Month: June 2021

Yesterday, one of my readers wrote the following: “

“An excellent Dr. is one that makes you feel they are concerned about you and are there to help you. They are easy to talk with and use lay terms so you can understand them. They take the time to listen to your concerns even if your concerns don’t seem like much to them, it could be a huge to the patient. As a patient all these issues are new and frightening to say the least. They’re looking for comfort from their Dr. to help them and put them at ease and be compassionate. Your Dr. may be the only person they have to talk with about these issues. Kindness and compassion go a LONG way…”

Kindness and compassion do, indeed, go a long way and are essential elements of every patient interaction.  Did you ever stop to look at the definition of the word “care”?  Did you know it could be used as a noun or a verb?

NOUN (copied from internet dictionary)

the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something.

“the care of the elderly” · [more]

synonyms:

safe keeping · supervision · custody · charge · protection · keeping · keep · [more]

serious attention or consideration applied to doing something correctly or to avoid damage or risk.

“he planned his departure with great care”

synonyms:

caution · carefulness · wariness · awareness · heedfulness · heed · attention · [more]

VERB

feel concern or interest; attach importance to something.

“they don’t care about human life” · [more]

synonyms:

be concerned · worry (oneself) · trouble oneself · bother · mind · [more]

(care for)

look after and provide for the needs of.

“he has numerous animals to care for”

synonyms:

look after · take care of · tend · attend to · mind · minister to · take charge of · [more]

I think the first quality that you should look for in a doc is “care.”  Over the years, patients who had bad outcomes would often come to me with a question.  “Doc, I think the surgeon screwed up and that’s why I’m still hurting.  I’m thinking about suing him/her.  What do you think?

My answer was always the same.  Let’s assume that the surgeon made a mistake.  Was that mistake made while he/she was caring for you or was he/she careless and messed up?  If the mistake was made while the surgeon was caring for you, then you should not sue.  The surgeon is human after all.  If the mistake was a careless one, meaning the surgeon didn’t care about you, then by all means sue him/her out of practice.  There is no place in medicine for doc who doesn’t care.

Can you teach a student to care?  I don’t think so.  I do believe that you can assess a person’s ability to care for his/her patients and fail those students who are careless when careless means without care.  Ultimately, it is the patient who needs to assess whether his/her doc cares about him/her; and, if the patient doesn’t feel that the doc cares, he/she needs to find another doc.

So, the attributes of a great doc are:

1. Caring
2. Compassion
3. Kindness
4. Listening
5. Easy to talk to
6. Uses plain, everyday language and vocabulary
7. Comforting
8. Finds the time necessary to treat his/her patients.

Unfortunately, medical school and residency training is mostly about diagnosis and treatment with very little emphasis on the items listed above.  As a patient, I want an expert trained on items one through seven, as well as being a good diagnostician an up to date on treatment modalities.  Yes, I want it all.

Here are your jokes today:

A sign on a cosmetic surgery clinic says:

“If life gives you lemons, a simple operation can give you melons.”

A couple gets married, and on their wedding night, the wife asks what a penis is. The husband, surprised, pulls his out. She says, “Oh, it’s like a dick but smaller.”

Does the prefix “Doctor” intimidate you?  When I practiced medicine, I was surprised to hear patients say that I was intimidating.  I always dressed casually, wearing a polo shirt and jeans a few days a week.  Most of the time, I sat when I talked with you and I worked hard at breaking the 11 second phenomena.  Nonetheless, patients were intimidated by my title.

We’ve established that listening is a critical characteristic of an excellent doctor.  We’ve also established that most doctors, while taking a patient’s history, will interrupt their patient within 11 – 15 seconds after their patient starts to talk.  So, what can you do?

The obvious answer is to politely interrupt your doc’s interruption by saying, “Doc, I know you have patients waiting and calls to make but there are more pertinent facts I need to share with you.”  At that point, you need to launch into the rest of your story. Writing out your story in advance allows you to organize it into a relevant, understandable presentation.  Organizing it in advance also allows you to prioritize your needs and saves time.

I want you to make your story into a presentation lasting no more then 3-4 minutes and highlighting the two most important features of your illness.  Sounds good to you?  Sounds easy?  It’s not if you find the letters, “M.D.”, intimidating.  Your doctor is there to meet your needs.  He/she are humans!  They eat, piss and crap the same as you.  If they intimidate you, imagine your doc sitting on your couch in PJs eating popcorn and watching TV.  I bet that will work.

