Too Many Doctors in the Room

I don’t like doctors. I always feel uncomfortable around them. When I am a patient I find myself second guessing everything the doctor says, wondering if he is getting it right. When one of my patients is a doctor I second guess everything I say, wondering if I am getting it right. It is extremely stressful.

As stressful as it is doctors are people and people need to go to the doctor, which is why I occasionally find myself seeing physicians in the office. One came in recently for an annual exam. I don’t know if he was nervous, but I was.

I did my best to treat him as I would any other patient in my practice. I asked about his health history and I asked about his family. He started to share some of the issues he was facing, at one point pausing to say “You don’t need to hear all this.”

I told them I did want to hear it, that it was important to know all of the issues in his life. We spoke for quite a while about his work, his wife and his children. We talked about the challenges of balancing family life and medical practice as well as the work required to maintain a healthy marriage.

I did my best to encourage him but found myself wondering if I had succeeded. It is one thing to give guidance about a medical issue. Encouragement about personal issues is different. There is a significant risk of offense or coming across as condescending, especially with a colleague.

A few weeks later I received an email from the doctor. In it he thanked me for the personal advice, telling me that one thing I shared had truly impacted him. He wanted me to know that my personal touch had made a difference and that he hoped I continued to encourage others in the same way.

His note accomplished its intended purpose. I was encouraged. He reminded me that I need never be afraid to love and encourage the patients that God brings to my office. In the midst of the making diagnoses and developingtreatment plans I must never forget that sometimes caring is the most important part of medical care.

-          Bart

10 Things Patients Want From their Doctors

Unhappy with the service you receive from your doctor? Want to tell them how they can do a better job? Here is a list of things patients all deserve from their doctors, feel free to share it with your physician.

Patients deserve-

1-      A smile. They deserve one from the receptionist and from the doctor. They are the reason we all have a job!

2-      A doctor who is on time. Patients understand that we have emergencies but also know that we do not have emergencies every day. Repeated long waits tell patients that we are uncaring and disorganized. My personal solution to the problem is to schedule same day illness appointments at the end of the morning after I am done with scheduled patients. My scheduled patients then have the time they need.

3-      A meaningful apology. When I am behind more than 30 minutes I give out Starbucks Gift Cards as an apology. This 5 dollar gesture lets them know that their time is important.

4-      Access. When patients are sick and want to be seen, we need to see them. If that means working late or working through lunch we need to do that. If we are not available when they need us, what good are we to them?

5-      Timely responses. We need to return our phone calls every day and notify patients of test results as soon as they come in. Worried patients should not have to worry needlessly. When we communicate quickly we tell them we care.

6-      Listening. I am not a naturally good listener and I am easily distracted by the computer screen. I have trained myself to step away from the computer and to sit down when there is something important to communicate. A minute or two of my undivided attention means a lot.

7-      Eye contact. Computers make this harder, but it is important. No one wants to look at the back of our head when they talk.

8-      Clear explanations. Doctors too often rush through instructions at an unintelligible pace. In my office I type out instructions that the patient can pick up as they leave. I have learned to be specific and clear. I don’t just write “ice your leg three times a day”, I have learned to write “Ice your leg for 20 minutes three times a day.”

9-      Honesty. When I don’t know something, I say so. When something is outside of my area of expertise, I share it. Patients know we are human and appreciate it when we admit it.

10-   Time. Some patients need a lot of it. Instead of rushing and trying to handle 6 things in 10 minutes, I ask patients if it would be okay to bring them back in a week or two for a longer visit. When I say that I want to make sure I have enough time to address all of their concerns appropriately and that it is hard to do a good job when I rush, they always understand.

When I first started in practice I did none of these things well (I do not naturally communicate warmth, I am more of a problem-solver type). As a result my patient satisfaction scores were only average. It took years of effort to incorporate these behaviors into my practice. The result has been happier patients, high patient satisfaction scores, a happier office staff, and a happier me!

- Bart

Thanks for reading. Comments and questions are welcomed, and shares are truly appreciated (just click the button)

Why Doctor Visits are Frustrating and What You Can Do About It

You wait weeks to see the doctor. You could have scheduled a visit sooner, should have scheduled a visit sooner, but life and time got away from you. It has been so long since you have been in and you want to make the most of your visit so you make a list of the things about which you are concerned. Not all of the things are major or important but you figure you might as well bring them all up, because it may be a while before you make it in again.

The receptionist was in a hurry when you called so you did not bother to tell her all of the issues you wanted to address, you mentioned the back pain and the blood pressure that you have been ignoring since the last time you were seen 2 years ago. You will bring the rest up when you see the doctor.

