Going For The Throat: Improving Patient Care, the Doctor’s Perspective, Part I
Written by: Robyn Davis Hahn
So, I conducted a completely informal, unscientific survey amongst my friends who are also doctors. I asked them just a few questions about aspects of the Doctor/Patient relationship, from their perspective. Only one of these docs was an endo, three are gynecologists (and former obstetricians), and one is an orthopedic surgeon.
Some of the answers I expected, others I did not, and all were refreshingly honest.
My first question:, What is the most common thing(s)–mistakes, attitudes, etc. that you encounter, patients making that could be a barrier to care or the doctor/patient relationship (either in the appointment or after)?
1. a. Patients need to understand that medical science is far from an exact one. Few problems are black and white or can be fixed or diagnosed in one visit. Many problems require out of the box thinking that may require several appointments. The internet has been a huge help for educating patients, but can also hinder their trust in their trained physician. Many patients arrive with preconceived notions about their illness that they have obtained from web research, not accounting for the fact that much of this information on the web is not provided by medical professionals. This can interfere with the trust that they have in their physician.
b. Patients need to have a better understanding of the time constraints we face as physicians. Unfortunately the business side of medicine comes into play here. Schedules are often too tight to accommodate those that are late for their appointments, and those that arrive with an expectation that multiple issues can be addressed in one visit. We all wish that we could spend an hour with each patient, but the pressures of keeping the practice viable financially prohibit this.
1. It’s always a, good idea for both doctor and patient to be open minded and to not enter the conversation with prejudice. , It’s always a good idea for both to listen and talk with each other, not at each other.
1. Biggest patient mistake–for me this is often a patient not mentioning something that is bothering them for fear that it is silly, or unrelated to anything. It’s always better if a patient has some idea about their symptoms before they come. “It gets better when I….. or “It gets worse when I do….., Think about it before you go into the office. Another mistake is if a patient isn’t really understanding the diagnosis/treatment plan, and does not bother to ask for further explanation.
1. Patients come in with pre-conceived notions about their problems due to either direct marketing of companies and the droves of info present on the internet.
My second question:, What problems/mistakes do you believe most, doctors make regarding their patient relationships?
2. Common mistakes on the MD side of the equation:
a. Medicine has become increasingly electronic and less personal, much to the dismay of many physicians. Some docs, don’t take the time necessary to foster a working relationship with patients and don’t listen well enough to appropriately address a problem.
b. Many docs practice defensive medicine in this climate of medico-legal issues. Many order unnecessary tests to “cover their bases”, to avoid a lawsuit.
c. There is little to no time to personally phone patients with results….much of this is done by nurses which tends to impede the development of a working relationship with a patient. , This is an unfortunate reality for many of us.
d. Docs sometimes enter a patient relationship with prejudice or preconceived notions about patients and their problems. This clearly can interfere with physician-patient relationship…
2. Some doctors and patients don’t have or take time to develop relationships–they’re just checking off the boxes and medicine is increasingly transactional and not relational.
2. Biggest doctor mistake–I think the biggest mistake doctors make is not really listening to their patients, especially if in the middle of busy office hours. Patients can often give you huge clues as to what is going on with them if you take the time to really listen. , This can be tough when there are time constraints. Hence the importance of the patient really speaking out about what is bothering them.
2. I think doctors don’t listen well enough to patients complaints and therefore don’t cater therapies in an individualized manner.
My last question: What is your biggest overall obstacle to improving the lives of your patients?
3. Obstacles to improving patients lives
a. Many patients are not compliant with instructions/advice or do not attend follow up appointments as advised to ensure that treatment plan is optimal.
b. Many patients show resistance to comply with lifestyle, changes as part of a treatment plan or preventive care, expecting a “quick fix” with medications or surgery instead. This is a global societal problem that many of us face as physicians. It is often frustrating for us as physicians to see many problems that are brought on by poor lifestyle choices including smoking, poor diet, lack of exercise. Many patients are unwilling to change these behaviors, opting for more risky treatment options with medications or surgery. If surgery is in the equation, these patients have many more complications and don’t heal as well.
c. Insurance companies dictating care.
d. Poor reimbursement from Medicare is a huge obstacle in providing care to seniors. Many docs don’t accept Medicare for this reason, leaving this group of patients with limited access, seeking their care in emergency facilities and hospitals. This population often requires the most care and the most time!
