What I Look For in a Doctor

>> Friday, June 5, 2009

I read this article in the New York Times this morning and I loved it, so, naturally, it's the story I'm going with today. It's all about how a doctor can and should become a partner rather than a dictator when it comes to medicine, should be letting the patient call the real shots and, rather than demanding compliance, the doctor should be educating the patient so that the patient can make the best decision.

Now, I'm not a doctor. I don't doubt that it's likely not that easy and that any number of patients aren't going to do the right thing no matter how carefully their educated. But I understand and encourage this concept anyway.

Let me tell you one reason why. People in my family get weird stuff. We get shingles when we're children. We get mold that grows in one's lungs. We get meningitis that attacks heart valves instead of the brain, drastically delaying diagnosis. We are weird. When I got married the second time, I married into a family that, oddly enough, had the same sort of unusual diversity - just different problems.

I've learned the hard way that I better be an informed patient, question doctors, insist on knowing what they're suggesting and why and objecting if I know better. Why? Because they can't know my family history, my history as well as I do. Because, in the end, I'm still responsible for what happens to me. Because my children can pay the price if I'm not careful.

I have dozens of stories (I suspect most of you do, too). Like when my cousin almost died from an infection after an in-grown toenail operation and my aunt insisted on taking him to the hospital when his doctor said NO (he had a fever over 106). She'd been trying to get the doctor's attention for two days and the poor kid was on IV antibiotics for six months afterwards.

But there's something more as well. There's something empowering in being part of the decision, to being listened to. Now, you're part of your recovery, your treatment. That's certainly part of it. More, though, you don't sacrifice your humanity, your dignity. That may sound like a small thing, but I think it's a big thing.

There's a favorite movie of mine starring the ever-charming Carey Grant called People Will Talk. It wasn't just that he played the kind of doctor referred to in the article I linked, it's that he never forgot these were living breathing people with minds as well as body needing nurturing. A little bit of dignity can go a long way. Let me give you an example.

My husband's great grandmother was diabetic and blind, a remarkable woman. With eleven children (ten of them girls), she worked as a seamstress and managed to take care of all of them even after her husband shot himself to death when they were teenagers. Books were her great pleasure. So the blindness was kind of a double blow. As it was described to me, most of her daughters went into nursing and, for the last decade or so of her life, she was passed from daughter to daughter, told what to eat and what to do, managed and coddled as if she were a child. Her brain worked fine, mind you, but she was glad to go, I think, when she left. She was quite a woman, but all of her capable children dismissed her as if she were incapable of thinking for herself.

Counter that with my aunt Sue and my grandparents. My grandfather died of asbestosis five years ago or so. Before he died, he couldn't walk to the door without his oxygen, but my aunt reworked the house so it would have ramps, got him a scooter and a portable oxygen tank. When issues for the house or anything else came up, she talked to him. She let him look through the mail first. His brain worked fine and she made sure he knew she knew it. He never lost his dignity. My grandmother, who's brain hasn't faired quite so well, is still listened to, is still cherished, is still given choices and control. One thing she asked Sue is never to go to another hospital and Sue has moved heaven and earth to get her the medical care she needs without going to a hospital. I find it particularly interesting that there's no bitterness at the restrictions and extra work for Sue. She's happy my grandmother is still there to be loved and cherished.

Sue would have made one hell of a doctor.


  • flit

    Obviously she would have... also anything else she wanted to do.

    I can definitely attest to the difference in having a doctor that actually listens - and tells one the truth. I SO need to find a new family doctor.

  • Stephanie B

    I know. I'm glad you're going to get a new doctor.

  • Roy

    I must be lucky or something; all my doctors have kept me up to date and in on the decisions. Well, that is when I had a doctor. Now without insurance I have to look after myself.

  • Stephanie B

    Since you were kept informed, you're in a better case to do so. But the FINANCIAL side of our health care system is a whole other set of blogs.

  • Lola

    I'll be looking for a new doctor this month after last month's new doctor debacle that I wrote about on my blog.

    Patients have to be informed as much as they can be because doctors spend such little time with them and see so many patients.

    I nearly died 2 years ago after several trips to the ER and my doc (a different one). I had numerous CT scans that diagnosed nothing. I persisted and kept going to the ER and telling them I thought it was something with my reproductive parts. Finally someone listened and did a simple ultrasound. Wah lah! My uterus had closed off with scar tissue from 4 previous unsuccessful procedures, and my body was still trying to have a period. The abdominal pain and back pain were unbearable.

  • Stephanie B

    Roy, it also makes a difference if have ailments that are out of the ordinary. When my daughter was in extreme pain from shingles, no one had a clue what it was until the fourth trip to the doctor (three of them to the emergency room) anyone ever considered it (pain comes before the lesions). Only old people get shingles. I'd had them twice, once when pregnant and no one ever diagnosed them either time, even though for the second it was atypical. I only found it was shingles when SHE had it.

    Lola, I knew I could find stories. I've been lucky myself to have doctors that listen to me. On the other hand, on those few occasions where someone didn't, I got a new doctor fast. My mother-in-law had the same sort of experience you did only she had a gall bladder problem for TEN years that was repeatedly misdiagnosed as heart trouble and everything else.. Who knows what would have happened if, the last time, she hadn't refused to leave until they figured out what was wrong. A simple bloodtest and they did surgery to remove a gall bladder 19 cm across (instead of the nominal 3) with 41 individual gall stones.

