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One: Is it important to like your doctor? Answer: Easy. Depends. If the doctor is just taking out a gallbladder, sure it would be nice if you wanted to bake him/her cookies and go out to lunch and knit slippers to wear after long days in the OR, but hey, as long as the job gets done without a bile leak, cool.
Primary care? OB? Yes. Like your doctor. And be sure that he or she seems to likes you. Probably not crucial if you only have strep throat or a UTI, but for more chronic medical problems, yes, please. Mutual admiration and respect make a difference, no matter what you fusty old MDs say. I have a lot of reasons for that, but I'm too pooped and hopped on Fluff to think about it right now. Let me just say that assuming your MD/DO is competent, yes, the relationship matters.
I think having reliable, likeable staff matters to an extraordinary degree, as well, but nobody in charge ever listens to me about that. However, I am blessed with likeable, extraordinarily talented, helpful staff. And it makes a HUGE difference in the care we provide. For the next 2.5 weeks. And then we are no more. So maybe I'm wrong...
But anyway. What do y'all think?
Second question: How personal should a doctor be with a patient? How much physician privacy is good? Is too much bad? VERY good question. There have been a number of "studies" (Like really, are they studies as much as consumer satisfaction surveys?) asking patients about how much they want their doctors to talk about themselves in an appointment. The answer, generally, is not so much, thanks, it's all about me, the patient today. Fair enough. Patient is sick and patient is paying.
My general attitude (if you are my patient, stop snickering) is that I use personal detail to establish where I am on the map. I'm from around here. You're from where? Oh, you went to WHAT school? Oh, yeah, I love the restaurant down the street. I establish street cred with some patients, like about parenting (although I think my dark circles and bald spots speak volumes there), middle age, or tampon use. Chit-chatting a little is a great way to establish rapport and put patients at ease, which is invariably helpful with regard to getting more medical information later. Over and over again I see patients who are convinced that what they are experiencing or feeling is horrifyingly abnormal. I think that relating personal stories, like, "Oh, yeah, I remember an hour ago when I wanted to kill MY husband" or "It was awful for me when my dad was sick and good Lord, I can pick up the phone and get drugs!" can be reassuring.
Patients who've never had a problem with anxiety or dysphoric mood often feel as though they've been taken over by aliens. Often, when I relate a personal or other patient experience the relief on a patient's face is quite dramatic. And touching. It's scarey to be sick. I have to remind myself when I've had a day when I'm happily up to my elbows in suppurative sputum that it isn't normal to be surrounded by snot, pus, poop, and vomit. Just acknowledging that it's perfectly okay to be a little terrified by relating a little short and to the point anectote seems to be helpful.
But maybe I'm wrong. What say you, Reader? Do you like your doctor? Should you? Do you care about my personal experience with pneumonia, when I got exactly one hour off to go get coffee and shower after a long night of call at Children's? I'm curious. You know what I think. How's about you?
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Definitely you should like your doctor and vice versa. Speaking from both sides. If a doc pisses me off, I won't go back. I have to admit, if a patient is being a jerk from the second I walk in the room, I'm probably not going to want to spend a lot of time with them. I'll probably outright say "you've seem angry even though we just met--is there a way I can help that?" and see if things get better, but if he or she is still a jerk, I'm just trying to get outta there.
ReplyDeleteAs far as personal information, I keep it to a minimum, but sometimes it helps. Some people really fear medications--a simple "I have asthma and this really helped me" can help.
I saw a lady last night who was convinced she was CAUSING her episodes of SVT (rapid abnormal heartbeats) because she often worried that one was going to happen and even avoided going places because of it. I could see she was harboring a lot of guilt about this (and had been since 1979). I kept telling her that she is not causing this and that she has an electrical problem with her heart, but she didn't believe me--until I told her I've recently had SVT. She looked at me and said "really, you've had this?" and looked completely relieved. I told her once more that she has cut out nicotine, caffeine, and done everything she can do to prevent these and that she needs to quit blaming herself for these episodes--and she actually believed me. She'd been harboring this guilt for 30 years and I hope she can finally let go of it!
I like your attitude. It's exactly what I would want my doctor to do. Establish some credibility (who are you to tell me that my periods shouldn't hurt this much.. oh, you have 4 daughters and a wife? ok), and relate some anecdotes where appropriate.
ReplyDeleteThe one thing I appreciate more than anything else (in primary care) is when the doctor does not rush me through the appointment. I know this is not always feasible with time=money and a full waiting room, but it can make the difference between mentioning that embarrassing problem and not mentioning it in the 4 minutes the doc was in the exam room, just because it takes me 6 or 7 minutes to get comfortable enough to mention it.
In primary care I think that the doc should always ask: is there anything else you'd like to discuss/tell me/ask today? And I bet that sometimes the doc wishes he hadn't asked that question, because a simple wart removal can turn into a "I hear voices and I want to kill myself" problem. But sometimes that's what it takes for people to mention those kinds of things (or the fact that you have a giant fungus on your foot, or whatever).
and then eveyone held hands,, hugged, and lived happily ever after.
I know some of this is idealistic, but hey, might as well aim high...
Sure, I definitely like to feel that I can relate to my doctor. While I want my doctor to be smarter/more knowledgeable than me, at the same time I feel more comfortable talking if the doctor seems human and approachable.
