Getting along: Part 1 – Doctor Rules

Why are patients mad at their doctors?  In comments on my previous post, people expressed real frustration and distrust – mainly from a lack of listening and connection.  Those who loved their doctors (and there were some) expressed the opposite.  They had a relationship with their doctor.
Here the rules I have for getting along with my patients:

Rule 1:  They don\’t want to be at your office

\"doctor2214627c9qk8\" It may seem odd to patients, but most doctors forget that going to the doctor is generally unnerving.  We Work there, and being in a doctor\’s office is normal to us.

Not so with most patients.  The spotlight is on them and their health.  They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing.  Yes, it seems that some patients are happy to be there – and I do my best to make my patients feel comfortable, but there is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table.

The best thing to do in response to that is to show compassion.  If you feel awkward, scared, or self-conscious, the thing you most want is for someone else to understand how you feel.  Patients are much more likely to follow a doctor\’s advice when the feel that the doctor understands.  Identifying the fear and relating to it are the first steps at building trust.

Rule 2:  They have a reason to be at your office

\"headache\" People don\’t like to waste time and money.  They don\’t come to the office to waste the doctor\’s time.  Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor.  Why come in for a headache?  Why come in for a cold?  Doesn\’t the person realize that a stomach bug won\’t get any better by coming to the doctor?

It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in.  Sometimes that reason is simple: they need an excuse from work, or they have terrible pain that needs to be treated.  Other times, however, the reason is more subtle.  When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer.  When patients have chest pain, they are afraid it is their heart.

On every visit I try to identify the real reason (or the real fear) that brings them to see me.  I don\’t end the visit until I have addressed that reason.  If they have an enlarged lymph node, I make sure and say \”I don\’t think this is cancer because….\”  If they come in with chest pain, I say \”This doesn\’t sound like a heart attack because…..\”  If I fail to do so, then they leave the office with the fear and feel ignored.

Rule 3:  They feel what they feel

Patients will often tell me their symptoms in a very apologetic tone.  They seem to think that they have to come to me with the \”right\” set of symptoms, and not having those symptoms is their fault.  Sometimes those symptoms make no sense to me at all and I am tempted to dismiss or ignore them.

But as a physician, you have to trust your patient.  Only the really crazy patients make up symptoms.  Yes, some may exaggerate what they feel out of anxiety or out of fear that you won\’t hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint.  I have heard from many patients that their doctor \”did not believe\” their complaints because they did not make sense.  If you don\’t trust them, why should they trust you?

If symptoms seem contradict what I know to be possible, I often openly tell them that this seems to contradict – but I make sure I don\’t imply that they might not be being truthful.  A puzzle is a puzzle.  It is my job to undo a seeming contradiction.  I may not ever be able to do so, but at least I don\’t make them feel bad for feeling what they feel.

Rule 4:  They don\’t want to look stupid

\"r0123m\" I remember when I broke my shoulder – a compression fracture of the neck of the humerus bone – and went to the orthopedist office.  I always felt self-conscious about how much pain I was reporting.  A colleague had fractured his humerus the year before and had reported he was back to doing surgery within a few weeks.  Here I was, a few months out and couldn\’t even lay down in bed.  I felt like a wimp.  Was this other guy just tougher than me?  My orthopedist made me feel much better when he explained that my colleague had a mid-shaft fracture, while mine was right in the shoulder joint – a much slower place to heal.

This event made me realize how many patients felt when they came into my office.  People are often worried that they are over-reacting.  They wonder what I must think for a person to come to the office with that symptom.  This is especially true of parents bringing their children in.  Nobody wants to be \”that mother that over-reacts to everything.\”  In response to this, I try to specifically say, \”I am glad you came to the office for this because…\” or \”Yeah, I can see how that worried you because it could be….\”

Rule 5: They pay for a plan

\"confusion\" What do people pay for when they come to the medical office?  They pay for opinion, yes.  They pay for knowledge as well.  But what they really pay for is a plan of action based on their circumstance.  If they have an ear infection the plan is to use antibiotic (maybe) and treat the pain.  If they have abdominal pain, the plan may be much more complex.  They want to know what is going to be done and want what is done to help.

I try and give a plan, either verbal or written, to each patient that walks out of the exam room.  What medications are given and why?  What medications are to be stopped?  What tests are ordered and what will the results mean?  When is the next appointment?  What should they call for if they have problems?  The better I can answer these questions, the more confidently the patient will walk out of the exam room.  The days of paternalistic medicine are over – no handing a prescription and just saying \”take it.\”  Patients should know why they are putting things in their body.

Rule 6: The visit is about them

With all of the stresses in a doctor\’s office, I get tempted to complain about things.  Who better to complain to than someone who feels much the same way?  But patients are paying for you to take care of their problems, not the reverse.  I keep my personal gripes or frustrations to myself as much as possible.

Go to Part 2 – Patient Rules

83 thoughts on “Getting along: Part 1 – Doctor Rules”

  1. Nice, Dr.Rob. IMO, you missed it on this one a bit: “Rule 4: They don’t want to look stupid”
    I’d amend that to, “They don’t want you to treat them like they are stupid”

    Most patients are smart. Some smarter than others. I’ve found most doctors (and I realize I’m generalizing) treat all patients as if they are the same level of “stupid”.

    No time for more, now, but lots of thoughts. Thanks for this.

    Robin

  2. Nice, Dr.Rob. IMO, you missed it on this one a bit: “Rule 4: They don’t want to look stupid”
    I’d amend that to, “They don’t want you to treat them like they are stupid”

    Most patients are smart. Some smarter than others. I’ve found most doctors (and I realize I’m generalizing) treat all patients as if they are the same level of “stupid”.

    No time for more, now, but lots of thoughts. Thanks for this.

    Robin

  3. Great points, Doc 🙂
    I’d say, bouncing off Robin’s comment here, that for Rule 4 it rather depends on the individual. Some don’t want to look stupid, and some want to make sure doctors don’t treat them like they’re stupid.

    For example, I’m still/again smoking. I’ve gone on Chantix twice, and bailed both times. It was a choice; smoking is my means of stress relief, and I’ve had quite a bit of that in the past year. That said, I know it’s bad for me. I know it will be deadly in my case if I don’t stop — my genetics alone make that clear to me.

    And yet I’m afraid to go back to my doctor for one more round because I don’t want to be treated like an idiot *and* I don’t want to look stupid. Granted, my actions aren’t productive, i.e., smoking again, but I do KNOW this stuff. That said, I KNOW this stuff… so why am I still smoking?

    It’s frustrating. I hope to kick this before it kicks me.

  4. Great points, Doc 🙂
    I’d say, bouncing off Robin’s comment here, that for Rule 4 it rather depends on the individual. Some don’t want to look stupid, and some want to make sure doctors don’t treat them like they’re stupid.

    For example, I’m still/again smoking. I’ve gone on Chantix twice, and bailed both times. It was a choice; smoking is my means of stress relief, and I’ve had quite a bit of that in the past year. That said, I know it’s bad for me. I know it will be deadly in my case if I don’t stop — my genetics alone make that clear to me.

