What Works?

Dr. Rob has Grand Rounds posted.  One of the links really got me to thinking.  In Do You Feel Respected by Your Doctor?  Lockup Doc poses an interesting question.

So, what I would like to know from you, whether you are a patient and/or a doctor: Do you feel respected by your doctor?

My answer in the comments section over there got too long, so I decided to flesh it out here.  As I’ve said before, my first rheumy wasn’t a good fit, but my PCP is the bestDid I mention that my PCP is awesome?  When we moved here, years ago, and I had to find a doctor, I was very happy to find him.  He listens, and he is thorough.  I learned more about him when I discovered that his practice is advertising for an additional physician.  It’s nice to know that he reads the reports from my rheumy instead of just initialing/filing them.

 The comment I left at Lookup Doc’s post:

My PCP runs an excellent practice.  When I phone for an appointment, the receptionist is clear whether I’ll be seeing the doctor or his NP.  Same-day appointments are available for urgent issues.  Phone calls are usually returned the same day.  Whether I’m the first appointment in the morning or the last appointment of the day, the doctor is pleasant, calm, and acts as though he has all the time in the world.  When it’s my turn to see him, he gives me his full attention and doesn’t act like he can’t wait to escape and move along to the next patient.  He listens without interrupting, then asks pertinent questions and listens to my answers (without interrupting).  He leaves the room while I undress for an exam.  He often uses a scribe so that he can focus on talking with me instead of writing in the chart.  When he doesn’t remember details on something, he pauses and looks back through the chart to refresh his memory.  He explains things so thoroughly that he usually answers most of my questions before I voice them. He asks if I still have questions (sometimes I have a list), and he answers them fully.  He explains abnormal test results clearly and offers me a copy.  He reads the letters sent by my specialist and asks me how that treatment is going.  Sometimes we just chat.  He treats me like a person, not like one more item to mark off his to-do list.

The portion of my comment that I omitted due to space constraints:

What a contrast with one specialist to whom I was sent.  Many people consider that specialist the best in the city, but they must have had a different experience than I did.  There was no respect.  Making an appointment to see the doctor resulted in a two-month wait and then being examined by his PA, not the doctor.  The PA got details wrong despite clearly written answers on my paperwork.  He asked questions, but interrupted and jumped to a couple wrong conclusions.  He made false assumptions because he didn’t listen.  Having already made two (wrong) diagnoses, he dismissed my most distressing symptom – it turns out that it’s rare, but is most definitely significant and might have been picked up if he’d listened.  When the PA presented me to the doctor, I was not allowed to correct the wrong details and the doctor was half-way out the door before he turned and as an afterthought said, “Do you have any questions?”  He gave the impression that he just wanted to get out of there, not listen to me or help me.

What’s funny is that I notice there are similarities in how these different doctors do things.  At future appointments, the PA tried to visit and get to know me.  I disliked him so much that all I wanted to do was get out of there as fast as possible, and found it annoying that he’d want to chat – even though it’s one of the things I like about my PCP.

I like my PCP taking time with his patients.  In all fairness, I have to say that the specialist scheduled a lot of time for my initial appointment with him.  Time isn’t enough if the patient’s concerns aren’t addressed.

Both my PCP and the specialist have asked if I have any questions, but there’s a difference.  My PCP does it when he’s in the room, looking at me, ready to answer.  The specialist had his hand on the doorknob and wanted to leave.

Both practices claim that phone calls are returned promptly, but there’s a huge difference between policy and implementation.  On those rare occasions that I phone my PCP’s office, I usually get a return phone call the same day.  Only one time (in fifteen years) was my call not returned; I phoned the next morning and the receptionist was so surprised to hear I hadn’t gotten a return call that she put me on hold and went to find the nurse to take my call right then (and it turned out that the nurse was – at that very moment – returning my call).  Phoning the specialist’s office was an entirely different experience, and although the receptionist claimed that calls would be returned, after leaving messages three days in a row (on multiple occasions), I realized that there was no point in ever phoning because they had no intention of returning my calls.  I even asked at my last appointment, “Under what circumstances should I call about this?” and was told, “Never.  There would never be any reason for you to call between appointments.”

Smiles.  My PCP smiles.  The PA never smiled.  This doesn’t really have anything to do with respect, but it sure makes for a more pleasant appointment.

The final distinction I notice is in the information provided.  My PCP assumes that I’m capable of understanding basic explanations and always gives me plenty of information.  As I said, he understands what patients want to know and usually answers my questions before I even ask them.  The specialist didn’t ever provide information – just a (wrong) diagnosis and unneeded prescriptions.

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3 thoughts on “What Works?

  1. I just had the strangest experience yesterday with a doctor how was filling in for my PCP. He wouldn’t allow the nurse to tell me my blood pressure! “Medical tests can only be reported by the physician.” By withholding my own information from me, the doctor asserts his control over both the patient and the staff. Frankly, I found it creepy.

    What you are saying rings very true for me – some doctors give you the impression that they have made up their mind about your ‘case’ before they say hello. Glad to hear that you have a wonderful PCP. That’s half the battle!

  2. An interesting post and an interesting subject.

    I started to write my own novel about this in your comments, so maybe I’ll write a post of my own, too.

    I’m glad you’ve got such great doctors on your side now.

  3. I think you and I have the same rheumy! lol! The PA hardly ever smiles and she will cut you off in mid-sentence. Calling the office is liking speaking to air…they rarely call you back the first time you call. It’s crazy! I worked as an office nurse for 13 years before RA hit and I made a job change to work at home. When I worked as an office nurse I never treated my patients that way. If for some reason the message didnt get to me…I apologized to the patient and took care of the problem. Common courtesy with some offices has gone out the door. They really should remember who pays their salaries! US, the patients!

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