Recently I wrote a blog attempting to help patients work with their doctors. It was an honest attempt to improve the physician/patient experience. What came back was an avalanche of comments filled with anger and hostility toward people's doctors and the health care system.
I decided to look at all of the comments and see if they would fit into categories. They did and the messages were loud and clear. Your doctor doesn't listen to you or care enough, makes too much money, makes you wait too long, and you might do better going to your dog's vet. I can see your heads nodding in agreement behind your computer screens. Here is what you said.
1. My doctor doesn't listen.
This was, by far, the most common complaint. Physicians breeze into the exam room with their own agenda and don't take the time to find out what the patient expects. I just had a colleague tell me that only a few weeks ago he accompanied his brother to an office visit with his brother's oncologist. Jim's brother has cancer with a poor prognosis and they were trying to evaluate their options. Every time Jim's brother and sister in law spoke, the oncologist interrupted, telling them what he wanted to do. Finally, my colleague stepped in and told the oncologist that he needed to "Listen" to the patient. Fortunately, the physician recognized his error and took the time to listen to them and answer all of their questions. Most people are not this assertive or fortunate enough to get such a favorable response.
Dr. Lisa Sanders is an Internist, New York Times columnist and a technical consultant for the TV series, House. In an interview on NPR about her book, "Every Patient Tells a Story," she aptly points out that there are two conversations going on at once. One is with the person telling the doctor about their problem. The second is a simultaneous conversation going on in the doctor's head when they are thinking, "what does it mean and what do I ask next?" This second conversation frequently fogs the patient's message and leads to the doctor interrupting the patient.
A study in Family Medicine reported the disturbing data that, on average, a patient was able to speak uninterrupted for only 12 seconds! On the other hand, Dr. Sanders noted that the average patient will get their story out in two minutes. Doctors do not listen and it interferes with the quality of care and the ability to make a diagnosis. Most of the time, if we take the time to listen, you are telling us what we need to do to help you. Even worse, after the visit was over, patients and doctors couldn't agree on the purpose of the visit. No one was listening!
You are right, many doctors don't listen. They don't sit down, get at eye level with their patients and they fear the dreaded "list." Try my friend's strategy and politely point out to a doctor who isn't listening that you need your questions answered. Although it may be difficult, we are getting used to a better informed and assertive consumer.
2. I have to wait too long.
I fully agree. There are lots of reasons that this happens and many are unavoidable -- an emergency patient has to be worked in; there are only so many slots in a day, etc. However, I recently visited one of my doctors and we used up more than my allotted time complaining about the changes in health care. He told me that the management committee that ran his large group had just informed him that he had to see a patient every 10 minutes. He convinced them to double the time for a new patient. Either way it is not enough time.
The study in Family Medicine reported that the average face time with a doctor was 11 minutes with the patient speaking for only 4 minutes. Add in all the other things that need to be done in a visit and you are always going to be running late. You can't manage your doctor's practice, but here are some things you can do to manage your time.
• Find out when the doctor starts and get the first appointment of the morning or afternoon
• Call 30 minutes before your appointment and find out if the doctor is running on time. If not ask if it is OK if you come later?
• Always bring work or a book, as the magazines in the office are outdated and at least you will be productive
• If your doctor is chronically late, find another doctor.
3. My doctor just doesn't care
Are there doctors with bad attitudes, bad bedside manners and an uncaring attitude? Yes, but I think it is a minority. The doctors I know really do care or they wouldn't have gone to school for 12 years and live the rigorous, demanding life they do. Maybe you caught them on a bad day. BUT, if the chemistry is wrong or you were unlucky enough get the doctor who is a jerk, switch doctors. I wouldn't go back to a restaurant where I got a bad meal twice; the same should be true for a doctor. I feel I am allowed a bad day every so often, but two bad visits back to back and you should go shopping.
Dr. Anna B. Reisman recently wrote an article in the Los Angeles Times entitled, "Doctors can be fired and taught to..." She notes that "we don't fire doctors enough," and I agree. If your doctor doesn't know you are unhappy, they have no chance to change their behavior. She offers excellent advice on how to communicate the message that you are unhappy and changing doctors. Dr. Reisman closes her article with,"an occasional serving of humble pie is good medicine for all doctors."
4. Doctors make too much money.
How much is too much? Do you really know how much money your doctor makes? Yes, some doctor's make a disproportionate amount of money and are overpaid for what they do. Get a group of pediatrician's, family practitioners and internists together and they will tell you exactly who it is that is over paid -- not them. The problem is that the doctor you are seeing for your routine care is most likely not one of those high income earners. Not that we are starving, but the average medical student comes out of medical school with over $100,000 in school loans and if they go into primary care they will be paying those loans back for decades. We are getting a reset in fees. Highly paid specialists are coming down, but primary care doctors are not going up. Unfortunately there will always be a discrepancy, for the politics of reimbursement has always been to favor procedures and hospitalizations as opposed to office visits. I can only ask you to think twice before you assume that your weary eyed pediatrician seeing their 40th sick child of the day is the one being over paid.
5. My dog gets more respect
Let's avoid the whole discussion on the relationship of people and their pets. The valid argument here is that when you take your pet to the vet for a procedure you are likely to get a call that evening or the next day to see how they are doing. Same thing after a dental procedure. Anybody had a call recently after their colonoscopy?
"It's a Dog's World," is a cleverly produced patient satisfaction training video that follows a man and his dog through simultaneous encounters at the doctor's and the veterinarian's office. It would be funny if the message wasn't so startling. Needless to say the dog gets much better attention and care.
[EDITOR'S NOTE: Pet owners are often ready and willing to pay vet fees out of pocket and right on the spot, no insurance billing. Patients need to know that insurance reimbursement is what determines time with patient, not the doctor's choice. Declining insurance reimbursement and rising practice costs is an unhealthy prescription that gets translated into less time with patients.]
I know all the conventional excuses, but I don't know why we don't make the follow-up calls to see if you got your prescriptions, understand the instructions and have your follow-up appointments.
It is good medicine and great for patient/customer satisfaction. I think it is the way we are trained. Medical school never teaches us how to be good at customer satisfaction or become good listeners. I suspect it is time we tried.