Talk to Your Doctor. TALK to Your Doctor. Talk to Your DOCTOR.

A healthcare system that does not work in “ordinary” times means no one has a doctor anymore.

Female doctor in medical facial mask have consultation with elderly patient during covid-19 pandemic...
Jacob Bacharach
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“Talk to your doctor about . . .” has long been the familiar refrain of prescription drug commercials, themselves a singularly American perversion, unheard of — indeed, prohibited — in most of the rest of the world but ubiquitous here. Boner pills, heart pills, arthritis pills, brain pills. I have a recurring case of mild psoriasis, and am now pursued by an algorithmic Cyndi Lauper, also a sufferer, who implores me to ask my doctor if Cosentyx is right for me every time I make the mistake of watching a show on Hulu.

But now that we are approaching the grim two-year mark of the Covid-19 pandemic, the phrase “talk to your doctor” has overflowed the banks of merely selling erectile cures to aging husbands and SSRIs to everyone It has flooded into the broad, urgent territory of real public health discourse.

Talking to one’s doctor was firstly proposed as a magic bullet for so-called vaccine hesitancy. The hesitant, we were warned, cannot — and should not — be “shamed” into getting the vaccine, nor, we were assured, would state or employer mandates work (until, of course, they were tried, and they did). On the other hand, “fact-based” conversations with one’s personal physician would allay fears, answer doubts, and, it was often implied, provide a form of face-saving exit for stubborn hold-outs, who could maintain their hatred and mistrust of Anthony Fauci, Joe Biden, the CDC, whomever, while still availing themselves of the vaccines’ effective and inexpensive intervention.

Simply as a matter of scope and size, this was always a questionable proposition. One of the reasons that mandates have proven so effective is that they do provide a very similar off-ramp for vaccine resisters—“The damn boss made me do it!”—and crucially, they do so at scale. But while in most other circumstances, conservative politics posits an American worker who essentially belongs to their employer, and oughta be thankful even for that much, here, because the boss is acting in concert with the damn Dems, to the picket lines they (don’t actually) go!

Yet even more pointedly, who has “a doctor” anymore? The kindly gray-haired man with his white coat and leather physician’s bag, who has known you since you were a child, and who doctored to your parents since they were children, who still knows your chart without looking, remembers when you had chicken pox, knows which knee troubles you, and spends more than five minutes with you in the exam room exists solely in the imagination of Baby Boomers.

I am now tripping into my forties, the world’s oldest millennial. I’ve been incredibly fortunate to spend my entire adult life with “good” insurance, and I’ve been luckier than so much of the younger half of my generational cohort to have started a career before the devastating crash and economic dislocations of the Great Recession. As a result of these little bits of good fortune, I have managed to acquire a degree of economic comfort and stability, and I’ve been free of any crushing medical debts and expenses, despite some occasionally somewhat costly treatments for that psoriasis, and a serious bike accident requiring a long physical therapy regime in my late twenties.

Although I do have a dermatologist, I do not have a regular primary care physician. I have on occasion tried to find one, but seem inevitably to be stuck on a waiting list or shuffled between overworked internists in hospital-owned practices. When lucky, I have maybe recognized a nurse or Physician’s Assistant from a prior visit. For the most part, I make do with the family health clinic in my neighborhood, where the interns and residents who actually see patients are now dismayingly younger than I am.

There’s nothing exactly wrong with this. I am also fortunate to be in generally good physical health, and it doesn’t much matter that someone different gives me a physical once a year. It does not, however, represent a relationship of trust; it does not represent a relationship, period.

Herein lies the impossible irony of suggesting that vaccine skeptics talk to their doctors and of assuming that this patient-physician bond represents a durable and valued connection between individuals and the larger institutions of health and medicine. No such bonds exist anymore. Like so many other stories of the “declining trust in institutions,” the real story is not the decline in trust per se, but rather the failure of the institution. The increasingly expensive, arcane, and impersonal US health care system, with its harried practitioners, shock billing, impenetrable insurance coverages, and regionally monopolistic consolidation, leaves no room for trust, and certainly has no time for conversation.

Is it really so surprising then that millions of Americans are more trusting of their favorite local radio personality, who talks to them for three or four hours every day (at least until he, too, dies of preventable Covid), or of the friends in their Facebook groups, than they are of a strange doctor whom they might see for three uncomfortable minutes once a year — often after an enraging two hours in a waiting room for an appointment made months prior?

The White House and many state health agencies are now making the same suggestion regarding the increasing demand for coronavirus vaccine booster shots, a recommendation that has been marred, like so much else of both the Trump and Biden administrations’ Covid responses, by conflicting and contradictory information. Well, never mind that the CDC and FDA disagree, and that there is even public disagreement within the agencies themselves. Talk to your doctor about it. Or just show up at CVS. Whatever. Eh, what are you gonna do?

This will not be the last public health crisis; it is only a grim foretaste of pandemics and climate catastrophes yet to come, whose frequencies will increase as the century ticks on. The vaccines are a marvel and a miracle; monoclonal antibodies and other biologics likewise; the promise of these technologies is extraordinary. But they are only technologies, and tools that are incompetently and incorrectly wielded don’t build structures that last.

A health care system that does not work in “ordinary” times cannot magically spin itself up to universal efficacy in a disaster. A global intellectual property regime that prevents the international production and distribution of necessary medicines cannot just unwind itself to address an acute crisis. A global pandemic? Well, build a vaccine. A quarter of the population won’t take it? “Talk to your doctor.” Don’t have a doctor? Well, have you tried telehealth, or an app, or entered the governor of West Virginia’s “Do it for Babydog” Covid vaccination raffle? Lord, anything but spending the ten seconds of thought necessary to realize that in the grand scheme and the long duration, from a social perspective, Covid is actually just another symptom of a deeper and even deadlier American disease.

Jacob Bacharach is a writer in Pittsburgh.