    And yet I’m afraid to go back to my doctor for one more round because I don’t want to be treated like an idiot *and* I don’t want to look stupid. Granted, my actions aren’t productive, i.e., smoking again, but I do KNOW this stuff. That said, I KNOW this stuff… so why am I still smoking?

    It’s frustrating. I hope to kick this before it kicks me.

  5. I think the plan aspect is important. Being a true adherent of Rule #1, I for one would like to be fixed-up and not have to return to your office anytime soon.
    So I like to know what the plan is. We’ll do this, but if that doesn’t happen, then we’ll try this or that…. I understand that stuff doesn’t always work out right off the bat; my knowledge of the plan helps me to know what to expect and look for.

    In this age of electronic records it’s nice if you leave the office with a paper with the plan printed out.

  6. I think the plan aspect is important. Being a true adherent of Rule #1, I for one would like to be fixed-up and not have to return to your office anytime soon.
    So I like to know what the plan is. We’ll do this, but if that doesn’t happen, then we’ll try this or that…. I understand that stuff doesn’t always work out right off the bat; my knowledge of the plan helps me to know what to expect and look for.

    In this age of electronic records it’s nice if you leave the office with a paper with the plan printed out.

  7. mottsapplesauce

    Awesome post Dr. Rob– going back to my comment from the previous related blogpost, I mentioned the surgeon I had some difficulty with was an excellent surgeon. I still believe that. What disappointed me was during a much needed consultation to address a manifestation (fistula), she wasn’t even in the room during the initial interview–she sent a student instead–which BTW, I’m totally cool with. We all have to learn somehow, right? But, given that, sometimes facts get lost in translation. I would’ve rather had her in the room with the student while he conducted the interview. Anyway, after their discussion she came up with a treatment plan that I couldn’t adhere to. For one, the hospital was several miles away & I have a disabled spouse to support. Second, she wanted to examine me under general anethesia before deciding on a course of action, which meant if surgery was what I needed (& it was very likely), I would have to go under a 2ND time. I told her I wanted to try a new approved treatment (Remicade) but she steered away from that suggestion because she didn’t know the long-term side effects. I told her I’d give it more thought before moving on. Well, I gave it about another year until I could no longer handle the pain. But I didn’t go back to her– I instead went to a local surgeon (who I had originally consulted with but he didn’t feel comfortable @ the time since he didn’t perform the original ostomy surgery) & told him my symptoms & scenario with the previous surgeon. He thought about it for roughly 5 minutes & had a course of action; seton sutures & follow-up treatments with Remicade. And it only required an overnight stay in the hospital. It worked like a charm, & seemed so simple a solution. So I opened up a can of worms & contacted the previous surgeon to ask her why she didn’t suggest this. Big mistake. She actually was upset with me. Apparently I had to spell it out for herwhat a huge inconvience & needless expense her suggestion was. Mind you, the second surgeon never treated me before; he only knew what I told him of my medical history. But the difference was, he was the only one who really listened. So– I apologize for raging on but this was my only example of an unfortunate relationship with a physician. I have been truly blessed with great docs, & we have wonderful relationships. Some of them even better than my own immediate family!
    Thanks for letting me rant!

  8. mottsapplesauce

    Awesome post Dr. Rob– going back to my comment from the previous related blogpost, I mentioned the surgeon I had some difficulty with was an excellent surgeon. I still believe that. What disappointed me was during a much needed consultation to address a manifestation (fistula), she wasn’t even in the room during the initial interview–she sent a student instead–which BTW, I’m totally cool with. We all have to learn somehow, right? But, given that, sometimes facts get lost in translation. I would’ve rather had her in the room with the student while he conducted the interview. Anyway, after their discussion she came up with a treatment plan that I couldn’t adhere to. For one, the hospital was several miles away & I have a disabled spouse to support. Second, she wanted to examine me under general anethesia before deciding on a course of action, which meant if surgery was what I needed (& it was very likely), I would have to go under a 2ND time. I told her I wanted to try a new approved treatment (Remicade) but she steered away from that suggestion because she didn’t know the long-term side effects. I told her I’d give it more thought before moving on. Well, I gave it about another year until I could no longer handle the pain. But I didn’t go back to her– I instead went to a local surgeon (who I had originally consulted with but he didn’t feel comfortable @ the time since he didn’t perform the original ostomy surgery) & told him my symptoms & scenario with the previous surgeon. He thought about it for roughly 5 minutes & had a course of action; seton sutures & follow-up treatments with Remicade. And it only required an overnight stay in the hospital. It worked like a charm, & seemed so simple a solution. So I opened up a can of worms & contacted the previous surgeon to ask her why she didn’t suggest this. Big mistake. She actually was upset with me. Apparently I had to spell it out for herwhat a huge inconvience & needless expense her suggestion was. Mind you, the second surgeon never treated me before; he only knew what I told him of my medical history. But the difference was, he was the only one who really listened. So– I apologize for raging on but this was my only example of an unfortunate relationship with a physician. I have been truly blessed with great docs, & we have wonderful relationships. Some of them even better than my own immediate family!
    Thanks for letting me rant!

  9. […]If you’ve kept track of what’s going on over at Dr. Rob’s Musing’s of a Distractible Mind, you already know he’s raised some thought-provoking topics lately…[…]

  10. […]If you’ve kept track of what’s going on over at Dr. Rob’s Musing’s of a Distractible Mind, you already know he’s raised some thought-provoking topics lately…[…]

  11. Most certainly patients (and parents) don’t want to look feel or be made to feel stupid. This is definitely something I take with me when we have to see our paediatrician yet again.Good post. I love hearing the doctor’s perspective.

  12. Most certainly patients (and parents) don’t want to look feel or be made to feel stupid. This is definitely something I take with me when we have to see our paediatrician yet again.Good post. I love hearing the doctor’s perspective.

  13. On this general subject, I notice you all mostly talk about how important actually listening properly to the patient is. I know GPs who don’t use their computers because they feel that looking at the patient during consulting is an important aid to diagnosis, and makes the patient feel more listened too as well. Is this a basis for a rule (8)?

  14. On this general subject, I notice you all mostly talk about how important actually listening properly to the patient is. I know GPs who don’t use their computers because they feel that looking at the patient during consulting is an important aid to diagnosis, and makes the patient feel more listened too as well. Is this a basis for a rule (8)?

  15. Good post. Rule #1 is definitely true! The “don’t want to be treated as stupid” part cannot be stressed enough as well… I’m so very tired of being spoken to as though I haven’t a neuron. It’s worse because I’m in a health program and I spend all day every day learning pathology, so it feels even worse when I get talked down to…

  16. Good post. Rule #1 is definitely true! The “don’t want to be treated as stupid” part cannot be stressed enough as well… I’m so very tired of being spoken to as though I haven’t a neuron. It’s worse because I’m in a health program and I spend all day every day learning pathology, so it feels even worse when I get talked down to…

  17. I agree with the husband arm-twisting. You would be surprised at the number of those visits. Some men are extremely resistant to coming in and I usually know when the wife is sitting next to him with her arms crossed that he is in trouble.
    I also agree that there does need to be eye contact. I type while looking at the patient.

