LIVE THE WELLTHY LIFE

I’m happy to report that day one of my new diet went extremely well.  I followed the rules, eating only food and only when I was hungry.  I was surprised how easy this diet is!  Once I resolved the issue of what was on the good list and what was on the restricted list, all guilt went away.  Of course, all food is on the good list giving me a limitless supply of choices.

Day two is going well.  I had food for breakfast and then took a walk around the block.  It’s off to the pool now and then fried flounder for lunch.

Strangely enough, I lost 3 pounds since yesterday.  I actually ate less partly because I didn’t worry about what or when I was going to eat and partly because the night before I started my diet, I ate everything cold and sweet in the frig. 

I’ve got to admit, guilt free eating is a pleasure.  It also eliminates the urge to eat special foods.  When we lived in Long Grove, I obsessed over Krispy Crème Doughnuts.  If we were lucky enough to find a KK, we stopped; and I ate a half dozen.  What a guilty treat!   On my current diet, a half dozen hot KKs is perfectly acceptable as they fall firmly into the category of food; and all foods are permissible.  Now that I can eat them anytime I want, I don’t want them.  I passed the “HOT” sign twice yesterday and had no urge to stop and eat some.  Goodbye, KKs.

I think comfort foods will lose their allure and sinful foods will lose the excitement that comes with sinful acts.  The other big plus is I do not need to record calories, cholesterol, etc.  Food has no limits!

I am recording exercise.  For this diet to work, I have to exercise.  Goodbye for now. I’m off to the pool for pool aerobics.  This afternoon, I’ll walk around the block a few times. 

My current plan is to give this diet a few years to work and then assess the results.  Meanwhile, I’ll keep doing fat jokes:

I wish I could see what it was like to be fat for just one day. I’m tired of being fat every day.

Fat people are lucky. They get to eat whatever they want and not worry about getting fat.

If, at first, you don’t succeed, try, try again.  If you fall down 4 times, get up 5 times.  There are countless cliches dealing with failure.  They all have a common theme:  you can overcome failure by being persistent in your quest for success.

Personally, I’ve failed every attempt I’ve made to lose weight.  I’ve become obsessed with food and weight loss and obsessions are almost never good.  I spent 40 years counseling others on diet, weight loss and wellth.  I was quite good at it, although I did have my failures.  In retrospect, those failures were probably related to the patient’s obsession/ psychological ties to eating.

I could take the easy way out and blame my medications.  One of the meds for Parkinson’s clearly warns patients that they are high risk for obsessive behaviors.  I could blame the medical marijuana for causing the “munchies.”  I could also blame my upbringing as my family was in the food business and my mother was a perpetual dieter. Lastly, I could blame my weight gain on the effects of depression.

Realistically, placing blame is a worthless exercise.  Laying blame only helps when, by recognizing the contributing factors, you can actually change them.  I’m not going to change my meds!  I can’t change my family history.  Medical marijuana helps the Parkinson’s!  So, what can I do?

My kids will tell you the Segal Motto is, “Go big or go home.”  I’ve gone big!  Big, as in, “You’re so fat the post office is issuing you your own zip code” big.  If carrying around an extra 50 pounds was easy, I would just accept my own zip code with pride and put on a little more.  The problem is carrying an extra 50 pounds is a lot of work and it’s killing my back and knees.

So, I’ve decided to go on a very strict diet.  I have decided that I’m only going to eat food for breakfast, lunch, dinner and snacks!  I’m going to limit the amount of food I eat to whatever it takes to fill me.  I’m going to stop obsessing about calorie counts, fats, etc.  I’m going to enjoy guilt free eating.

My new obsession is going to be exercise.  I’m going to obsess about burning calories.  I’m going to start everyday with sexercise, then walking, swimming and doing whatever I can to burn calories.  Of course, my Parkinson’s and bad back almost guarantees failure, as walking and swimming are difficult; and, at 70, sexercise is pretty much a mental exercise. But, at least, I’ll succeed at enjoying my all-natural food diet.  I will continue Rock Steady twice a week until I’m strong enough to go three times a week.

Wish me luck.  Who knows, I might even lose a pound or two as my obsession with exercise grows!

Here’s my fat joke for the day:

I’m so fat I wore a yellow rain jacket and people yelled, “TAXI.”

Let’s assume that nothing I say or do is going to change today’s medical delivery model.  Assume that the qualities listed in past articles that make a physician truly great are either innately present at the time a student enrolls in medical school or that they are not part of the student’s tool chest.

Further, let’s assume that today’s employers of medical providers have no interest in teaching providers how to listen, comfort and reassure, as those traits take time and time is money.  If you doubt my assumptions, take a minute to think about “telemedicine,” the newest doc in a box.

