The Doctor’s Waiting Room, Vladimir Makovsky
I know ahead of time. I know when I see the name, so familiar in its tongue-twisting clumps of consonants. That long, obviously Russian name on my schedule. New patient. Russian patient. Here to talk to me,no doubt,about his diabetes which he has failed to control. He sees my obviously-Russian name and assumes that, unlike all those American doctors, I will get it. I will know what to do. I will use the natural stuff. That stuff we doctors don’t give to just anyone. That secret we keep to ourselves. Because unlike all of those American quacks, I am not brainwashed by the likes of the CDC. I will not use those poisonous medications on him, which I should know better to even offer. I know this will be a long visit. It will feel longer even because my Russian is only as good as that of a 10-year-old girl who came here back in the early 1990s.
I flip through the chart and note the uncontrolled high blood pressure and cholesterol. Politely worded documentation from doctors who came before me uses words like “declined” and “reluctant” to signal a much less polite word: “noncompliant.”
I am an endocrinologist. I specialize in hormones, and as much as this makes most people giggle, all that really means is that I treat a LOT of diabetes. Diabetes is one of those ubiquitous yet mysterious diseases – sufficiently familiar to most but truly understood by few. It’s a silent disease, like carbon monoxide, gripping its victim often when the damage is irreversible. It’s a disease that requires the patient buy in to the fact that they are treating a condition which, if I do my job well, they will never feel.
My patient has not really bought into the fact that he is a diabetic. He has, however, bought a tea on the internet that claims to cure diabetes in 14 days. He has been imbibing it religiously in the days leading up to this visit. He shows me the container to get my approval. Because I am likely to be familiar with this product. Because maybe I will tell him that I always recommend this tea to my patients and he’s ahead of the curve. Because I am Russian. I get it. Because even though I am one of “them” (as in doctors), I am also one of “US.” It’s like having someone on the inside who secretly rebels against the system from within.
The resistance to medical treatment in the Russian community is well-known among doctors who work within it. My American colleagues see Russian patients as a challenging curiosity, often asking me questions like “Is it typical for a Russian patient to [pee on burns, take 15-year-old meds they emigrated with for chest pain, put vinegar in the ear, refuse insulin, etc]?” The answer is usually yes. Some Russian doctors cater to the crowd and stock their offices with vitamins and supplements.
I spend a great deal of my time simply educating my patients about their disease as a means to get them on board with treatment. Russian patients will politely listen yet maintain skepticism on the very fundamental principles of the physiology involved. As if biology is relative. As if chemistry is a matter of opinion. Imagine the world where this is so. One may begin to question everything.
I know they have been lied to. Openly. Shamelessly. The scars of communism haven’t healed yet, not all the way. They never will. It’s like a collective PTSD, not fully recovered from Soviet oppression. Soviet-born patients are fiercely independent, forsaking all that is prescribed in a top-down manner. The solid wave of Trump support in the Russian community grows its branches from the same don’t-tell-me-what-to-do roots. This does not breed implicit trust in doctors. It does not help that recently, there have been several well-publicized cases of medical fraud perpetrated by Russian “providers,” including a well-known radio personality.
The trouble is that in assuming that all “government sanctioned” [medical] truth is suspect, one inevitably stumbles into the clutches of alternative reality grasping at straws of half-truths, fear mongering, wishful thinking, homeopathy and broadly alternative medicine. The latter defined (by me) as treatments without high-quality scientific proof of benefit. Because once such proof is available, it becomes just medicine.
I once had a conversation with a friend who admitted that,despite seeing a parent suffer of a treatable chronic disease, he would not take steps to treating the same disease should it be diagnosed in him- unless the consequences were imminent, usually occurring in absence of preventative treatment. Many Russian immigrants that I know, including my own parents, do not wear seat belts out of contempt for being mandated to do so by law. Some patients have been known to stop their meds on a whim, or – better yet – send the drugs to relatives abroad who are in need, with no attention paid to dosing or indication.
My patient and I stumble through the visit – me with my laughable Russian, the patient with his skepticism. It ends amicably enough, and I am lucky if I convinced him to give the treatment a try. It’s a fraction of what he needs but it’s a start. I hope he didn’t see through me. I hope I fooled him. I hope he didn’t realize that underneath my Russian name and native fluency, I am one of those American doctors after all: I believe in evidence-based medicine and guidelines from the American Medical Association, and I will slowly, slyly try to erode his defenses, gain his trust and get his diabetes under control with those poisonous medications he vowed not to take.