  18. I agree with the husband arm-twisting. You would be surprised at the number of those visits. Some men are extremely resistant to coming in and I usually know when the wife is sitting next to him with her arms crossed that he is in trouble.
    I also agree that there does need to be eye contact. I type while looking at the patient.

  19. healthcaretoday.com

    Getting along: Part 1 – Doctor Rules…
    Why are patients mad at their doctors? In comments on my previous post, people expressed real frustration and distrust – mainly from a lack of listening and connection.

    Here are the rules I have for getting along with my patients…

  20. I like the last rule.
    I left a dentist once. He was a good dentist, and my husband still goes to him. He likes gadgetry and staying on the cutting edge, and my husband really appreciates that. I did, too, but it wasn’t as important to me.

    My problem was that the dentist always *complained.* About how hard the work was; about how unsatisfying it was; about all the bureaucracy; about all the unnecessary paper work; about all the difficult patients … The guy was in burn out.

    I felt sorry for him. But he also made me feel guilty for adding to his burden. I had no answer for him other than my unspoken “then why don’t you quit?”

    Instead, I quit him.

  21. I like the last rule.
    I left a dentist once. He was a good dentist, and my husband still goes to him. He likes gadgetry and staying on the cutting edge, and my husband really appreciates that. I did, too, but it wasn’t as important to me.

    My problem was that the dentist always *complained.* About how hard the work was; about how unsatisfying it was; about all the bureaucracy; about all the unnecessary paper work; about all the difficult patients … The guy was in burn out.

    I felt sorry for him. But he also made me feel guilty for adding to his burden. I had no answer for him other than my unspoken “then why don’t you quit?”

    Instead, I quit him.

  22. I love these rules.
    I don’t mind gadgets at all, as long as the doctor is listening, not playing solitaire or something

    My PCP uses a tablet PC – he used to use a PDA – but this is even better. He has my extensive records right there in the palm of his hand, can look up drug interactions immediately and the cost of various drugs.

    When I get to the payment window, he has already wirelessly sent my bill and it’s printed out. A real time saver!

    Using technology like this gives the impression, whether true or not, that he’s on top of things.

    He may be spending all his time looking up how to install programs on the tablet instead of keeping up with my diseases but it appears to me that he could be on top of recent research and I like that!

    I agree with the others. Listening is so important. So is believing!

    I would imagine that this is a 2-way street. I know that non-compliance is a pretty big problem for doctors. They prescribe drug X and the patient wonders why s/he didn’t get any better even though s/he didn’t fill the script.

    Honest communication is so important. I’ve often expected my doctors to somehow “know” some of my symptoms even though I haven’t mentioned them because I thought that they were insignificant (even though important to me).

    One of my former doctors had an extensive questionnaire to fill out while I was waiting. I checked off all my symptoms honestly and the answers were all ignored during the visit. The doctor didn’t address any of my problems/symptoms and just went to the “fat/depressed” diagnosis.

    What was the point of asking what I felt I had wrong with me if the doctor isn’t going to read, let alone listen?

    Thanks again, Dr. Rob, for your thoughtful posts!

  23. I love these rules.
    I don’t mind gadgets at all, as long as the doctor is listening, not playing solitaire or something

    My PCP uses a tablet PC – he used to use a PDA – but this is even better. He has my extensive records right there in the palm of his hand, can look up drug interactions immediately and the cost of various drugs.

    When I get to the payment window, he has already wirelessly sent my bill and it’s printed out. A real time saver!

    Using technology like this gives the impression, whether true or not, that he’s on top of things.

    He may be spending all his time looking up how to install programs on the tablet instead of keeping up with my diseases but it appears to me that he could be on top of recent research and I like that!

    I agree with the others. Listening is so important. So is believing!

    I would imagine that this is a 2-way street. I know that non-compliance is a pretty big problem for doctors. They prescribe drug X and the patient wonders why s/he didn’t get any better even though s/he didn’t fill the script.

    Honest communication is so important. I’ve often expected my doctors to somehow “know” some of my symptoms even though I haven’t mentioned them because I thought that they were insignificant (even though important to me).

    One of my former doctors had an extensive questionnaire to fill out while I was waiting. I checked off all my symptoms honestly and the answers were all ignored during the visit. The doctor didn’t address any of my problems/symptoms and just went to the “fat/depressed” diagnosis.

    What was the point of asking what I felt I had wrong with me if the doctor isn’t going to read, let alone listen?

    Thanks again, Dr. Rob, for your thoughtful posts!

  24. Which rule was broken in this scenario?I suffer from chronic pain secondary to four cervical disc procedures.
    I currently have ruptures @ c7-t1, t1-t2 and stenosis of the foramen @c6 all with nerve root impingement.
    These cannot be repaired because I am waiting for a new liver secodary to the handsful of nsaids (after my surgeon unexpecedly died) and self medicating with ETOH.
    Found a pain specialist (out of town) who put me on, all be it, a powerful narcotic that is regulated trans-dermally. This worked wonders and allowed me to perform chores to maintain an old house.
    Doctor said it would be easier & less expensive (gasoline) if my local PCP would manage the meds locally. Asked her if she would (Rx must be written out each month) manage the meds, did she have any issues with prescribing this particular medicine. She said she would do it without problems. I was on this med 6 months 3 of which she wrote the Rx.
    The 4th time to have her refill it she informed me ( by phone through her nurse fo course) that she would not fill it without a diagnosis of cancer.
    1. This med should not be abruptly stopped for obvious reasons;
    2. Without a referral from her it would cost $300.00 to see the specialist in the city. No referral!
    How should I approach her; what to say to her; Should I find another Primary Care Physician??? I would have understood if she had told me of her concerns initially. That is why I asked.

  25. Which rule was broken in this scenario?I suffer from chronic pain secondary to four cervical disc procedures.
    I currently have ruptures @ c7-t1, t1-t2 and stenosis of the foramen @c6 all with nerve root impingement.
    These cannot be repaired because I am waiting for a new liver secodary to the handsful of nsaids (after my surgeon unexpecedly died) and self medicating with ETOH.
    Found a pain specialist (out of town) who put me on, all be it, a powerful narcotic that is regulated trans-dermally. This worked wonders and allowed me to perform chores to maintain an old house.
    Doctor said it would be easier & less expensive (gasoline) if my local PCP would manage the meds locally. Asked her if she would (Rx must be written out each month) manage the meds, did she have any issues with prescribing this particular medicine. She said she would do it without problems. I was on this med 6 months 3 of which she wrote the Rx.
    The 4th time to have her refill it she informed me ( by phone through her nurse fo course) that she would not fill it without a diagnosis of cancer.
    1. This med should not be abruptly stopped for obvious reasons;
    2. Without a referral from her it would cost $300.00 to see the specialist in the city. No referral!
    How should I approach her; what to say to her; Should I find another Primary Care Physician??? I would have understood if she had told me of her concerns initially. That is why I asked.