Take the time to schedule a “telemed” visit.  Experience, first-hand, what the future of medicine looks like.  Did the doc listen to you?  He/she should have!  He/she certainly couldn’t touch you, examine you or draw lab.  Did you feel you were cared for?  Were you comforted?  Can you imagine developing a relationship with the doc on your computer screen?

I think not!  So, if I’m right, what’s a person to do? Perhaps the answer is in training and developing a new type of healthcare coach, the patient advocate. There are thousands of retired physicians in the United States, many of whom would like to work, part-time, in their chosen fields.  Licensure requirements, malpractice insurance and the overhead of running a business prevent most retired physicians from practicing medicine.

“Ask An Old Doc” (AAOD) could be the answer to the patient’s need for an experienced and caring advocate, as well as meeting the needs of the retired doc who wants to continue to support patients in need of advice.  AAOD would employ retired physicians in the role of healthcare advocates and life coaches.  While the AAOD employee would not function as an MD, his/her wealth of knowledge and experience would prove to be invaluable tools in helping individuals through whatever situation they find themselves in.

AAOD would function best as a not-for-profit organization, charging patients on a sliding scale basis according to need.  Before I go any further with this idea, I’d like to hear what your thoughts are.  Would you likely use such a service?  What would you be willing to pay/donate to AAOD? 

Here’s your joke for the day:

A mentor of mine once told me that a great way to let go of your anger is to write letters to people you hate and then burn them. Well, I did that; and I feel much, much better, but I’m not sure what to do with all these letters.

As I look back over my blog, I realize that my central premise is faulty.  The medical complex I grew up in is long gone.  New docs are graduating this summer and entering a system so foreign to my background as to be almost unrecognizable.

When I graduated, everybody went into the private sector, either hanging out their own shingle or joining an established practice.  Today’s docs will sign employment contracts with large medical conglomerates.  They will be given an employee manual outlining their responsibilities to the corporation and the corporation’s patients.

Their marching orders may not tell them how long to spend with a patient or what to prescribe but, instead, will give them parameters that they must follow in order to be financially successful.  The electronic medical record (EMR) will grade their care:  what percent of their prescriptions are generics, what percent of their specialty referrals were to docs employed by the healthcare conglomerate, how many antibiotics did they write, how many patients did they see per hour, etc.

In the new world, my proposed book is worthless.  Yes, a small percentage of the doc’s overall performance rating will be dependent on patient feedback’ and, following the guidelines I’ve laid out, patient satisfaction should be high but it’s going to be almost impossible to be a good listener, a caring and comforting doc and address the demands of an uncaring EMR whose only goal is to collect data. Much of what transpires between the doc and the employer will be invisible to the patient; but enough will be visible that, inevitably, the patient will be unhappy and uncomfortable.

Sounds depressing, doesn’t it!  It’s time to put the top down and go for a ride.  It’s almost impossible to be depressed while cruising, top down, on a sunny summer day. For those of you who don’t have a convertible, my suggestion is to find an old doc who is still independent, not yet disillusioned and settle in with her/him.  If you can’t find an old doc, find one of the few who work for physician owned groups. 

Meanwhile, I’m going to take a brief sabbatical from writing while I reassess the premise behind this blog.  Feel free to make any suggestions or share any thoughts you have with me.

Here’s your joke of the day:

My grandfather, Randy, was a brick layer.

He said: “I was a brick layer for 10 years, but no one calls me Randy, the brick layer.

I was a farmer for 20 years, but no one called me Randy, the farmer.

But you have sex with just one goat…”

I just got a frantic call from an old colleague of mine.  He’s a modern-day David fighting against one of the Goliaths of medical corporations, AMG.  My friend and I have served the northwest suburbs of Chicago for decades.  When I opened in Barrington, EHS (Evangelical Hosp Systems) ran the local hospital. EHS had a heart of gold and a charitable policy like none other.

A simple phone call to the COO of Good Shepard Hospital could zero out the account of a patient who was about to go to collection or worse, whose choice was pay the hospital bill or feed the kids.  More than once, the hospital provided babysitters for a patient whose spouse was in the ICU or dying from a horrible disease.

During those golden years, Good Shepherd’s staff was comprised of some of the best generalists and specialists you could find anywhere.  The physician practices were all privately owned and unencumbered by insurance companies or employers, thus decisions regarding testing or referrals were made by the patient’s physician in conjunction with the patient.

Over the years, the insurers slowly took control of the medical decisions by creating specialist and diagnostic panels that both generalists (Internal Medicine/Family Practitioner) and patients were required to use or suffer a financial penalty.  In the last 15 years, a new player joined the game. 

Hospital corporations, like EHS, started to merge into much larger and powerful healthcare conglomerates.  As they grew, they started buying medical practices.  Their business models were ingenious.  First, the hospital bought a large number of internal medicine and family practices.  Then, they purchased key specialty groups and fed all of their patients into a few, corporate owned specialty practices. 

