Physickians as resolvers of insults

Medical care is not an automatic entitlement. A harsh truth to remember is that a physickian¹ is not our mammary custodian and thus owes us zero inherent obligation to provide care.

Medical care is a privilege bartered through the movement of electrons that ultimately deplete the resources in our digital ledger. Or, if we are fortunate, the monetary vacuum created by the extrinsic care provider is filled with liquid piped from a communal pool shared by a group of individuals unrelated to us.

A visit to a physickian is usually prompted by a biochemical or mechanical insult to our body. While it is natural for us to hope for rapid neutralization of these unwanted insults, this expectation is often unrealistic and unfair to the physickian. A more reasonable outlook is to recognize that the clinical evaluation—along with subsequent prescriptions and management plan—may not immediately, or even fully, resolve the underlying complications. On rare occasions, our body may feel more insulted after the visit than before.

As payment is typically completed long before the therapeutic effects of the management plan become apparent, there is often limited recourse if the clinical outcome fails to align with our expectations. Furthermore, most of us are not medically qualified to challenge the therapeutic rationale or pharmacologic selection, as the physickian can readily assert that the chosen intervention was consistent with their diagnosis—or, at the very least, with their diadoxa.²

Turns out, I was just another hoss to Dr. Phos.

Although such care is a paid subscription, albeit temporary, this does not grant you the right to insult the physickian by bluntly declaring that his management plan is excrementary and orthonormal to the resolution of the insult originally inflicted upon us by the biochemical aggressor. Such remarks may, in turn, invite subtle psychosocial insults from the physickian—particularly when his prefrontal cortex struggles to maintain control.

The experience, therefore, differs markedly from that of a restaurant. When ordering food, our autonomy is considerably greater—our choices are guided by clearly listed prices on the menu and constrained only by prior palatal encounters that have shaped our preferences. In contrast, there is nothing legally amiss with the physickian selling us medications with nonlinear markups. After all, such transactions are veiled in the drapery of clinical authority and pharmacologic necessity.

1. These last words are in the form of a horse-doctors' bills. The Canada Medical and Surgical Journal has seen several; but the following, from a St. Louis veterinarian, is the most striking. Sant Lewis Ganewerry the 4d 1873. Mr. — to James Hankox Vetturerinary physickian and Surgeant Dr.
   
   Too medikle advice twict, 3 dollars; Konsultation over a ded mare sed too hev hed the eppzout, 75 cents; Goin to see two sick hosses in the nite (very cold), 2 dollars; To treatment a kream kolered hoss two days with medisuns, 4 dollars 50 cents; To making to obstetrikul examinashun of a hosses throat, 1 dollar 50 cents; To settin up all nite in a barn with a sick hoss, 2 dollars 50 cents; To writin a preeskripshun for botts, & also one for spaving, 1 dollar; To holding a postmortim examinashun on a hoss who afterwards recovered, 1 dollar 50 cents; to giving my opinyun one day on the street regardin the kause of the zoot, 4 dollars. Totil, 20 dollars 75 cents.
   
   See Last words about the epizooty, The British Medical Journal 1(644), p. 524 (3 May 1873).
   
   
2. Ch’ng et al. (2017, p. 10) listed two common missteps in the process of locating the roots of dermatological polynomials: (a) Observing the rash and prescribing a topical treatment without establishing a definitive diagnosis; (b) Observing the rash and initiating investigations without considering a differential diagnosis.
   
   Since the opposite of gnosis (γνῶσις) is doxa (δόξα), clinical evaluations that disregard these two principles scarcely qualify as diagnoses at all, and they should be more aptly termed diadoxa, e.g. Believing he appeared more professional with his fancy medical gadget, the physickian examined my arm using his dermoscope, and then diadoxed me with eppzout.
   
   In a way, I was but a hoss to Dr. Hankox. My first visit took place on a Saturday (22 March 2025, br-opc2948). The initial two-week management plan was: Topical steroid = Betnovate (15 gram), topical antibacterial = Betadine 5% (15 gram); oral antibiotic = Zinnat 250 milligram (28 tablets for one week), 309 dollars 20 cents. The second konsultation took place again on a Saturday (12 April 2025, br-opc3856), The one-week preeskripshun was: Another topical steroid: Clobetasol 0.05% (15 gram) and Bilaxten 20 milligram (7 tablets for one week), 135 dollars 65 cents. The third visit took place on Saturday (19 April 2025, br-opc4215), 105 dollars. The last session was on 3 May 2025 (br-rpt20107), 78 dollars, 50 cents. The last two sessions were purely visual examinashun with no medishuns dispensed. The last medikle advice I received from Dr. Hankox was strikingly brief and candid: ‘I am stumped'. A statement that, in its politest clinical form, is essentially a physickian's way of telling the hoss to bugger off.
   
   
   
   From Dr. Hankox's clinic, I drove 8 km to see another physickian, lured by her clinic’s ad: Top rated ⭐⭐⭐⭐⭐ clinic. Rawatan tanpa steroid dan bahan kimia berbahaya. Unfortunately, I failed to realize the whole self-inflating ad was a joke, just not a very funny one (because clearly, nothing says credibility like a five-star rating you give yourself). Dr. Phos decided that she was not stumped by what she saw and proceeded to give me a list of medishuns (Receipt no. 17863): Potassium permanganate (of unknown concentration), 30 gram of skincare cream compounded with list of ingredients not immediately clear to me, and an antiobiotic course for five days (Doxycycline 100 milligram, 10 capsules), 215 dollars. I realized 10 days later that Dr. Phos's treatment plan was probably not able to tackle the root of the problem. To extract her opinyun, I returned to Dr. Phos for another konsultation session (14 May 2025, receipt no. 18130), which concluded with a referral letter with no medishuns, 50 dollars.
   
   Turns out, I was just another hoss to Dr. Phos.