Thursday, June 15, 2006

What Do You Really Want from your Doctor?

A physician friend once said to me you can either “get love or attention from your doctor or the best technical skills available but rarely both”

Over the years as a practicing physician it seems to me that often many intelligent patients equate the quality of, at least their outpatient physician interactions, with the amount of time the physician provides to them.

(If you need a highly technical skill of a specialist or sub-specialist especially in the areas of invasive diagnostic procedures or highly technical surgery this essay is not really that relevant. In that case find the best technician you can locate who has a track record of many successful procedures to assist you)

But much has been written on the topic of time spent with patients in the outpatient office as an indicator of patient satisfaction. See for example. In the era of managed care with shrinking allotment of time provided to each patient this often leads to frustration in both the patient and the physician. Frustration may also aggravated it seems by requirements for physicians to be required to directly input patient data into a computerized Health Information Technology Systems- so called “HITS” while with the patient!

The intelligent educated patient while being empowered by democratized health information on the internet is perhaps further frustrated by their physician’s inability to answer all the questions that this often voluminous information stimulates. The access to health information by patients has caused nothing short of a seismic shift in the doctor-patient relationship with some estimates that there are now over 100,000 health related websites on the internet today with anywhere from 40-80% of all adult Americans accessing them for health information.(see for some guidlines who how to use the internet effectively.

Often, in my opinion, for example if a patient has a rare disease and a modicum of intelligence it is even likely that the patient, after a thorough computer search, may know more about recent developments about their own particular conditions than their primary care doctor. This takes a mature physician to cope with that shift in heretofore traditional information driven power dynamics.

Dr George Lundberg, former Editor of the Journal of the American Medical Association (JAMA), has said that the Internet is one of the three biggest advances in medical science in the last 500 years.

Anyway this got me thinking about possible new emerging roles for especially primary care physicians like family doctors and internists besides the traditional valid roles of diagnostician and interveners- usually with prescribing medications, ordering routine diagnostic tests and perhaps some very limited counseling on health behavioral changes

These new possible emerging roles for primary care physicians in the new 21st century medicine might include:

-Information sorters, guides and interpreters
-Decision specialists/coaches in an emerging co-decision model
-Teachers of health care topics
-Motivators of Behavioral Change
-Integrating patient’s deepest values into health care decisions and practice
-Spiritual guides especially during major life transformational events like death and dying
-Care coordinators (“quarterbacking”)
-Patient advocates against unjust medical practices
-Providers of emotional support (simply being there or “attending to”)

Let me here from you on what you expect from your doctor or what you really want from your outpatient doctors? It's worth thinking about?

Many scholars believe, as I suspect, that this is highly variable and should be individualized always in the context of, at the very least, mutual respect between two human beings.

As for me the best healing occurs when both the doctor and patient recognize that a mutual meaningful connection has been made and growth occurs in both the physician and the patient.

Dr. Rick Lippin