Over time, this new model changed and continues to change the referral pattern by choking off the patient flow that independent specialists need to keep their offices open. Eventually, independent specialists either give their practices to the hospital corporation or they retire.  As the number of specialists decrease, independent generalists begin to have problems obtaining specialty consults. Eventually, the generalists either give their practices to the hospital conglomerate or they have to retire. 

Specialty care is an essential part of medical care. Imagine the following scenario:

“This is Dr Segal’s office.  His patient, Mr. X, needs to see a cardiologist this week.   Can you please find him an appointment and call him?”

“I’m really sorry.  We are so busy taking care of our employed physician’s patient that we couldn’t fit your patient in for at least 120 days.”

“Dr Segal, would like to talk to Dr AMG?  Can you have your doc call mine?”

“Is Dr Segal an AMG doc?”

“No.”

“Sorry, I can’t help you.”

Now, do you understand why my old friend and colleague is frantic? He’s an independent and recognizes that the above scenario is actively unfolding in Barrington.  Unfortunately, I think Goliath wins this and all future rounds.  Unfortunately, you lose, too.  As your choices for specialty care dwindle, so may the quality of your health care.

I’m happy I’m retired.  .

Whenever possible, support independent physicians!

Here’s your joke for the day.

There was a man named Billy. Billy worked at a pickle factory. One day Billy comes home to his wife and says…

…“Honey, I want to put my pp in the pickle slicer.  His wife tells him that’s absurd and not to do it and then went to sleep. Billy goes to work the next day and comes home and tells his wife, “Honey, I put my pp in the pickle slicer!” His wife yelled, “What happened? Was it bloody? Did it hurt?” The man tells his wife, “No, but I got fired and so did she.

We’ve defined the some of the attributes needed to be a good/great doctor.  Now, let’s explore what attributes a great patient brings to the doctor-patient partnership.  I bet you have never considered your role in healthcare, have you?

No matter what your doc does for you or to you, he/she will be ineffective without your input and cooperation.  Coumadin, a common blood thinner, is also used as rat poisoning.  When patients find out that they are on “rat poisoning,” they freak out.  There are a multitude of horror stories associated with Coumadin.  

I routinely informed my patients about Coumadin’s usage, benefits, and risks.  Until recently, Coumadin was an essential medication used to prevent strokes and blood clots.  Making coumadin even harder to use is the fact that its anticlotting property is managed with blood work and must be kept in a tight range.  Too much and the patient bleeds, too little and the clot or stroke.

The story goes like this:  I spend a half hour reassuring my patient that, in her case, Coumadin is a life-saving medication.  I remind my patient that she is not a rat and doesn’t have to worry about taking a “rat poison.”  She agrees and goes on Coumadin for a while.  One day, she reads an internet rant about Coumadin and stops taking it. A few weeks later, she has a massive stroke.

No matter how good your doc is, he/she can’t help you when you make unilateral decisions.  A simple call could have saved a life full of misery.  The internet is not a reliable source of medical information.  At best, its use should help patients formulate questions to be answered by their docs. Luckily, there are new meds that take the place of Coumadin; but all medications have risks and part of what your doc does is risk manage.

The qualities of a good/great patient are the same as the qualities that make a good physician.  My favorite patients were engineers.  They are usually analytical and organized.  They are usually good at describing their symptoms and breaking the symptoms into their various components:

“Doc, I’ve been feverish and tired (general symptoms).  My nose is congested, and I’ve got a sore throat.  My ears are popping (HEENT). I’m coughing up clear sputum.  I’m a little short of breath (respiratory).  Otherwise, I’m fine.” 

The engineer has done most of my job in advance of coming to the office.  Engineers are usually good listeners, analyzing what I’m saying as I’m saying it.

I know, you’re thinking, “I’m not an engineer.”  You don’t have to be.  You should organize your needs, thoughts and questions before coming in to see your doc.  All too often, I would get a phone call a few hours after I saw you with an “Oh, by the way, I forgot . . .”  The absolute worst is when the patient’s wife calls, “Doc, did he tell you he has chest pain?”  My response was no, he denied any chest pain.  In the background, my patient is yelling, ”It’s just indigestion!”  He refuses to go the ER. Hours later he collapses and spends 3 days in the cardiac ICU.  Luckily, he survives.

As a patient, not only do you need good listening skills, but at some point you need to accept and act on what you hear.  In this gentleman’s case, I told him that we had to make sure he was not having heart pain and that I would gladly apologize for panicking him once I knew he was well.  I loved being wrong about chest pain but, most of the time, was right.

