A Closed Response

One and a half weeks ago on February 19, I posted here an open letter to my new primary care physician which I also sent to them through Kaiser’s somehow antiquated messaging system. There was a response the next day, but in my overall and general dysregulation and intermittent depression over a gout flare, I didn’t have the wherewithal to read it, until today.

Here is the response, with names redacted.

Good afternoon, Bix,

Thank you for using kp.org. My name is [redacted] and I am a LPN with [redacted], MD's team.

Thank you for your message. If you have any other health care needs please contact us.

Your overall health is important to us. Please see the recommendations from your clinician, regarding any preventative care you may be due for, online www.kp.org/action-plan.

Have a wonderful day.

[redacted], LPN

Now, I didn’t expect a treatise in response to my 900-word open letter, but I also very much did not expect this. Once again, perhaps a failure on my part to castrophize sufficiently.

The entire reason I even have a new primary care physician is that with previous one (whom I’d chosen after my longtime doctor left Kaiser early last year) there’d been a persistent communications problem that neither of us seemed able to explain and overcome. We agreed that perhaps we just weren’t a good fit.

The above response is diminishing and insulting, not the least because there isn’t even any indication that the open letter had been passed along to my doctor. This is the response I’ve sent back today.

This is how you respond to an autistic adult patient who took pains to give lengthy introductory background information, and feedback on their first appointment, to better help everyone provide and understand care. As I said in the original message, lengthy responses are not my norm, but given the situation they were necessary. The below response from not even my doctor never acknowledges any of it. As an autistic adult, I expected better from a doctor who professes “social justice” and medicine as “an avenue towards dismantling systems of oppression”.

I’ve argued before in the context of psychotherapy that you can either be engaged in social work or social control. This applies to medicine as well. The entire reason I picked my previous doctor was because they said they took into consideration each patient’s “unique circumstances” as well as expressing an acknowledgment that “health depends mostly on things that happen outside our visits”. They were my second choice after this latest doctor who at the time was not paneling new patients.

It’s been a very long and hard slog since my autism diagnosis in 2016 to fight through layers of bullshit and other impediments to build up my toolset for self-advocacy, and—especially at this particular moment in political history here in the United States—having this much trouble getting doctors who profess to being allies of one sort or another to understand that treating an autistic patient simply is not like treating other, more neurotypical ones is extremely frustrating and even more extremely dispiriting.

Yes, I understand that doctors and therapists themselves are under a tremendous amount of pressure and stress, and that these pre-date the current political crisis which is just compounding things for everyone. There’s too much medical and psychotherapeutic work and not enough people or time to cover it all, and the professionals in these fields also are subject to demands for “efficiency”.

It’s just that I don’t find that to be a compelling excuse. Everyone is stressed. Everyone is under pressure. That’s all the more reason why we need to be better at this.

We need to be better at this.