  26. Last month I walked away from my doctor, my internist, of more than a dozen years. I’d asked her to write a letter documenting the existence and nature of a physical handicap. Her response was that she had not seen me in more than two years–wrong: she had seen me only eight months ago (my financial records clearly demonstrated) but apparently she had not included that information in her records of my medical file. Go have a consult with the neurologist I was told.
    This was not a complex matter–I have had the handicap since the day I was born almost 60 years ago. The cerebral palsy is obvious to the most untrained eye when I walk with my native halt across a 10 x 10 room. It has been obvious to prospective employers in the past–the walking stick is a dead give-away. And I simply need to have the documenting paper work (lost by a past employer) re-inserted into my personnel file for my present and/or a potential future employer. I would have gladly paid for the office visit: I did not and do not expect something for nothing.

    But no.

    O.K. The neurologist met with me, moved through a brief examination, and wrote the letter. Bless him.

    Now I am scheduled to meet and learn about a new internist–and he, or she, meet with and learn about me. It is a doctor’s appointment that should not have been necessary, and so well could be a waste of resources, time and money on both sides of the equation. But if it means getting a doctor who is respectful of me as I hope to be respectful of her or him, it is worth it to me.

  27. Last month I walked away from my doctor, my internist, of more than a dozen years. I’d asked her to write a letter documenting the existence and nature of a physical handicap. Her response was that she had not seen me in more than two years–wrong: she had seen me only eight months ago (my financial records clearly demonstrated) but apparently she had not included that information in her records of my medical file. Go have a consult with the neurologist I was told.
    This was not a complex matter–I have had the handicap since the day I was born almost 60 years ago. The cerebral palsy is obvious to the most untrained eye when I walk with my native halt across a 10 x 10 room. It has been obvious to prospective employers in the past–the walking stick is a dead give-away. And I simply need to have the documenting paper work (lost by a past employer) re-inserted into my personnel file for my present and/or a potential future employer. I would have gladly paid for the office visit: I did not and do not expect something for nothing.

    But no.

    O.K. The neurologist met with me, moved through a brief examination, and wrote the letter. Bless him.

    Now I am scheduled to meet and learn about a new internist–and he, or she, meet with and learn about me. It is a doctor’s appointment that should not have been necessary, and so well could be a waste of resources, time and money on both sides of the equation. But if it means getting a doctor who is respectful of me as I hope to be respectful of her or him, it is worth it to me.

  28. I wish I had the nerve to send this to my doctor.I hate going and would rather find a vitamin to make me feel better.
    Rule number two is one that should be taught in medical school.

  29. I wish I had the nerve to send this to my doctor.I hate going and would rather find a vitamin to make me feel better.
    Rule number two is one that should be taught in medical school.

  30. Bravo, Dr. Rob!! This ranks way up there on the best blog entries I’ve ever read. We need to clone you so you can teach at every medical school.
    Thank you so very, very much! I’ll be sending my readers to see this post.

    Teri Robert

  31. Bravo, Dr. Rob!! This ranks way up there on the best blog entries I’ve ever read. We need to clone you so you can teach at every medical school.
    Thank you so very, very much! I’ll be sending my readers to see this post.

    Teri Robert

  32. Thanks, Dr. Rob, for this excellent post. I was that mother (Rule #4) who called the pediatrician and risked dismissal of our child’s symptoms. Each time, the “advice nurse” gave me a verbal pat on the head (“you’re an older first-time mother, and older mothers tend to be more anxious,” etc.), but our pediatrician took me seriously.
    The first time, our 11-month-old daughter started whimpering for no apparent reason and kept it up for several minutes, which was not typical. Advice nurse: “All babies whimper, Mrs. R., but bring her in if you want to.” Pediatrician: “Dislocated elbow.”

    Second time, five years later (it’s not like we were in there every week; we did go for yearly check-ups), daughter was pale, off her feed, and rude. Advice nurse: “Sometimes children don’t feel like eating, and all children can be rude.” Pediatrician: “Pneumonia.” (This child, slender as she is, still “has a hollow leg” at age 21 — if she won’t eat, something is seriously wrong. Also, she was rude as all get out between ages 14 and 17; otherwise, rarely so.)

    Third time, 10 years later, daughter chose taking a nap over going bathing-suit shopping. Had had a tick crawling on her that had not yet embedded itself when I found it and took it off. Advice nurse: “If the tick was not embedded, you have nothing to worry about. Is she having her period, perhaps?” Pediatrician: [after a blood count] “Very low platelets; let’s treat her for erlichiosis and check those platelets every day until they come back to normal.” Titres confirmed the diagnosis two weeks later. Good thing he listened and took the cautious approach; if he had waited for lab confirmation, she likely would have bled to death internally.

    We cried when this man retired. He always said that parents know their children best. He always listened and took us seriously. He was a master diagnostician, a great human being, and a great doctor.

  33. Thanks, Dr. Rob, for this excellent post. I was that mother (Rule #4) who called the pediatrician and risked dismissal of our child’s symptoms. Each time, the “advice nurse” gave me a verbal pat on the head (“you’re an older first-time mother, and older mothers tend to be more anxious,” etc.), but our pediatrician took me seriously.
    The first time, our 11-month-old daughter started whimpering for no apparent reason and kept it up for several minutes, which was not typical. Advice nurse: “All babies whimper, Mrs. R., but bring her in if you want to.” Pediatrician: “Dislocated elbow.”

    Second time, five years later (it’s not like we were in there every week; we did go for yearly check-ups), daughter was pale, off her feed, and rude. Advice nurse: “Sometimes children don’t feel like eating, and all children can be rude.” Pediatrician: “Pneumonia.” (This child, slender as she is, still “has a hollow leg” at age 21 — if she won’t eat, something is seriously wrong. Also, she was rude as all get out between ages 14 and 17; otherwise, rarely so.)

    Third time, 10 years later, daughter chose taking a nap over going bathing-suit shopping. Had had a tick crawling on her that had not yet embedded itself when I found it and took it off. Advice nurse: “If the tick was not embedded, you have nothing to worry about. Is she having her period, perhaps?” Pediatrician: [after a blood count] “Very low platelets; let’s treat her for erlichiosis and check those platelets every day until they come back to normal.” Titres confirmed the diagnosis two weeks later. Good thing he listened and took the cautious approach; if he had waited for lab confirmation, she likely would have bled to death internally.

    We cried when this man retired. He always said that parents know their children best. He always listened and took us seriously. He was a master diagnostician, a great human being, and a great doctor.

  34. Martha Mitchell

    Does anyone out there know of a law out their that limits how many topics are discussed at an actual doctor’s office visit. I went for an evaluation for workman’s comp to make it final. He said there was a law that he could not fill out the form to put in a second request for an outpatient procedure that same day. That I have to make another appointment for that. I am thinking this is his office policy just to get another visit out of me. Please advise.

  35. Martha Mitchell

    Does anyone out there know of a law out their that limits how many topics are discussed at an actual doctor’s office visit. I went for an evaluation for workman’s comp to make it final. He said there was a law that he could not fill out the form to put in a second request for an outpatient procedure that same day. That I have to make another appointment for that. I am thinking this is his office policy just to get another visit out of me. Please advise.

