago, Diane Rehm had a show addressing unnecessary medical tests and procedures that rack up patients’ health care bills and ultimately do not improve care.  A panel of various physicians addressed this issue, speaking about the fear of litigation by physicians, the requests by patients for various tests, and also the money generating side of the issue.  What I found interesting was that this issue was strongly tied to power differentials, norms, and social constructs maintained at doctors’ offices.  In addition, I thought it significant that the solutions suggested by physicians required a change in current rules and assumptions. http://thedianerehmshow.org/shows/2012-04-09/cutting-back-unnecessary-medical-tests-and-procedures

And there you have it.  My two cents on do’s and don’ts of the doctor’s office and why they exist.  Although it clarifies my questions, I am not sure it convinces me to start liking doctor’s visits. 

REFERENCES:

Anderson, K. (1987).  "The Idea of Chinatow:  The power of place and instiutional practice in the making of a racial 
       category."  Annals of the American Geographers, 77(4):  580-598.

Cresswell, T. (2004).  Place:  A short Introduction.  Oxford:  Blackwell Publishing.  Pp. 1-12. 

Wood, D. and Beck, R. J. (1994).  Home Rules.  Baltiore, MD:  The John Hopkins University Press. Pp. 1-7, 13-23.

The Diane Rehm Show:  Cutting Back on Unnecessary Medical Tests and Procedures. Retrieved from  
       http://thedianerehmshow.org/shows/2012-04-09/cutting-back-unnecessary-medical-tests-and-procedures.