THE GOOD PATIENT

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!

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