3. , The incredible pressures and complexity of their lives–their relationships are all asymmetric.
3. There are a couple of recurring themes I see as obstacles for patients reaching optimum health. Financial constraints are the most obvious- i.e. a patient needs an expensive therapy and is unable to afford it (i.e. medications, surgeries). This is the biggest obstacle I run into more than I’d like. Number two is a the patient not taking charge of their own health by maintaining a healthy lifestyle or following the behavioral changes that have been recommended. Many medical issues I see on a daily basis are because of poor eating habits, lack of exercise and being overweight. , While easier said than done, losing weight and eating right can fix so many issues for patients, or prevent issues to begin with.
3. I think the major obstacle for me is that the insurance companies have put the patient and doctor at odds with each other and removed themselves from the equation. Exorbitant co-pays and poor reimbursement have made the financial aspects of medicine part of the patient-doctor interaction.
Wow, right?, All the doctors mentioned not listening or lack of time to develop a relationship with their patients as the biggest problem or mistake on the doctor end of things!
So here’s the funny thing–my endocrinologist friend answered me sort of free-form instead of in number form, which totally cracked me up!, Nevertheless, I love what he has to say:
I never wanted to be a doctor; when I went with my mom/grandmother to the doctor I was always irritated by the MD’s “attitude”. Anyway, here I am and I like to think I try to be aware of what the patient is hearing on the other side of the table.
I think one big obstacle is time, patients want to tell their story and doctors have a room full of patients to work through and many times know what they want to do before they see or talk to the patient. Looking at diaries, counting the number of hairs in the ziplock, etc. all take time–the easy path is to just look at the numbers. Give me time and I can connect and “fix” the patient–that’s the hard part. Looking at labs and decision making is the easy part.
Most doctors fail to look at the “whole” patient – they look for 1 visit 1 problem. I think it is important to understand that certain problems travel together–and look at tests in context. For example, a TSH of 3.5 in a woman with a goiter is different from a TSH of 3.5 in a woman postpartum is different from a woman on thyroid hormone or someone with cholesterol of 200 or 300–many MDs think they are all the same. You have to have clinical acumen. I think you are born with this–you cannot teach it. You can make it better in someone, but you cannot give it to them. Throughout all this you need a provider that is not threatened by questions and not feel challenged by questions.
So the biggest mistake for doctors is not truly caring for the patient. Patients understand and forgive many faults if at the end of the day they feel that they are your priority. There is not a lot of work in making the difference between being a good doctor and a great doctor–it comes down to being inquisitive and caring. Intellect helps, but is not essential.
For this week’s article, I decided to just lay out the responses I had gotten from the various doctors. One of the things I found most impressive is that I emailed four of my doctor friends and got FIVE responses, because one of my friends forwarded the email to a colleague (whom I’ve never met) who also sent me an answer. All of them said they would be willing to talk to me more in depth about the answers as well. I can only interpret this as positive and more proof (to me–like I said, there’s no “science” in this survey) that the vast majority of the doctors out there at least recognize the problems we encounter in our health care and may even share our frustrations.
Next week, I will look at the answers more in depth, and offer some analysis. Your homework is to read the answers carefully and try to imagine you and your doctor somewhere in these lines. Does anything sound or feel familiar?
In an ongoing effort to improve our relationships with our doctors what are your thoughts regarding this article? What points do you agree with or disagree with? Speak up and out, beautiful babies.
Tags: conveying symptoms, endocrinologist issues, Going for the Throat, Health Care Column, improving patient doctor relationships, patient responsibility, Robyn Davis Hahn Health Care Writer, speaking with doctors, thyroid health, thyroid patient issues