  36. Workman’s comp are different beasts. Generally I know of no laws of this sort, but there may be problems related to the fact that it was a WC visit.
    It scares me to think about being cloned. One set of problems is more than enough.

  37. Workman’s comp are different beasts. Generally I know of no laws of this sort, but there may be problems related to the fact that it was a WC visit.
    It scares me to think about being cloned. One set of problems is more than enough.

  38. I don’t know exactly what the laws are, but from what I’ve seen so far working in HIM, you cannot address unrelated matters in a visit relating to a workman’s comp case, for they will not be paid. (E.g., if a person has a back injury dating from 2002 and it’s comp, the doc cannot address their hypertension or high cholesterol and then bill this visit with all of those diagnoses to comp. The claim will surely be denied.) Sometimes I’ve seen docs actually generate two bills for the same visit in a case like this; one for the comp related problems and another for those that aren’t related. Other times there are actually two distinct visits required. I don’t know if that’s consistent across the US or if it’s unique to each state or what.

  39. I don’t know exactly what the laws are, but from what I’ve seen so far working in HIM, you cannot address unrelated matters in a visit relating to a workman’s comp case, for they will not be paid. (E.g., if a person has a back injury dating from 2002 and it’s comp, the doc cannot address their hypertension or high cholesterol and then bill this visit with all of those diagnoses to comp. The claim will surely be denied.) Sometimes I’ve seen docs actually generate two bills for the same visit in a case like this; one for the comp related problems and another for those that aren’t related. Other times there are actually two distinct visits required. I don’t know if that’s consistent across the US or if it’s unique to each state or what.

  40. You sound like a WONDERFUL doctor! Everyone should have a doctor like you!
    I have always thought that for most people with most doctors it is a bit like going to the auto repair shop. You know the high-pitched screech that you hear when you step on the brakes? Chances are 50/50 that the car repair guy will tell you he did not hear it and there’s nothing wrong, and then you hear the screech on the way home and the next day the brakes fail. I often will find myself in the situation of having all my friends telling me that I need to see the doctor even though I suspect I have a virus, then I get to the doc and he rolls his eyes and says I have a virus and need to buck up and live through it. Being miserable isn’t a enough, you have to be miserable and think there’s a reasonable hope that the doc can actually DO something.

    My endocrinologist always tells me to lose weight, but he himself is at least 50 pounds overweight. My friend’s doctor told HER to lose weight (she’s 64 years old) but she gained instead and so now she refuses to go to the doctor and can’t remember WHEN she had a pap smear or a mammogram and despite the fact that her Mom DIED of colon cancer she HAS NEVER had a colonoscopy. That is where a lecture hurts the patient’s health more than helps.

    Most ALL of us who are overweight have struggled to lose weight over and over again. At age 57 I find myself overweight once again. In the past starting at age 18, I have gotten down to slender at least 10 times. I kept the weight off 3 years one time and most recently I kept the weight off for over 7 years. It takes me continuous all-out effort to maintain which includes 2 hours a day of exercise and preparation of special foods and taking the foods everywhere (to avoid prepared foods). As soon as I let up weight comes on. It is easier for other people to be thin. it is frustrating for me to have a doctor tell me to “just cut out the sweets” (I don’t eat any) or walk a half hour a day (I already do), or my favorite “JUST eat less and exercise more”.

    At any rate, thanks for a great blog posting!

  41. You sound like a WONDERFUL doctor! Everyone should have a doctor like you!
    I have always thought that for most people with most doctors it is a bit like going to the auto repair shop. You know the high-pitched screech that you hear when you step on the brakes? Chances are 50/50 that the car repair guy will tell you he did not hear it and there’s nothing wrong, and then you hear the screech on the way home and the next day the brakes fail. I often will find myself in the situation of having all my friends telling me that I need to see the doctor even though I suspect I have a virus, then I get to the doc and he rolls his eyes and says I have a virus and need to buck up and live through it. Being miserable isn’t a enough, you have to be miserable and think there’s a reasonable hope that the doc can actually DO something.

    My endocrinologist always tells me to lose weight, but he himself is at least 50 pounds overweight. My friend’s doctor told HER to lose weight (she’s 64 years old) but she gained instead and so now she refuses to go to the doctor and can’t remember WHEN she had a pap smear or a mammogram and despite the fact that her Mom DIED of colon cancer she HAS NEVER had a colonoscopy. That is where a lecture hurts the patient’s health more than helps.

    Most ALL of us who are overweight have struggled to lose weight over and over again. At age 57 I find myself overweight once again. In the past starting at age 18, I have gotten down to slender at least 10 times. I kept the weight off 3 years one time and most recently I kept the weight off for over 7 years. It takes me continuous all-out effort to maintain which includes 2 hours a day of exercise and preparation of special foods and taking the foods everywhere (to avoid prepared foods). As soon as I let up weight comes on. It is easier for other people to be thin. it is frustrating for me to have a doctor tell me to “just cut out the sweets” (I don’t eat any) or walk a half hour a day (I already do), or my favorite “JUST eat less and exercise more”.

    At any rate, thanks for a great blog posting!

  42. RE: “They pay for a plan.”
    No, I pay for an understanding of the underlying problem that is causing my symptoms. Maybe I’m a little different than my neighbor (she was born/educated in Japan and knows how to design clothing). I have an MA in Health Education as well as am a licensed LPN. I want to understand so that I am better able to deal with my symptoms at home–particularly since I am highly suspicious of medications. I pay for a doctor’s knowledge so that I can apply it to my own body which is neither of average height nor weight-for-my-age and is a senior female body not that of the college student males that are very often used as research subjects to test new meds.

    For example: I have a Drug Reference book that lists all the potential side effects of all the meds. I had tinnitus for over a year while the doctors told me in effect to “Grin and bear this symptom of aging” before I got that book. It told me that tinnitus can lead to permanent hearing impairment and can be caused by aspirin overdose. I am still being told that I ought to be taking the aspirin a day I had been taking when I have discovered that a quarter aspirin every other day or so is all that my body can stand. The hematologist still is “deaf” to my pleas to understand that I want to save my hearing; thus he is still marching to his own “law of averages” ideas he learned elsewhere than my own smaller than average, female body that is in its present condition due to the fact that I have been using estrogen supplementation since menopause in 1987.

    However, I can only rarely find a doctor willing to impart information and not just judgemental “law of averages” dicta.

  43. RE: “They pay for a plan.”
    No, I pay for an understanding of the underlying problem that is causing my symptoms. Maybe I’m a little different than my neighbor (she was born/educated in Japan and knows how to design clothing). I have an MA in Health Education as well as am a licensed LPN. I want to understand so that I am better able to deal with my symptoms at home–particularly since I am highly suspicious of medications. I pay for a doctor’s knowledge so that I can apply it to my own body which is neither of average height nor weight-for-my-age and is a senior female body not that of the college student males that are very often used as research subjects to test new meds.

