I recently published an article called 13 Things Good Doctors Wish Their Patients Knew- Demystifying the Doctor Patient Relationship. If you haven’t read Part One, take a quick trip over to that article to read the first 13 things. Thanks to my readers’ comments and social media shares, I have had some great feedback from doctors both in my life and around the world. Here are 13 MORE things good doctors wish their patients knew.
- We need the complete truth.
I feel for patients when they seem hesitant to reveal something they deem embarrassing or shameful. Two things on that. First, we hear so much. There is very little that is truly shocking. The shock factor wore off early in our training, never to return. Secondly, we realize we haven’t walked a mile in your shoes. Or an inch. We take in the facts and then get down to the work of helping you; we don’t judge, and we certainly don’t gossip about you. But in order to take good care of you, we need the straight truth. Period. This means telling us about what drugs you’ve taken, legal and illegal, to avoid potentially fatal drug interactions. It means telling us exactly when you ate last before surgery in order to avoid a potentially deadly pneumonia. It means answering honestly about sexual encounters. We don’t need every detail, but we ask questions for very specific reasons and need your careful, honest, thorough answers to direct your care. At age 21, I had two back-to-back abdominal surgeries. For days afterwards, awkward surgical med students and interns came to see me on their rounds. They all wanted to know if I’d passed gas. Well, sheesh. I was a young woman in an already unflattering and revealing hospital gown. Of course I haven’t passed gas. Must you rob me of my last shred of dignity?! What I didn’t know was that this made them concerned that my bowels weren’t functioning properly. I wasn’t getting out of there until the answer was yes. I finally tumbled to it. Honesty would have avoided delay and directed my care more appropriately. It didn’t change my outcome, but trust me. A dishonest or partial answer to a medical question can have a terrible ripple effect. The truth is imperative. Clunky and awkward at times, but essential just the same.
- We get frustrated when we can’t find the answers.
I hated having to tell patients “I don’t know.” As an ambitious problem solver, it is so frustrating not to be able to fix your problems and even more frustrating not to be able to explain their cause. Medicine is an ever-developing, inexact science with more questions than answers. I used to tell patients that I’d love to be able to climb in and take a look around. It would make things so much easier. In a way, imaging studies come close, but there are some things that will remain mysterious. It is so hard. It feels like failure on our part. We hate nothing more than letting you down.
- Antibiotics hurt if they can’t help.
Viral illnesses are not susceptible to antibiotics. Antibiotics are for bacterial illnesses only, and they need to be reserved for bacterial illnesses. Every time they are prescribed and taken inappropriately, the patient is being placed in harm’s way due to unnecessary potential side effects, and humankind as a whole is ever so slightly closer to a very scary eventual reality where bacterial infections are no longer susceptible to our medications. Antivirals are sometimes appropriate for viral illnesses, but for most viruses, like the common cold, they are useless and can be harmful.
- Sometimes, “watch and wait” is the most appropriate first reaction.
This can feel a lot like doing nothing, but trust me when I say that reacting to every situation with an imaging study, lab test, or medication can cause very dangerous and avoidable complications. If you trust your doctor, trust that sometimes time is the best clarifier.
- We make mistakes.
It is impossible to reconcile our imperfection as humans with the gravity of having the well-being of our patients in our hands. The importance of providing thorough, thoughtful care in combination with being human is exhausting, weighty, and ever present. We do make mistakes. Be very wary of anyone who won’t admit that. We are extremely vigilant. But we can’t always be perfect. This is the very hardest thing about being a doctor.
- We are safe confidantes.
I had a patient in residency that I always enjoyed seeing. After a couple of years of routine visits, she came to me for what she thought might be long standing depression. She was right, and I was taken aback. We had built a rapport. When I asked her why she hadn’t told me sooner, she said that she didn’t want to ruin my impression of her; that she thought I really liked her and she didn’t want that to change. I’m not sure how to have done things differently with her, and in the end she got the help she needed, but I wish she would have known earlier that I was a safe confidante. Confide in us. We can help you or guide you to someone who can help. We hate the stigma attached to mental health problems. They are so much more common than our patients realize, and we don’t look down on someone who needs help with mental health. It is intimately interwoven with your physical and spiritual health. The best care comes when a full picture is provided and each element attended to.
- Words can hurt us.
