My Doctor Is Wonderful

Yesterday I felt trapped in an impersonal hospital room.  I was miffed at being ignored.  Sure, the hospitalists are busy, but ordering lab tests and looking at consult notes without ever seeing the patient doesn’t seem like the best of care to me.  Having nurses and techs who don’t respond to alarms and call lights, and don’t respond to requests for medicine, is miserable.

Fortunately I have my cell phone. I phoned my family physician’s office to cancel my biopsy appointment.  My family physician follows his own patients in the hospital and doesn’t use hospitalists, so the receptionist told me that my doctor would be by to see me.  Later a nurse popped her head in to say that my doctor would be in after he was done seeing all his patients in clinic.  He didn’t make it, but I felt more hopeful just knowing that he knew I was here.

This morning he came to see me.  It is so nice to have someone in charge of my care who knows me and can coordinate everything.  When he came in, I told him that I think I would’ve preferred the biopsy to this.  He grinned back and said he’d been thinking that this was a pretty extreme way to avoid having a biopsy.

He asked me questions, did an exam, and explained what the tests have shown so far.  When he learned that I requested more pain medicine at 3:00, but didn’t get any until after 7:00, he was not happy about it and wrote new orders.  Now the nurse is supposed to give meds regularly whether I ask or not, and can give extra if I need more before then.  That is a much better system.

My doctor told me I’ll be here at least a few more days.  Even though the CT showed tons of gallstones, the EGD didn’t find any stuck anywhere and my liver function tests look good, so the gastroenterologist believes that my sulfasalzine is responsible for the pancreatitis.  This is a bit of a problem for me, since last time my rheumatologist took me off ssz I could barely walk.   My family physician will talk with my rheumatologist and figure out what to do long-term.  Everyone else has been pretty vague, and I love finally getting some straight answers and feeling like I have someone looking out for me.

Thanks for reading.
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Why I <3 My FP

“Do you know a good doctor?” is a question tossed around in conversation sometimes.  If the person is reasonably nice/intelligent, I’m happy to hand out my doctor’s name and phone number.  Occasionally, however, the person asking is a dingbat; in that case I don’t offer any suggestions.  I like my doctor, and wouldn’t want to inflict aggravating people on him.

Recently, I referred more friends to my all-time favorite doctor.  Instead of just taking his name and phone number, the couple wanted to know why I like him.  That’s a fair enough question.

First, he’s a family physician.  Family practice physicians are my favorite kind of doctor. After finishing medical school, they don’t promptly forget most of the information they worked so hard to learn.  The use that information to treat their patients.   My doctor delivers babies, does vasectomies and biopsies, removes lumps, takes an EKG if symptoms warrant it, casts broken bones, injects steroids into inflamed tendons/bursa, and sews fingers back on.  I love seeing a doctor who specializes in providing comprehensive medical care for the whole family.  He has to be a great diagnostician because he might see anything.

That said, my friends were sold on seeing a family physician.  Their next question was what sets my doctor apart from all the others?  They wanted something more specific than, “I really like him.”

First, he runs his practice well.  These are not in order of importance:

  1. People, not machines, answer the phones.
  2. The staff is cheerful, nice, and polite.  They smile, remember people’s names, and are people you’d actually want to spend time with (unlike some places, where it seems the staff has been sucking pickles).  I’ve never heard them speak disparagingly of patients.  Patients are treated with respect.
  3. The staff is helpful.  For instance, when I asked how to go about getting a copy of part of my chart, the person hopped up and said, “I can get that for you right now.  What do you need?”  When patients with a walker or wheelchair needs to go downstairs, there’s always someone right there with the elevator key.  I’ve never seen patients have to ask; the help is automatic.
  4. There are a few same-day appointments saved for urgent issues.  Since there will always be calls for same-day problems, saving a few spots in the schedule seems like an efficient way to keep things running a little more smoothly.
  5. There’s a sign in the lobby stating, If you have been waiting more than 15 minutes past your appointment time, please see the receptionist.  They really try not to fall too far behind, but when it happens, they let people know.
  6. On those rare occasions that I need to phone the doctor’s office, the nurse calls back promptly.  In fifteen years, I’ve only had one call that wasn’t returned on the same day.  That’s a pretty good record!
  7. When appointments are made, the receptionist is clear whether you’ll be seeing the MD or the NP.  I’ve been other places where I didn’t learn until I was in the exam room that the appointment wasn’t with the doctor, but someone else.
  8. The practice doesn’t bill until after insurance has processed claims.
  9. The practice accepts my insurance.  I like my doctor enough that I’d try to still see him if he stopped taking insurance, but I don’t know if that would be financially possible (and hope I don’t have to find out).
  10. If there’s a credit on my family’s account, the billing person sticks a post-it note in the chart of whoever has the next appointment, and they tell us that we don’t owe a co-pay.  This doesn’t happen everywhere.  I appreciate honesty.

