Demystifying the Doctor Patient Relationship
A few days ago I happened upon a blog post that’s had me thinking ever since. The author of the post and I both had one of our articles mentioned on a roundup of inspiring blog posts (a real honor!) It is a beautifully written letter of gratitude from a young woman to her surgeon six years after a surgery that changed the direction of her life. The thing that struck me is that she wasn’t sure she was worthy of what he’d done for her (he did the surgery gratis), and she wasn’t sure he’d ever see the letter (she mailed him a copy, of course) or care. As a physician (retired, but still), this made my heart ache. And it got me thinking…the doctor patient relationship is an almost ubiquitous first-world human experience, but I think that most patients have misconceptions about how that relationship is perceived from the other side. I want to clear up a few things, so I’ve decided to give you a rundown of the things good doctors wish patients knew.
Now, I have to tell you a few things about myself to establish some context for the crazy things I’m about to admit. Please know that I am not bragging, self-aggrandizing, or posturing. If you think you might take anything I say in that way, you are not allowed to continue reading. Seriously. Go away, now.
Ok, if you are still here, you need to know that I was a good doctor. I know I diagnosed and properly treated some things other doctors would miss. I took good, thorough care of my patients. I had always been a good student, and medical school was no different. I excelled, mostly by sheer will. I’m bookish and all, but I also tried really hard every day. I scored very well on my boards all the way through board certification for family medicine. I felt you needed to know so that what I’m about to tell you didn’t just seem like sad drivel coming from a person who should have been better. Of course, I should have been better. We all should. But I was good by any standards. I have been retired for almost fourteen years. If you’d like to know more about why that is, take a look at this blog post about surviving parenthood after being a professional. OK, here goes. Here is what good doctors wish their patients knew…
- We worryWe lie awake at night worried sick about you. Not every night or about every patient, but more than you’d think. Did we miss something? Did we do all of the needed tests? Did we choose the right medication? Doctors have lives in their hands. I know it sounds cliché and dramatic, but it is just the truth. We take that fact very seriously. I don’t even know if it is something humans are properly designed to do without a lot of fear and struggle. It is so hard, the stakes are so high, and we know it.
- We WonderWe wonder about you years later and love hearing how you are doing. I ran into a fellow swim mom who’d connected with a patient I’d had sixteen years earlier. This mom was able to give me some follow-up (she’d been given permission by the patient to share her story with me), and it made my day. No, my week. Maybe month. It was a year ago and I’m still thinking about it. This gal had come to me for back pain and there was something I just didn’t like about the story and exam. I can’t remember the details, but I’ll never forget her. She was young and healthy. I did some blood work checking for the unlikely thing I was concerned about, and it turned out that she had it, multiple myeloma. A blood cancer was causing her bone pain in her back. I referred her on to oncology, and then residency was over and I moved to Nebraska. But I’d always wondered. What a gift it was to hear she had survived and was doing well! There are many patients that I still wonder about years and years after the fact.
- We forgetDon’t be embarrassed to see us in the grocery store just because we did your pap smear. I know exams like pap smears, rectal exams, full skin checks, hernia checks and breast exams feel like a humiliating violation, but we do each of those things multiple times per day. After a while, body parts are just body parts. We are looking at them clinically and objectively from a professional and responsible perspective. We are looking for things we need to detect and address. Maybe what I’m trying to say is that doctors are great at compartmentalizing. Chances are, if we see you in a store, we’ll remember if you just went to Africa on a mission trip or are trying to adopt, but I can promise you we will not remember what your cervix looks like. It is just so routine and numerous to us. Like your job is to you. I know this seems in direct conflict to #2, but just accept it. It’s complicated.
- We scraped by for years
If you calculate the hourly pay along with the years of education to get there, it is not something to do if you are looking to get wealthy! Hour for hour, the pay is not great. At least not for primary care docs like pediatricians and family physicians. Don’t get me wrong. I didn’t think I deserved more, but sometimes I did feel like I needed some emotional hazard pay. I know there are many occupations and professions that have it much worse in terms of compensation (and emotional liability for that matter). Military personnel and teachers come quickly to mind. But doctors go to 4 years of college, 4 years of medical school, paying tuition those 8 years, and then go to a minimum of 3 years of residency (on the job training) where they make about $10 per hour. It’s salaried, but at around 80 hours per week of work (and a lot of times more like 90 or 100), it pencils to right around minimum wage. After that, salaries vary widely by specialty. Surgeons make the most, but they also have at least 5 years of residency where the pay increase year-to-year is minimal.
- We do a lot behind the scenesBeing admitted to the hospital is scary, and doctors forget this. It would do well for someone to explain to every patient how the hospital actually works. I was fortunate enough to have a pretty scary and lengthy hospital stay about a year before I started medical school. I remember thinking, where are the doctors?! Do they even remember that I am here? What is the plan?! What I didn’t know is this. When a patient gets admitted to the hospital, a doctor does an initial interview and exam. Then he (or she, but “he” is easier to type; don’t read anything into that. I’m a “she” for heaven’s sake) scurries off to a desk somewhere and gets to work. He writes/types/dictates a history, physical, assessment, and plan. He then writes a page or so of orders outlining what needs to be done for you for the next 24 hours (appropriate hospital unit, vitals checks, activity limitations, nursing tasks, dietary specifications, IV fluids, all medications, labs to be run, and special tests to be done such as MRI, CT scan, x-ray, etc). He then is available by phone continuously to address any concerns that the nurses, pharmacist, nutritionist, therapist, or social worker has regarding your care. He checks back looking for lab and radiology results as often as necessary, and is all the while calculating and recalculating his diagnosis and plan for your care. You may not see him again until the next morning, but he or his associate (the poor slob on call over night) is immediately available at all times to react to your changing condition and adjust your care. Oh, and there are probably 5 or 10 more patients for which he’s doing the same thing. Also, during the day, he may be seeing 20 or so patients at his office in between hospital calls and life changing decisions. So when I was lying in that hospital bed wondering what the heck was going on, I wish I had known all of that. I would have felt a lot better about my situation. I also would have loved to know what boxes needed to be checked before I could go home. All doctors have a running mental list of these boxes. They live by them. Why they don’t inform the patients of them is beyond me. I always did because of my experience. It’s things like holding down liquids, passing gas (if something abdominal is going on; tell the truth about this, btw; it shortens your stay… I may be speaking from experience here), no longer needing supplemental oxygen, standing up without fainting, not having a fever for 24 straight hours, tolerating all needed medication by mouth, etc.