    For example: I have a Drug Reference book that lists all the potential side effects of all the meds. I had tinnitus for over a year while the doctors told me in effect to “Grin and bear this symptom of aging” before I got that book. It told me that tinnitus can lead to permanent hearing impairment and can be caused by aspirin overdose. I am still being told that I ought to be taking the aspirin a day I had been taking when I have discovered that a quarter aspirin every other day or so is all that my body can stand. The hematologist still is “deaf” to my pleas to understand that I want to save my hearing; thus he is still marching to his own “law of averages” ideas he learned elsewhere than my own smaller than average, female body that is in its present condition due to the fact that I have been using estrogen supplementation since menopause in 1987.

    However, I can only rarely find a doctor willing to impart information and not just judgemental “law of averages” dicta.

  44. Hi,
    so many of these things work in reverse too. For years I fixed computers in doctor’s offices (and nurses, and therapists, and…) for a large medical school in Tennessee.

    My “patients” were doctors and their computers… my worst patient was the chair of the obgyn department and she’d just make up symptoms, call in the service call, and leave her office… of course the symptoms she’d given couldn’t be duplicated… then she’d get mad and call department heads all over the university bitching.

    But then she was a patient who besides “fibbing” about her symptoms wouldn’t follow the “doctor’s” orders either.

    She went thru 4 assistants her first year.

    I’m glad I’m not taking care of her now and feel sorry for the poor soul who got assigned that department (and her).

  45. Hi,
    so many of these things work in reverse too. For years I fixed computers in doctor’s offices (and nurses, and therapists, and…) for a large medical school in Tennessee.

    My “patients” were doctors and their computers… my worst patient was the chair of the obgyn department and she’d just make up symptoms, call in the service call, and leave her office… of course the symptoms she’d given couldn’t be duplicated… then she’d get mad and call department heads all over the university bitching.

    But then she was a patient who besides “fibbing” about her symptoms wouldn’t follow the “doctor’s” orders either.

    She went thru 4 assistants her first year.

    I’m glad I’m not taking care of her now and feel sorry for the poor soul who got assigned that department (and her).

  46. I’m pretty fortunate. My physician trains others, which affords her the opportunity to actually sit and talk to me. On average, my doctor and I talk about 15 minutes before she even begins to ask about my health. She notes items from our conversation on my file. She’s also very willing to offer traditional and homeopathic practices, in addition to Western medicine. I consider myself truly blessed to have such a wonderful healthcare provider.

  47. I’m pretty fortunate. My physician trains others, which affords her the opportunity to actually sit and talk to me. On average, my doctor and I talk about 15 minutes before she even begins to ask about my health. She notes items from our conversation on my file. She’s also very willing to offer traditional and homeopathic practices, in addition to Western medicine. I consider myself truly blessed to have such a wonderful healthcare provider.

  48. Strong opinions about communic

    Feeling respected is critical. A doctor who makes you feel dumb, disrespected or like a waste of his/her time is anti-therapeutic. Why haven’t the clinical professors figured out that the way they treat their students sucks the life out of them? If students see big, “important” doctors acting arrogantly in front of patients, not listening to patients, acting as if the patient weren’t even in the room during rounds and rushing around as though the patients are a nuisance, students will adopt these behaviors… after all, everyone wants to be big and “important.” Most students probably enter med school because they want to become healers and take care of people who are sick. It seems like they graduate only after they’ve been taught to have attitude problems and have been groomed to truly believe they are better than most people (except for other physicians). This does not breed patient-physician trust; it breeds dislike and avoidance. Avoidance of doctors means diagnosing problems at a later stage. It means gaps in continuity of care. Poor communication is injurious to trust. Injured trust means not revealing critical information during exams. It also means a patient is less likely to adhere to treatment… and it means an increase in the number of 2nd opinions and an increase in the risk of litigation. The reasons for doctors not to display arrogance or attitude problems in front of patients abound. The reasons for doctors to learn how to communicate effectively with patients also abound. THIS is what needs to be taught in medical school.

  49. Strong opinions about communication

    Feeling respected is critical. A doctor who makes you feel dumb, disrespected or like a waste of his/her time is anti-therapeutic. Why haven’t the clinical professors figured out that the way they treat their students sucks the life out of them? If students see big, “important” doctors acting arrogantly in front of patients, not listening to patients, acting as if the patient weren’t even in the room during rounds and rushing around as though the patients are a nuisance, students will adopt these behaviors… after all, everyone wants to be big and “important.” Most students probably enter med school because they want to become healers and take care of people who are sick. It seems like they graduate only after they’ve been taught to have attitude problems and have been groomed to truly believe they are better than most people (except for other physicians). This does not breed patient-physician trust; it breeds dislike and avoidance. Avoidance of doctors means diagnosing problems at a later stage. It means gaps in continuity of care. Poor communication is injurious to trust. Injured trust means not revealing critical information during exams. It also means a patient is less likely to adhere to treatment… and it means an increase in the number of 2nd opinions and an increase in the risk of litigation. The reasons for doctors not to display arrogance or attitude problems in front of patients abound. The reasons for doctors to learn how to communicate effectively with patients also abound. THIS is what needs to be taught in medical school.

  50. I am a 92-year old male who has been a hearing-disabled patient for about 50 years. Way back when, I’ve taken my children to the family doctor many, many times. I was there during quite a number of medical/hospital procedures and took particular note how healthcare professionals interacted with their patients. So, for your information:
    A medical/industrial face mask or shield significantly muffles the speech of a health care professional, hospital staff or other person who needs to communicate with a hoh client/patient in the course of a procedure, industrial/commercial/management conversation, or a social interaction, even if the hoh listener is wearing hearing aids. (It’s common knowledge that ‘hearing aids’ at their best are nowhere near ‘normal’ hearing.) If at all possible, slow your speech down and enunciate with more care than usual. Usually, your normal tone and the sound level of your voice will suffice if you slow down. A brief pause between sentences will help the hoh listener to understand. Should the listener ask you to repeat, don’t show your impatience; it’s extremely intimidating to many ailing (plus being hoh) persons to deal with an impatient health professional along with their own MOUNTING guilt and frustration in not being able to understand what is being said.

    Specific ‘oral’ instructions, recommendations, etc., by a healthcare professional to an hoh, ailing, elderly, and/or confused patient in the course of, or concluded examination/procedure are, quite often, not adequately recollected afterward by the patient and his/her accompanying companion who, also tense, is trying to deal with, what is to them, an abnormal and even threatening situation. A form checklist to remind the patient/family what he/she/they should do or not do toward healing would help enormously, but almost invariably, also, in the event an specified contingencies occur, will help the hoh patient, and his/her family considerably.

    Consider adding a color-coded signal to the file folders of your hoh patients so that you are alerted and can adjust accordingly.

    I have the highest regard for all who devote their lives and careers to the well-being of human kind. Thank you.

