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 http://www.aamc.org/newsroom/reporter/april01/physiciansvisit.htm 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 http://ibscrohns.about.com/cs/activismandibd/a/aa051903_p.htm) 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”)
-Others?

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
(“Blake”)

6 Comments:

Blogger stoney13 said...

What do I want? THE TRUTH!!!

15 years ago I caught a roaring case of the flu. A real good case! So I went to the local hospital Emergency Room and signed up to see the doctor on call. As soon as he read on the questionaire that I had smoked a pack of cigarettes a day since I was fifteen years old, he sent me for a chest x-ray. After the uneeded and very expensive exposure to radiation, he told me I had emphesima! I would die in three years if I didn't quit smoking! Seriously freaked out I requested a copy of the x-rays and sought a second opinion.

I went to a local practitioner and filled out the form. THIS time I stated that I did not smoke! After he checked me out he told me that I had a flu bug (big surprise!) and prescribed some capsules. When I asked him to check out my x-rays, he told me my lungs were fine! He said that I had a little congestion from the flu but other than that, I was in great shape!

Six months later I had a complete physical done to renew my IHRA and NHRA competion liscenses (for driving a race car). Once again I had the same chest x-ray, colo rectal exam, and all the normal poking and prodding that a complete physical entails. THIS time I was told that I had "The lungs of a 20 year old"! After I told this doctor that I had smoked a pack a day for thirty years, he said, "Well I can't tell"! He called another doctor in and told him about my smoking and showed him my x-ray. He couldn't tell either!

Which brings me back to the first doctor! This man's misdiagnosis sent me scrambling to spend more money and take more time to find out it was all a load of shit! I'm sure he thought that he was doing "the right thing" by lying to me to get me to stop smoking, but it had the opposite effect! Now I find it hard to trust doctors and usually seek a second and sometimes a third opinion! Doing the wrong thing for the right reason can have serious concequences for the doctor and the patient! Oh, by the way! I still smoke a pack a day, but when I have my yearly physical I'm still told my lungs are healthy! Maybee it's this mountain air!

4:36 PM  
Blogger Blake said...

Stoney13- Sorry that doctor used the tactic of outright lying to you to try to get you to quit smoking. This is dispicable. As far as wanting truth from doctors, of course patients deserve and need that. Yet there are still some doctors, especially in other countries,who do not reveal a fatal diagnosis to their patients fearing it will worsen their condition or they cannot cope emotionally with that reality? What do you think?

6:39 AM  
Blogger stoney13 said...

Blake,

If I was given a fatal dianosis, I would most likely laugh and keep right on living! I've got this funny idea that you don't die untill your damned good and ready to die! As long as you keep fighting, and don't give in, death can't catch you!

I've got a friend of mine who has had several serious cardiovascular problems. Mostly complications from "Giantism" (He's 7'6" tall and weighs over 500 pounds)! He told me once that if he went out and bought a casket every time somebody told him he was going to die, he'ld have the market cornered!

Basicly what I'm trying to say is that every patient is different and no two cases are the same. Some patients would probably take the fatal diagnosis as a reason to just give up and stop fighting. Some patients would take it as a motivation to fight all the harder! Some would be a combination of the two. ALL need to be told the truth about their condition, and to be advised of their option of getting a second opinion. It's the patients life after all and ALL options should be opened up to find the best treatment for each individual patient

11:30 AM  
Blogger Cervantes said...

Well Rick, you've raised a lot of the most important issues in doctoring, that's for sure. As you know, there is a great deal of interest these days in trying to create new divisions of labor in the health care biz. The argument is that M.D.s are extremely expensive, and the reason is that it costs so much to stuff them with technical expertise. Ergo, the cost-effective thing is to have them make the technical judgments and let lesser-paid people -- NPs, PAs, health educators, "navigators" -- actually spend time with patients, doing the health education, facilitating the informed choice, counseling on treatment adherence, feeling the pain, etc.

Of course, this does not feel right to doctors such as you who actually want to care for people, rather than body parts. But the economic pressure to have you see 16 patients in a 4-hour clinic is overwhelming.

I'm not going to state a definite opinion about this -- I think that a larger role for such practitioners could be very useful but that physicians will be much more effective if they have the opportunity to know patients as whole people, and that's what most people want from their doctors as well. It's a difficult balance.

12:15 PM  
Blogger Cervantes said...

Oh, and Stoney -- please quit smoking.

12:17 PM  
Blogger Alan2012 said...

BLAKE WROTE:

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”)
-Others?

.....................

Wow! Quite a list!

Far more than physicians of today
could properly handle. I cannot see
them even handling (well) a single
item from that list, on top of
their other duties and obligations.

I say: forget it. Forget trying
to patch up the system by
redefining physicianhood. Don't
try to retrofit. Can't properly be
done. Let physicians (and their
schools, and professional
societies, and etc., etc.) be
who they are. And develop OTHER
collateral, complementary and
supportive professions -- RN,
PA, etc. -- to do the real work
of HEALTH care, properly so called.

Don't bother trying to patch up
the Titanic. Develop a new system,
collateral to the old.

Alan Lewis

PS: You forgot nutritional
counseling -- probably more
important than anything else
on that list.

6:25 PM  

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