After a 30 minute wait in the waiting room and another 15 in the exam room the doctor hurries in. He greets you briefly before turning to his computer. “I see you are having some back pain and your blood pressure is still high,” he says without turning to look at you, “How long has your back been acting up?”

You want to give him the full story, so you begin to tell him about how it all started 4 years ago lifting boxes at work, and how it has been bad off and on since then but has been really bad for the last 3 weeks. He interrupts you 15 seconds in, “How long for this episode?”

“Three weeks, but it all start…” interrupted again, “Any weakness or change in your bowel or bladder?”

“No, but…” you reply, “Let me have you sit up here,” again interrupted, you sit on the table and the doctor does a quick exam on your legs, checking your reflexes and strength. He doesn’t even look at your back. Within what seems like seconds he tells you that he is going to give you an anti-inflammatory medication and send you to physical therapy. If you are not better in 3-4 weeks you are to come back for a follow up visit.

He then tells you that he wants you to check your blood pressure at home 2-3 times a week and return in a month for a follow up blood pressure check as you may need medicine. He says you also need lab work and tells you to pick up the order at the desk on your way out. As he reaches for the doorknob he says you also need a mammogram and a colonoscopy and that he wants you to pick up the paperwork for those at the desk as well.

“Okay, but there were a few other things I wanted to talk to you about,” you plead.

“We can discuss those when you come back in a month,” he replies as he disappears out the door.

The entire interaction took about 10 minutes and you are left wondering what happened. You are walking out with several recommendations you did not ask for, little attention for your main issue and no attention at all to the remainder of your list. You ask yourself, “Is this why I have health insurance?”

Welcome to modern medicine, where the doctor does what he is required to do and the patient feels as if nothing has been done at all. Here are the things you need to know to help you understand and navigate this seemingly uncaring healthcare system.

1-      Routine visits are scheduled 15 minutes apart. Most doctors do not type well and electronic records are horrendously slow and inefficient, so the time available for the doctor-patient interaction is a net of 10 minutes or so. If there are two issues to be addressed, that is 5 minutes each. Very few doctors can effectively treat more than a few complaints at a time, and you really don’t want them to!

2-      Longer visits cost the doctor money. In a perfect world physicians would make the same for one 30 minute visit as they do for two 15 minute visits. The world is not perfect and they don’t. Under many insurances a long visit may only pay an additional 50% over a short visit. Doctors can do the math, so instead of scheduling long visits they ask you to return if there are many issues to address.

3-      Common complaints don’t usually require much thought or attention. Back pain in a healthy person without weakness or incontinence is almost NEVER anything to worry about. It will go away in 3-4 weeks with or without treatment. MRI’s and X-rays don’t change this fact. For many mild illnesses and conditions there is not much to do. If lengthy discussions and examinations don’t change the treatment plan, why do them?

4-      Doctors are responsible for your preventative health screens, whether you are interested in them or not. We get evaluated based on the percentage of patients who have mammograms, colonoscopy, PAP smears and appropriate immunizations. As we do not know if or when a patient will return for follow up we are forced to squeeze time for these recommendations into other visits. The result- We may not have the time for everything you wanted to discuss.

5-      There is much more to a doctor’s day than patient visits. Doctors spend a minimum of 2-3 hours a day working on issues outside of the exam room. Medication refills, phone questions, review of test results and lab results, disability and FMLA forms, home health orders, consult requests, referrals and appeals of insurance denials are endless. Doctors get paid for none of this work. We frequently try to do some of this work between visits, which further cuts into patient care time.

While this explains why your doctor is hurried and grumpy, there is still the question of how you get the care you desire. Here are somethings you can do to help your doctor take better care of you and get your health issues addressed.

1-      Take responsibility for your preventative screening needs. Schedule a wellness visit and ask what you need. Write it down, or save a link to recommendations. Enter the dates in your calendar or cell phone and then get the screenings done. If you take the time to make sure you are up to date your doctor won’t have to.

2-      If you have a number of issues you want to discuss, prioritize them. Tell the receptionist and the nurse the issues so the doctor will know when she comes into the room. Tell the doctor the items that are most important to you and be willing to come back if more time is needed.

3-      Don’t expect a lengthy visit for a common problem. Doctors sometimes see simple complaints such as acute back pain, bladder infections and colds as short visits that allow them to catch up when they are behind or to gain time after a complicated visit.

4-      If you do not feel comfortable with your visit, let the doctor know. Try saying something like, “I sorry, but I am confused. Could you explain this to me?”

5- If you need a lot of time, ask for it! You may need to come back, but most doctors want to help and may be willing to spend the extra time you need.

- Bart

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