ReplyDeleteFrom a more pragmatic point of view, I think this type of rapport fosters a healthy therapeutic relationship that makes a patient more likely to be honest with the doctor about their symptoms, family/social situation, medication compliance, and other factors that may influence diagnoses and outcomes. It also makes the patient more likely to trust the doctor and their recommendations. Part of the art of medicine, no? Of course, I'm just a patient and a horse vet tech(ish), not a doctor, so maybe I'm just talking out of my rear here.
I agree about the staff. I've been lucky -- the nurses at the peds office (where I went until I turned 21!) and at my current GP's office are great, and it makes a big difference.
OK, I think my "I" key is wearing out now . . .
Suffice it to say that the GYN who told me to "spread 'em" when it was time for my pap did not continue to enjoy my custom. Nor did the physician who spent my entire appointment talking about her cat and then said, "Okay, bye Tammy!" My name isn't Tammy.
ReplyDeleteI agree with you wholeheartedly. I actually had a specialist point out to me that, because of chronic conditions, I have to visit one or the other of my docs too often to stick with one that leaves me frustrated at every turn. I need to like them, and I absolutely must trust them, but it's certainly not all on them. If I'm not going to partner with my doctor, be honest with her/him, and stick to the treatment plan we agree on, I might as well just send $30 to a random stranger and save the doc and myself some time. I've lately been reading a number of these medical blogs, as well as reading a few books "e.g., "How Doctors Think" and it's made me appreciate my docs even more, and reminds me of the discipline and sacrifice required of them to become and be MDs. I hope it's made me a better patient. And yes - personal information from my doc does help. I do enjoy when they share a little glimpse of them on a personal level. I can't explain why, really, but I find it comforting.
ReplyDeleteFor what it's worth, I was kinda irritated with Dr. Goopman's tome on how MDs think. He doesn't have a clue, I don't think, how the vast majority of doctors who don't practice in academia think at all. Since, of course, we had that Big Pharma chip implanted in our head by the UHC Ninja Neurosurgeon.
ReplyDeleteAlthough I did walk away from his book emboldened to tell patients whom I really, really, really didn't like or get along with for one reason or another that I think their care would be better gotten from somebody they trusted, liked, valued, etc. more. I'm doing the patient (and yes, me) a favor. There are just some people who make my skin crawl, and I'm not talking about the vulnerable crazy uninsured person who'd be a dump to another MD. I can't get along with everybody; everybody can't get along with me. For primary care, find somebody you like!
If, that is, you can find anybody still doing primary care. Good luck with that.
I just want to agree with you about the staff being VERY important. One of my previous PCP's staff members forgot to submit my claim to insurance, and then eventually billed me for the lost revenue. I informed the staff that the late submission was not my fault, and I left that office pronto. My current PCP has had varying levels of success with staff, but so far it hasn't been worth leaving over. But it has come close. I do like my doc, though, so that helps, and I THINK she likes me, sort of...
ReplyDeleteThat's pretty ballsy to charge you for a claim the staff forgot to submit! Yikes! I'd move along.
ReplyDeleteI think that having a connection with your family physician is crucially (sp?) important! As I'm sure a first time visit is a time of judgement for both patient and Doctor, that knowing a bit of we have common makes me feel like less like the flawed human I have felt in other Doctors offices.
ReplyDeleteIn the office with my clients, in social services, I find that thread which connects us can change the mood of the room. Yes, I'm here to help but I've been there too. From bad teeth to
wedding jitters.
Also trusting the maturity of the Doctor in charge helps alot. I still love (not) the memory of excited med student who examined and said my kidneys were failing - I was 20 at the time and believed him. Never heard anyone before or since so thrilled over my early demise. Well,
he was wrong and I learned that dealing with a grown up helps alot!
I think that having a connection with your family physician is crucially (sp?) important! As I'm sure a first time visit is a time of judgement for both patient and Doctor, that knowing a bit of what we have in common makes me feel like less like the flawed human I have felt in other Doctors offices.
ReplyDeleteIn the office with my clients, in social services, I find that thread which connects us can change the mood of the room. Yes, I'm here to help but I've been there too. From bad teeth to
wedding jitters.
Also trusting the maturity of the Doctor in charge helps alot. I still love (not) the memory of excited med student who called at 6am to tell me my kidneys were failing - I was 20 at the time and believed him. Never heard anyone before or since so thrilled over my early demise. Well,
he was wrong and I learned that dealing with a grown up helps alot!
Oh, Lord, I wonder what I said when I was a medical student that was completely preposterous and haunts the poor patients who were unlucky enough to partake of my knowledge? Oh. I'll have nightmares tonight about that.
ReplyDeleteEggplant: Imagine how awful you'd feel at your first appointment if you were there with a butt problem! I FEEL for those patients. I sit around for a long time with them (both of us clothed) and jawbone for a while. After all, it takes but a moment to look at the source of the dismay. I try to plow some time into establishing some rapport and THEN express consternation for the patient about having to bare it all for me.
ReplyDeleteI do fear asking "anything else"? About half the time I want to kill myself when the patients takes a deep breath and says, "Well, yes." But hey, c'est la vie.