At first, your doc may appear a little incredulous or annoyed when you interrupt him/her. Hand the doc a copy of your presentation, apologize and tell the doc you need “x” minutes to finish relating important facts about yourself.  Actually, you’ll be teaching the importance of listening to your doc much the was my wife trained me.

One of two things will happen.  Either your doc will learn to listen to you without interruption or you’ll need to get a new physician.  You will learn to prep for your visit, laying out the facts as you see them.

Your relationship with your docs should be optimized over time such that both you and your physician learn how to effectively communicate.  In time, your feelings of intimidation should dissipate and be replaced by mutual respect.

Tomorrow, we’ll review the importance of mutual respect and we’ll add respect to the list of attributes that make a doctor exceptional.

Here’s your joke:

What is mutual understanding?

Wife: I love you.

Husband: How much money do you need?

Husband: I love you. Wife: Not now, the children are still awake.

I’ve got to admit. I was disappointed by the meager response I received to my last article.  While only a few of you sent me their ideas of what it takes to be a good doc, the few who responded agreed that a “good” doc has to be a good listener.  One reader sent an inspiring quote, “The biggest communication problem is we do not listen to understand.  We listen to reply.”

Take a minute and think about it.  How fast does your doc interrupt you when you are telling him/her about how you feel?  There are multiple studies posted to the internet showing that, on average, docs interrupt their patients’ story in eleven seconds.  What is truly regrettable is that, when I started in medicine in 1979, statistics showed the identical 11 second interruptions.

 “The biggest communication problem is we do not listen to understand.  We listen to reply.”  If I’m listening to reply, eleven seconds works.  In eleven seconds, I think I’ve got the gist of what you are saying, I then cut in and start into my diagnosis and treatment plan.  If I’m listening to understand, I let you finish telling your story and uncover facts I missed in the first eleven seconds.

So, why aren’t doctors given courses in listening?  One of the things that impressed me during my first month of residency was an exercise in listening.  Our director played a cockpit recording from an airplane that crashed due to a miscommunication between the pilot and co-pilot.  We spent about an hour analyzing what happened and another hour discussing how it could have been prevented.  That was the extent of my listening training!

While listening to understand is essential in every facet of life, it is particularly critical in medicine. It is also time consuming and, regrettably, time is money. Yep, I had salaries and bills that had to be paid. In a perfect world, docs would be paid by the minute.  You need 60 minutes; you get 60 minutes.  In the real world, Medicare and the insurers pay an hourly rate that doesn’t come close to covering the overhead of a modern medical office.

Do you have a solution?  I did but very few patients liked it.  I learned to limit the number of problems I would listen to during an office visit.  It works like this: 

Patient – “Doc, I’m having problems with a cough.  Oh yeah, I also have acid indigestion.  I almost forgot to tell you, I pee every 2 hours.  My nose is congested …

Me- “I’m sorry you are having so many problems.  I’m going to step out of the room for a few minutes.  Please make a list of everything that’s bothering you and then prioritize your list.  Today, we’ll deal with items one and two.  We’ll see you in a week and follow up on one and two and start on three and four.”

Patient- “Oh, by the way, I forgot to put chest pain on the list.  I’m sure it’s just indigestion.”

Patients who had saved up a lot of problems did not want to wait a week or two to resolve all of their issues, despite the fact that the cough started last year, the bladder issues started 6 months ago, etc.  All too often, the patient’s priorities did not match mine.

At the end of a twenty-minute visit in which we developed a list of problems to be addressed, had addressed the most pressing problems and had arranged for the future handling of unresolved issues.  The patient, while standing at the discharge desk, complained that the doc didn’t listen to him and did nothing for him.

So, when asked how I would fix our broken medical system, I would answer, “We do not listen to understand.  We listen to reply.”  Before trying to fix our broken system, we need to do a lot of listening to develop an understanding of what people truly need.  Unfortunately, only 4 out of a hundred readers responded to my first question, “What makes a good doctor and what makes an excellent doctor?”  Now, what makes a good patient and what makes an excellent patient?

Jokes about miscommunications:

My wife and I have such a wonderful marriage. I always know what she is thinking because she always tells me what she’s thinking.

She always knows what I’m thinking, because she tells me that, too!