  51. I am a 92-year old male who has been a hearing-disabled patient for about 50 years. Way back when, I’ve taken my children to the family doctor many, many times. I was there during quite a number of medical/hospital procedures and took particular note how healthcare professionals interacted with their patients. So, for your information:
    A medical/industrial face mask or shield significantly muffles the speech of a health care professional, hospital staff or other person who needs to communicate with a hoh client/patient in the course of a procedure, industrial/commercial/management conversation, or a social interaction, even if the hoh listener is wearing hearing aids. (It’s common knowledge that ‘hearing aids’ at their best are nowhere near ‘normal’ hearing.) If at all possible, slow your speech down and enunciate with more care than usual. Usually, your normal tone and the sound level of your voice will suffice if you slow down. A brief pause between sentences will help the hoh listener to understand. Should the listener ask you to repeat, don’t show your impatience; it’s extremely intimidating to many ailing (plus being hoh) persons to deal with an impatient health professional along with their own MOUNTING guilt and frustration in not being able to understand what is being said.

    Specific ‘oral’ instructions, recommendations, etc., by a healthcare professional to an hoh, ailing, elderly, and/or confused patient in the course of, or concluded examination/procedure are, quite often, not adequately recollected afterward by the patient and his/her accompanying companion who, also tense, is trying to deal with, what is to them, an abnormal and even threatening situation. A form checklist to remind the patient/family what he/she/they should do or not do toward healing would help enormously, but almost invariably, also, in the event an specified contingencies occur, will help the hoh patient, and his/her family considerably.

    Consider adding a color-coded signal to the file folders of your hoh patients so that you are alerted and can adjust accordingly.

    I have the highest regard for all who devote their lives and careers to the well-being of human kind. Thank you.

  52. We are in the holding pattern. Planes circle the runaway until they can get clearance to land. We are circling and waiting. Mindless circles of alternate despair and hope.We ask the tower for instructions to land and pray that we will not crash and burn. We know the fire is licking at our middle so we fly with only one engine. Ask any pilot how difficult it is to keep a plane in the air and not panic the other passengers as you circle and speak in a calm voice. I know the chances are slim for a safe landing. I have been in the air before. I know this is risky. I know I may need help after a hard landing. I have been with the survivors and also sat with those that didn?t make it. I try to prepare for the worst but continue to pray. Please God, my tower of strength, don?t let it be cancer again.

    My daughter will be operated on tomorrow. One doctor told her on the phone it was Ovarian Cancer, two others have met with us and spoke of a large suspicious tumor.
    They will not call it cancer until a pathology report. So we circle and wait. The circling is not hard. One day follows another. The waiting has no such pattern. Panic and anger followed by crying and then peace until the circle comes round and we watch to see where it will stop this time. Stop at peace I can cry no more.

    How do Doctors do it? How do they calmly tell someone they have a life threatening tumor and then tell them to come back in two weeks for surgery? How do they sleep at night knowing the terror they have established in a patient?s mind? I thank God for the surgeons that will remove this tumor but question the need for the fear created by the calm disclosure of a life threatening disease to an unsuspecting recipient. When my mother was told she had Ovarian Cancer she was alone in a hospital bed. No one thought to have any family members with her as she was given her death sentence. She cried in silence and told no one for a full day her secret horror. My sister was already in surgery when they realized her cancer. An oncology surgeon was called in immediately and her primary doctor came out to the waiting room where I sat by myself to tell me that my younger sister had crashed and burned. They would do what they could to help her recover. The air becomes so thin the breathing so shallow when you are circling. Be like the doctor; be like the pilot; speak in a calm voice to the other passengers. They need to be told. They need to prepare. They need to see that you are in control in the damaged cockpit. They need to know that you and they will survive this. Now the plane has veered off course and it is my sister-in-law looking for a parachute. In the next year she will be in surgery twice to remove the aggressive cancer they have found. She knows I have flown this plane before so I am her pilot. How many times must I fly this route? How many times must I tell my passengers that we have a life and death situation?

    Tomorrow I sit in the cockpit again. No amount of money could get me here willingly.
    But I will put on my captain?s uniform and turn on my radar and pray that the Tower will guide me and my passengers to safety. We are in the holding pattern.

  53. We are in the holding pattern. Planes circle the runaway until they can get clearance to land. We are circling and waiting. Mindless circles of alternate despair and hope.We ask the tower for instructions to land and pray that we will not crash and burn. We know the fire is licking at our middle so we fly with only one engine. Ask any pilot how difficult it is to keep a plane in the air and not panic the other passengers as you circle and speak in a calm voice. I know the chances are slim for a safe landing. I have been in the air before. I know this is risky. I know I may need help after a hard landing. I have been with the survivors and also sat with those that didn?t make it. I try to prepare for the worst but continue to pray. Please God, my tower of strength, don?t let it be cancer again.

    My daughter will be operated on tomorrow. One doctor told her on the phone it was Ovarian Cancer, two others have met with us and spoke of a large suspicious tumor.
    They will not call it cancer until a pathology report. So we circle and wait. The circling is not hard. One day follows another. The waiting has no such pattern. Panic and anger followed by crying and then peace until the circle comes round and we watch to see where it will stop this time. Stop at peace I can cry no more.

    How do Doctors do it? How do they calmly tell someone they have a life threatening tumor and then tell them to come back in two weeks for surgery? How do they sleep at night knowing the terror they have established in a patient?s mind? I thank God for the surgeons that will remove this tumor but question the need for the fear created by the calm disclosure of a life threatening disease to an unsuspecting recipient. When my mother was told she had Ovarian Cancer she was alone in a hospital bed. No one thought to have any family members with her as she was given her death sentence. She cried in silence and told no one for a full day her secret horror. My sister was already in surgery when they realized her cancer. An oncology surgeon was called in immediately and her primary doctor came out to the waiting room where I sat by myself to tell me that my younger sister had crashed and burned. They would do what they could to help her recover. The air becomes so thin the breathing so shallow when you are circling. Be like the doctor; be like the pilot; speak in a calm voice to the other passengers. They need to be told. They need to prepare. They need to see that you are in control in the damaged cockpit. They need to know that you and they will survive this. Now the plane has veered off course and it is my sister-in-law looking for a parachute. In the next year she will be in surgery twice to remove the aggressive cancer they have found. She knows I have flown this plane before so I am her pilot. How many times must I fly this route? How many times must I tell my passengers that we have a life and death situation?

    Tomorrow I sit in the cockpit again. No amount of money could get me here willingly.
    But I will put on my captain?s uniform and turn on my radar and pray that the Tower will guide me and my passengers to safety. We are in the holding pattern.

  54. God love you, Mary. I will pray for you and your family. I’m so sorry I can’t do more. Will you let me know how things are? I don’t know you, but I do care.

  55. God love you, Mary. I will pray for you and your family. I’m so sorry I can’t do more. Will you let me know how things are? I don’t know you, but I do care.

  56. I had to tell a woman today that she possibly had cancer. I did my best to make sure the time between me telling her and her finding out the truth. I called the specialist to see how fast they could get her in.
    I am with you. You don’t tell someone that “maybe they have cancer” and then make them wait. That is just untinking.

    My prayers are with you.

  57. I had to tell a woman today that she possibly had cancer. I did my best to make sure the time between me telling her and her finding out the truth. I called the specialist to see how fast they could get her in.
    I am with you. You don’t tell someone that “maybe they have cancer” and then make them wait. That is just untinking.