A well-run office is nice, but the doctor needs to be good, too.

  1. Whether I’m the first appointment in the morning or the final appointment in the afternoon, my doctor is pleasant, calm and acts as though he has all the time in the world.  Before finding his practice, I once saw a doc who rushed into the exam room, coat-tails flapping behind him, as he dictated notes from the previous patient; that entire appointment was a bit like being hit by a whirlwind.  I prefer calm.
  2. My doctor listens without interrupting.
  3. He leaves the room when patients are undressing.  This seems like an obvious thing to do, but I’ve heard of doctors who expect patients to disrobe in front of an audience.
  4. My doctor focuses on what he’s doing.  Sometimes he’ll pause to write things down, then resume the conversation.  Other times he brings a scribe into the room so that everything is documented and he can focus on talking with me instead of stopping to writing in the chart.
  5. He doesn’t ask me for information that’s clearly already in his possession.  When he doesn’t remember details on something, he pauses and looks back through the chart to refresh his memory.  No guessing and getting it wrong.  He checks.
  6. If something is unclear, he asks for clarification.
  7. He explains things so thoroughly that he usually answers most of my questions before I voice them.  This, I believe, comes from experience in dealing with people, and wanting to help.  He knows the types of questions people have about various conditions, and addresses those issues so patients know what to expect.
  8. He once apologized.  For something that wasn’t even his fault.
  9. He asks if I still have questions, and he answers those questions fully.  Cheerfully.  Unhurriedly.
  10. If he doesn’t know something, he admits it and says he’ll look it up.  And does.
  11. He never acts like I’m taking too much time.  Even if I am.*
  12. I’ve checked all the online doctor-rating sites.  Most people feel the same way I do.  Only one negative comment, and it was from someone upset that his chart noted he’d cussed out the nurse and the doctor told him that wouldn’t be tolerated.  I don’t really see that as a negative; I think bosses (medical or any other field) should support their staff.
  13. The doctor explains abnormal test results clearly and explains what can be done to address the problem.
  14. He writes referrals when appropriate, but most things can be dealt with in his office.
  15. He reads the letters sent by my specialist and asks me how that treatment is going. 
  16. He treats me like a person, not like one more item to mark off his to-do list.

Aside from his clinical practice, he’s involved in volunteer work that I would support.  He provides medical support to the local crisis pregnancy center.  He also does short-term missions trips.  That can be inconvenient for office staffing, since one of his nurse practitioners liked the work so much that she left to work overseas full time, but he’s dedicated to helping people and doing what’s right.  Every year he and his staff help out at the American Cancer Society fundraising walk.  These activities tell a little more about the kind of person he is.

My family physician has gone above and beyond the call of duty in providing exemplary medical care for me and my family, and I highly recommend him.  But not to dingbats.

*In my defense, I don’t wear a watch and there are no clocks in the exam rooms. It’s hard to know how much time has elapsed.  I wouldn’t purposely take extra time.

Seeing the Doc

It’s really weird to expect a quick in-and-out appointment, and instead have the doctor bring up an extra topic.

I thought I was seeing my PCP to refill my headache-prevention medicine.  He did that – fairly quickly.  He was also interested in what’s going on with the RA, and I hadn’t realized that would be up for discussion.  See, my PCP has a new policy posted in his exam rooms.  I don’t have the exact wording, but the gist of it is we’ll deal with everything you bring up, but multiple issues might need to be documented as two separate appointments which will require a second co-pay .  I’ve been tempted to ask if he can do that retroactively to get additional compensation for one of my extremely lengthy appointments last year.

But I digress.  When the whole point of the appointment was to get a refill, I wasn’t sure it would be okay to ask about anything else.  Then he brought up a different subject.

It turns out that my rheumatologist sends a letter to my PCP whenever she sees me.  He’s been getting lab results and a letter every month.  Unfortunately, it’s apparent in her written communication that English is not my rheumatologist’s native language, so my PCP wasn’t sure exactly what the current plan is.  He asked.  We talked about it.  So simple.

It provided an opportunity to ask another question (since we were on RA anyway).  The warning label on biologics gives a list of symptoms which warrant a call to your doctor.  Which doctor?!   So I asked.  We discussed it.  Dang, this is easy.

I’m a lot more comfortable talking to my doctor now than I used to be.  That’s partly due to the fact that I’ve had to do it so frequently, but mostly due to what I’ve learned reading medblogs.  A few posts I’ve found helpful are here and here and here and here and here and here and here and here and here  and even here and here.