- We know you’ve already answered the questions and we are sorry we have to ask againIt’s just the way the medical world is. When you call to make an appointment, you are asked what’s going on. Then, when the nurse/MA checks you in, you are asked again. Then, you may be asked again by a medical or nursing student. When you finally get to see the doctor, you are sick to death of telling the story. But we can’t help it. We have to hear it with our own ears. And we’ll have more questions, of course. I’m not sure how to change this. It annoys me too.
- We define fever in a very specific wayA doctor does not consider your temperature to be a fever unless it is an oral or rectal temperature at or above 100.4 F, and they usually will not consider a tympanic or skin temperature a fever unless it is above 101 F. And fever is a very nonspecific finding. It doesn’t really guide our actions by itself unless the patient is 4 month of age or younger, elderly, or has a compromised immune system. You also need to know that a rectal temperature in an infant 4 months of age or younger of 100.4 F or above is a medical emergency that requires evaluation and care that can only be done at a hospital. Your pediatrician needs to know about this right away. He may want you to stop by his office on your way to the hospital, but don’t wait. If you can’t get him on the phone, just go to the ER and make sure the intake person knows the details. They should take you right back.
- Some of us have PTSDI have been retired for 14 years. And not a month goes by when I don’t have a nightmare about calls coming in to my pager (I know I’m dating myself) faster than I can react or patients in every room down a fun-house-mirror infinity hall of exam rooms waiting to see me, each problem worse than the one before. Now, some doctors may be much more psychologically hearty than I, but they can’t all be. And the injury is additive. Don’t get me wrong. I’m fine. But I talk to other doctors, and most have at least some symptoms of PTSD, with a potential for new trauma with each work day. In my short career I saw a baby take her last breaths. That was the first and last time this girl who cries in most movies and with most emotions cried on the job. I watched a woman bleeding uncontrollably after giving birth lose consciousness as I worked, careful to remain upright myself while slipping on the pool of blood at my feet. I looked into the eyes of patients and told them they had cancer. While attempting to insert her urinary catheter, I heard a woman in a trauma center, after having both legs severed at the knee by a dump truck, tell her father to take care of her boys, assuming she wouldn’t survive. And I could go on and on. I’m not saying ours is the only traumatic job. Not at all. And you could say we signed up for it. But just keep it in mind when you are tempted to be angry with your doctor.
- We can be idiotsIsn’t it just so embarrassing to be human sometimes? Do you know how many prescriptions I have written? And to this day, when I need to use the word prescription or subscription in conversation, I freeze for a second. Criminy! You’d think a grown woman of my particular background would have a solid and automatic footing of knowledge regarding the difference between these two relatively common English words. It’s akin to having to recite the alphabet real quick in your head when you are about to step up to a certain line at a registration table divided by last name. I can’t be the only one.
- We hate medication adsIt’s not that we don’t want well informed patients. Believe me. It’s just that those commercials are relevant to such a small slice and are so painfully detailed, particularly regarding potential side effects, that they seem aimed to send every healthy Tom, Dick, and Harry into a frenzied tailspin of worry. “Do I need that medication? I bet I do. Darn it. But if I take it, I’ll be dizzy and depressed and have greasy stools. I’m doomed to a life of misery!” How about let’s just be honest and detailed about your symptoms, get a health maintenance check yearly, and let your doctor recommend necessary medications and discuss likely potential side effects when and if necessary. Mkay?
- We do respect your timeOne of the most stressful parts of the job is to try to stay on schedule while dealing with the varied array of problems that come up at appointments along the way, giving each patient the actual time they need. We don’t think our time is more important or valuable than yours. But if you have an 11:45 appointment with your doctor and the patient before you, who is on the schedule for a 10 minute sore throat, mentions that he has blood in his stool or is feeling suicidal, 11:45 can’t happen. We can’t be two places at once, and we have to do the right thing for each and every patient. Don’t confuse urgency with importance or lack thereof. I hate waiting at doctors offices. So frustrating! But it is the unpredictable nature of the beast. Until some miracle of medical office management occurs, if you need to be seen on time, your best bet is to get the first appointment of the day. Everyone at your doctor’s office is stressed about this. Trust me.
- Some of us are jerksJust like in any area of life, most people mean well and are doing their best, but there are always the handful that are arrogant, incompetent or both (a particularly bad combination). If you are not getting a sense that your doctor, although human and harried, has your best interests at heart, please find another doctor. Those of you who expect camaraderie or witty conversation with your doctor may never be satisfied, but if you are just looking for the good, conscientious, thorough care you deserve and don’t feel you are getting it, keep looking. Those doctors are out there.
- We like to feel appreciatedA quick note or a thank you can make our day. Because we are trying our best for you. Hearing that you notice is such a treat!
I hope you feel a little more in-the-know about your doctor after reading my list. I can really only speak for myself, so keep your eyes out for Part 2: More Things Doctors Wish Their Patients Knew. I’m going to interview the doctors in my life and anonymously (to encourage candor) let you know what they have to add.