    My prayers are with you.

  58. Dr Rob,
    Great topic! I wanted to share something that my PCP just started doing with his patients that’s been so helpful!

    My doc is very committed to educating his patients and he does a great job of incorporating natural medicine with conventional. He just started having one of his nurses come in at the conclusion of the apt to fill-out a “treatment plan” sheet with all the action items for the patient.

    Things like:
    – instructions for medicine or suppliments to take……or stop taking something I was already on
    – exercise, diet, or sleep changes
    -info for a specialist he wants me to see while his office faxes the records to
    – when I should schedule a f-u apt
    – blood tests, etc. I need to schedule to have done

    Now I normally take notes, but this has really helped me to be able to focus on what he’s saying and ask questions vs. focus on writing down what he’s telling me. I recently took my Mom to see him after we learned she has suffered 2 strokes, and she gets confused easily. So this was REALLY helpful for her. This is something she can put by her medicines so she can refer to it.

    I really think this simple “tweek” has really made a big difference, so I just wanted to share for any of your MD readers who might find this helpful.

  59. Dr Rob,
    Great topic! I wanted to share something that my PCP just started doing with his patients that’s been so helpful!

    My doc is very committed to educating his patients and he does a great job of incorporating natural medicine with conventional. He just started having one of his nurses come in at the conclusion of the apt to fill-out a “treatment plan” sheet with all the action items for the patient.

    Things like:
    – instructions for medicine or suppliments to take……or stop taking something I was already on
    – exercise, diet, or sleep changes
    -info for a specialist he wants me to see while his office faxes the records to
    – when I should schedule a f-u apt
    – blood tests, etc. I need to schedule to have done

    Now I normally take notes, but this has really helped me to be able to focus on what he’s saying and ask questions vs. focus on writing down what he’s telling me. I recently took my Mom to see him after we learned she has suffered 2 strokes, and she gets confused easily. So this was REALLY helpful for her. This is something she can put by her medicines so she can refer to it.

    I really think this simple “tweek” has really made a big difference, so I just wanted to share for any of your MD readers who might find this helpful.

  60. Fantastic post. In my opinion rule number 5 is the most important. If many doctors followed this plan they might find that the “why” part of what treatment rendered is lacking. In the US we need to get on board and start using EBM instead of letting money, politics and drug companies drive our health into the ground.

  61. Fantastic post. In my opinion rule number 5 is the most important. If many doctors followed this plan they might find that the “why” part of what treatment rendered is lacking. In the US we need to get on board and start using EBM instead of letting money, politics and drug companies drive our health into the ground.

  62. I discovered your wonderful blog recently, and have just finished catching up on previous posts.
    Thanks especially for Patient Rule #5, “They pay for a plan.” I’ve spent a lot of time in doctors’ offices over the past few years (not because I particularly like doctors, although I do, but for more usual reasons), and I find that I often leave not really understanding what I’m supposed to do, or what’s supposed to happen, next. Reading Rule #5 made me realize what I’ve been feeling, and given me a plan. From now on, I will know that I should ASK what comes next, which should make my care much more efficient and effective. Thanks again, Dr. Rob!

  63. I discovered your wonderful blog recently, and have just finished catching up on previous posts.
    Thanks especially for Patient Rule #5, “They pay for a plan.” I’ve spent a lot of time in doctors’ offices over the past few years (not because I particularly like doctors, although I do, but for more usual reasons), and I find that I often leave not really understanding what I’m supposed to do, or what’s supposed to happen, next. Reading Rule #5 made me realize what I’ve been feeling, and given me a plan. From now on, I will know that I should ASK what comes next, which should make my care much more efficient and effective. Thanks again, Dr. Rob!

  64. I shadow in the local Emergency Room and I can see every day how difficult it is to foster a doctor-patient relationship in only minutes. However, it is absolutely possible, and most certainly necessary, because trips to the emergency room are generally more serious and need more trust among the physician, the patient, and the family members that accompany the patient. Since the doctor doesn’t have the repeat visit relationships with his/her patients and often the ER experience is pretty taxing, understanding, honest discourse, and kindness go a long way.

  65. I shadow in the local Emergency Room and I can see every day how difficult it is to foster a doctor-patient relationship in only minutes. However, it is absolutely possible, and most certainly necessary, because trips to the emergency room are generally more serious and need more trust among the physician, the patient, and the family members that accompany the patient. Since the doctor doesn’t have the repeat visit relationships with his/her patients and often the ER experience is pretty taxing, understanding, honest discourse, and kindness go a long way.

  66. I disagree on rule #3; patients don’t want their doctor to treat them like a spoiled child. I hate it when I feel my doctor dismisses what I think is going on with my health. It’s my body and my health, my doctor doesn’t know how I feel unless he listens to me. I had to twist my doctor’s arm just to run a thyroid panel because my TSH was “normal” but my FT3 and FT4 aren’t. They’ve been steadily decreasing. All he was worried about was my high triglycerides…but duh…that’s a symptom of hypothyroidism.

  67. I disagree on rule #3; patients don’t want their doctor to treat them like a spoiled child. I hate it when I feel my doctor dismisses what I think is going on with my health. It’s my body and my health, my doctor doesn’t know how I feel unless he listens to me. I had to twist my doctor’s arm just to run a thyroid panel because my TSH was “normal” but my FT3 and FT4 aren’t. They’ve been steadily decreasing. All he was worried about was my high triglycerides…but duh…that’s a symptom of hypothyroidism.

  68. […] Getting along: Part 1 – Doctor Rules Excerpt: Rule 4. They [Patients] don’t want to look stupid. I remember when I broke my shoulder – a compression fracture of the neck of the humerus bone – and went to the orthopedist office. I always felt self-conscious about how much pain I was reporting. A colleague had fractured his humerus the year before and had reported he was back to doing surgery within a few weeks. Here I was, a few months out and couldn’t even lay down in bed. I felt like a wimp. Was this other guy just tougher than me? My orthopedist made me feel much better when he explained that my colleague had a mid-shaft fracture, while mine was right in the shoulder joint – a much slower place to heal. This event made me realize how many patients felt when they came into my office. People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….” […]

  69. Could you possibly relate to the issue of whether or not doctors should, would, could, admit their mistakes to a patient who is the victim of an iatrogenic injury. And how this could be done to the benefit of both. (the doctor not having to decieve or back pedal and the patient deserving and recieving the truth)?

  70. Could you possibly relate to the issue of whether or not doctors should, would, could, admit their mistakes to a patient who is the victim of an iatrogenic injury. And how this could be done to the benefit of both. (the doctor not having to decieve or back pedal and the patient deserving and recieving the truth)?

  71. I am with you. The ego of most drs get in the way of seeing the patient and the needs that they are presenting with.
    When is the last time you saw an humble dr? I am still waiting to see one.

  72. I am with you. The ego of most drs get in the way of seeing the patient and the needs that they are presenting with.
    When is the last time you saw an humble dr? I am still waiting to see one.

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