  • JD at I Do Things

    Agree, agree, agree! And if you find one of these doctors who actually listens to you and respects you, hang on for dear life! My PCP is like that, thank god. I got the big brush-off from an orthopedist for suggesting that my hip and back pain are related. He didn't even let me finish my sentence, which actually made a lot of sense. I tried more than once to get this one issue across to him, but he was programmed not to listen. And he? Is no longer my doctor.

  • Stephanie B

    Good for you, JD.

  • The Mother

    As a medical professional (although, thankfully not patient care medicine--but hubby is), I have two thoughts on this issue:

    1)anyone who is unhappy with their doctor should switch. You are the consumer. If your doctor doesn't talk to you or brushes your concerns aside without explanation, FIND A NEW ONE.


    2)Although I am willing to admit that the system, in its current incarnation, is impersonal, I also do not think that the average patient is informed enough to actually dictate his own care. Witness the anti-vax community. Or the massive success of homeopathy or "The Secret."

    Many patients will believe what they wish, regardless of what doctors tell them. They simply don't have the education or the tools to understand evidence-based medicine. And a doctor should not have to waste five hours of his time explaining why a double-blinded, randomized clinical trial is better evidence than Aunt Sally's anecdotal experience. Especially since those five hours are generally truly wasted, the patient being firmly convinced that, indeed, he was right all along.

    In this world of lawsuits, doctors are still forced to document such ideas as "noncompliance," because otherwise, when Joe dies of a stroke due to his hypertension, which he chose to deal with by using a homeopathic remedy rather than taking his medication (or, more likely, chose not to deal with at all), the doctor IS going to get sued.

    It would be lovely if Dr. Berwick's world was real. If it truly works for him in his practice, I suspect he is a far better communicator than most (I would also suspect that he has a largely middle-class, educated patient base--I doubt that someone who works in the third wards would have written this piece).

    Unfortunately, I doubt that world exists for most practitioners.

  • Stephanie B

    I suspected you'd have a different perspective on this, Mother, and I'm not surprised. I thought about you when I wrote it because I know you're not wrong for many folks.

    The problem I have is twofold though. Although you're right about many, you're not right about all and there are many who have received the wrong care because doctors refuse to listen (and I agree with your advice and have followed it). A doctor can never take the time to know your body like you do. I also acknowledge at least as many people who didn't recover because they refused to listen to the doctor. I agree that a partnership is an idealized notion universally but disagree that it is impossible for people willing to take the time to understand their conditions.

    The problem of people refusing to accept things despite overwhelming evidence is endemic to more than medicine, though I don't disagree it's endemic there too.

    I also think that people like myself and other members of my family have a responsibility to stand up for themselves given the weirdnesses we have individually. I've never blamed the doctors, for instance, for not recognizing the shingles earlier, though I might if they refuse to listen in the future (fortunately, it has not recurred for Steph or myself in years).

    I do maintain that, if you're a doctor unwilling to listen or to explain, you're not a keeper. But I don't think you're likely to disagree with me there. As for the NYT article here - I suspect that it's not readily attainable, especially with insurance and the legal ramifications as they are. But I'd like to see us move in that direction rather than the impersonal world where doctors know no more about you than what they see in your charts when they take the time to read them (and some do not).

    I'm not picking on doctors per se. You should hear me complain about engineers. And don't get me started about the kind of lawyers who specialize in going after doctors.

    Thanks for the other point of view, Mother.

  • The Mother

    I think we would all like to see us move in that direction. Doctors, too.

    But the economics of health care (and especially the HMO, gatekeeper style of health care) ARE pulling us further from that idealized goal.

    When patients are in HMO type practices where they never get the same doc twice, and the doc they get has a choice of a) reading through a chart larger than the OED, and b) getting to at least SEE the hundred other patients on the list for the day, you can guess what gets picked.

    When patients have to BEG for referrals to specialists, and then spend six months waiting to see a specialist (becauseathe specialists get paid less than the primary care docs, even though they spent twice as long in school), NO ONE is properly served.

    Unfortunately, I see the proposals for nationalized/universal health care moving us further, not closer, to this idealized goal.

    And I see the popular media (Oprah, for example) moving us daily further away from the informed patient base that is necessary for this idealized goal.

    You and I, Stephanie, live in the Ivory Tower. The people we meet and associate with are, in general, educated professionals who are invested in their own care and their own health.

    We are the minority. I promise.

  • Stephanie B

    You may be right, Mother.

    But I can't see what I can do to improve the situation except try to educate.

    If you are right, here's hoping you won't always be.

  • Valerie David

    That was an interesting article, especially about how even just the little things like the silly gowns add to how patients feel powerless.

    I definitely don't like a doctor just saying "Do this" without an explanation, or only answering questions as they're backing away out the door.

    But on the other hand, there's been a new trend of going to the doctor who looks you over and says "Well, what do you want to do?" And I'm thinking, I don't know, you're the one that went to freakin' medical school!! The last gastroenterologist I went to asked if it was okay for him to give his opinion on what option I should choose. I was so excited to finally find a doctor who actually told me what *he* thought--along with the reasoning why he thought it. It seems there's so much fear of lawsuits now, that doctors now won't tell you what you should do because they don't want that opinion held agains them. And that isn't good, either. If they can't tell me anything, what do I need a doctor for?

    The other advice I'd give patients is to always tell the doctor ALL your symptoms, and don't be afraid if you don't fit neatly into some diagnosis category. I realized last time that if I'd left out a couple conflicting symptoms, I would have had my gall bladder out. But I stuck to my weird story and so they kept looking, and it turned out I had stomach ulcers. So definitely, no one should ever leave out details or accept a diagnosis just to make the doctor's life easier.

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