As a patient, you need to be assertive, your own advocate. Second opinions are great if there is time.  When the stakes are high, the ER is your second opinion.  “Doc, I know my body better than anyone and I know this is indigestion, not heart.  I have no family history or risk factors.  I’m a distance runner.”  Yes, by history, the patient is in a low-risk category but he had significant coronary artery disease (widow maker). Yes, he was unlucky enough to be the first in his family. He ignored the ER doc’s advice and went home against medical advice.  He wanted to see his chiropractor/naturopath.  He made a widow out of his wife.

Being a good patient means knowing when to comply, when to follow through and when to get a second opinion.  One of my favorite patients was an anxious patient who came in with 5-10 pages of hand-written history, observations and questions.  She always apologized for taking up too much time; but, actually, she saved me time by being prepared.   If the visit was for her husband, she came with him in the role of patient advocate.

Tomorrow, we will discuss the patient advocate role’s importance. Here’s your joke: What’s worse than ants in your pants? Uncles!

One of my readers, in response to my recent articles about the qualities of an excellent doctor, wrote, “Respect is a two-way street.”  Indeed, it is!  Those of you who have followed my blog over the years know that my childhood doctor played a major role in who I was to become.

I don’t know why, but I called Dr Perlman by his first name, Jerome.  I was very ill and very scared!  I suspect I started using his first name around the time I started getting sick and was in his office frequently.  No matter the reason, Jerome never balked, never corrected me.  In turn, I never balked when a patient used my first name. 

Yes, the title “Doctor” brings with it a certain level of respect at the onset of a relationship; but, realistically, respect should be earned over time.  By the same token, the titles “Mr.” and “Mrs.” should also be treated respectfully.  In the instance my reader and former patient wrote about today, he was rebuked for calling his doc by her first name.  He writes:

“She was a taken back and said that’s Dr. (insert first name). I asked, what do you call me? Her answer was hi or hey. Sorry, not acceptable. If you’re Dr. such and such, my name is Mr. C. Otherwise, you lose the title. Respect is a two-way street. “

In 1984, I used the Mr. and Mrs. designation until I got to know my patients well.  In the nineties, I became more relaxed and dropped the Mr. and Mrs. and started using my patients first name from the onset of our relationship.  By the turn of the century, my established patients started using my first name.

Yesterday, I wrote about kindness and compassion as key elements of an excellent doctor.  Today’s blog is about comfort!  Respect is a two-way street and is best when earned.  When my patients became comfortable enough with me to drop my title and use my first name, I knew I had finally earned their respect.  I know that sounds illogical but the initial respect they showed me was really for the title I had earned, not for the man holding it.

When my patient became comfortable enough to call me by my fist name, I knew I had truly established a caring relationship, a medical home.  I knew the comfort I felt in having “Jerome” caring for me and had finally arrived in my journey from a good doc to a great doc.  A great doc makes his/her patients comfortable in his/her presence and with his/her care.

If I was Mr. C’s doc, I would have welcomed the transition from the formal “Dr.” to Mr. C’s comfortable “Brenda.”  Confusing?  Definitely!  I told you this was a tough topic to write about.

To make things more confusing, doctors are supposed to keep a professional distance from their patients.  I think the idea is that, by keeping a professional and emotional distance, the doctor will make more objective decisions, decisions not influenced by emotions.  BULLSHIT!  Keeping a professional and emotional distance is what is wrong in medicine today.  Maybe it worked in the old days when docs were put on pedestals but not in today’s world.

Docs are taught to care for strangers but caring for those you hold close comes naturally.  My office was my home and should have been a place of comfort and security.  When you were comfortable enough to drop the title, you were finally home. 

A quick story.  When patients would call and tell my front desk that they were good friends with “Stu” or “Stewie,” my staff would crack up.  No one who knew me used either of the diminutives.  While my first name was a welcomed title, diminutives were not.

Initially, give your doc the respect of using his/her title. If and when you become comfortable with your doc and want to transition to a first name basis, ask how he/she feels about it. Your doc might surprise you and realize that he/she has now truly EARNED your respect as both a physician and a valued healthcare partner in your life.  

Here’re your jokes for the day from the great Rodney Dangerfield:

“When I was a kid, my parents moved around a lot; but I always found them.”

”What a kid I got! I told him about the birds and the bees and he told me about the butcher and my wife.”

“I haven’t spoken to my wife in years. I didn’t want to interrupt her.”

“My wife and I were happy for twenty years. Then we met.”

“My wife’s cooking is so bad the flies fix our screens.”

“I told my wife the truth. I told her I was seeing a psychiatrist. Then she told me the truth: that she was seeing a psychiatrist, two plumbers, and a bartender.”

“It’s tough to stay married. My wife says no because she’s tired, then stays up and reads her book.”

“Once somebody stole our car. I asked my wife if she saw who it was. She said: “No, but I did get the license number”.

60 Best Rodney Dangerfield Quotes And Jokes You Need To Know (humoropedia.com)

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!