Remember that we have feelings. We try not to take your behavior personally. We know that we see you during the most trying times of your life and are there to support you and walk through it with you, but remember that our jobs are only one facet of who we are. We are tender, vulnerable people just like you. This is a little difficult to talk about, but some patients are downright verbally abusive to doctors, nurses, and other medical professionals. We have thick skin. We grew it during training. But I want to make sure I say that when a person is abused, the natural instinct is to retreat. We remain professional. We try to suppress our reaction to retreat. But a doctor or nurse in retreat mode isn’t in the position to administer the best kind of care. Just keep it in mind. I hope you are never in such an extreme situation that you find yourself behaving in an out of control, abusive way, but if you do, remember that your behavior can effect your care. It shouldn’t, and ideally it wouldn’t, but healthcare is administered by humans.
- We know lifestyle change is hard.
And boring. We struggle with it too. Chances are there is a box of donuts in the break room as we speak. It’s so hard to take the straight and narrow. We try and fail often. But sometimes a specific diet, or an increase in exercise, or abstinence from alcohol, or better sleep hygeine really are the best treatments for what you are going through. We know it’s not shiny and quick like a pill, but we must recommend what is truly best.
- We are not conspiring with insurance companies or drug companies.
In fact, they drive us crazy. All we want to do is the very best, most appropriate thing for your care. When insurance companies tell us no or drugs are prohibitively expensive, it frustrates us. We are your advocates. You are our priority. Period.
- We come in all ages, genders, and races.
This is another one that is hard to discuss without sounding defensive. Some doctors are women. Some are minorities. Some are older. Some are young. None of these factors can inform you as to the quality of care a particular doctor can provide. I’ll never forget a patient during residency asking if I was his doctor as I pushed him along the hall in a wheelchair at the VA. When I answered that I was, he said, “I don’t want to be taken care of by any kind of a teenager.” Inside, I laughed so hard, because it was funny to me. I love it when blunt truths are spoken. But I understood his hesitancy. I was really young. Being fresh out of training has its upside. Experience does too. A conscientious doctor of any shape, size, color, or age can deliver great care.
- We can be terrible patients.
When I was pregnant with my oldest daughter, I knew exactly how I was going to behave during labor. I planned to be quiet and stoic and focused and compliant. After all, I’d delivered hundreds of babies and had seen the full behavioral spectrum from unwavering stoicism to flailing, screaming, escape attempts. Well, my behavior was complete lunacy. I was so shocked, but I couldn’t help it. The pain was savage, and I felt so out of control. When I finally got an epidural (I’d planned to try without) after several hours of hard labor, I was so relieved that I practically proposed marriage to my anesthesiologist. With my husband by my side. Bananas! Then when my obstetrician decided to turn the epidural off so that I could feel to push, I panicked. When the pain returned full force, I said, “it hurts” at least nine hundred sixteen times. Just in case he hadn’t heard me the first time. My sweet doctor finally said, “it’s ok if it hurts.” Well, I begged to differ. I dreaded showing my face at my postpartum appointment, but he didn’t bat an eye.
- Some of us use hospitalists.
This is a bit dry, but I think it bears explaining. Most of you have a primary care physician, either a family physician, pediatrician, or internist. If you need to stay in the hospital overnight, you may be cared for by your primary care doc, the doc on call for him, or a hospitalist. Hospitalists are doctors that only do hospital care. They don’t do outpatient work. The drawback is that they don’t know you or your family and can’t follow up with you after discharge. The upside is that they deal with hospital-worthy illness all day every day and are well versed in appropriate care and the inner workings of their particular hospital.
- We don’t sneak in the back and google your symptoms.
We only sneak in the back to eat donuts. No, really. If we come up with the same conclusion that you found when you googled, remember that we bring wisdom, experience, and an understanding of your history that makes our care for you unique. But sometimes google is right. I said it. Just be careful. The internet can lead you down a very dangerous path, can cause unnecessary panic that talking to your doctor could avoid, or can lead you to dismiss something that shouldn’t be ignored. And please be extra wary of online chat rooms and discussion boards. Straight up wrong advice can sound very convincing. There is no substitute for medical training, experience, and complex analysis.
Here are a couple of other articles from around the internet that you may also enjoy:
- A wonderful quick interview with an OB/Gyn from my favorite blog, Cup of Jo (if you only click over to see the graphic for the article, it’ll be worth it!)
- A great article about the approrpriate use of the internet for patients researching medical topics
- An insightful, warm article about the doctor patient relationship written by a phyisician for The New York Times
We want the very best for you. Just know that. It’s the bottom line.
I’d love to hear your thoughts. As a patient, does any of this surprise you or make you angry? As a health care provider, what rings true to you? What would be your number 27? Let’s talk about it!