Physician, Know Thy Patient

When I meet a physician for the first time,  I immediately begin evaluating that potential relationship.  Everything from how they greet me (or not), whether or not the environment is a good one (or not), how convenient it is for me (or not), and if I am going to give them my money (or not).  I’m respectful, but if I see a potential problem I am forthright and I don’t pull any punches.  So in the spirit of being forthright, I thought it might not be a bad idea to write a post with the intent to gently inform our doctor-friends about their client’s view of the world.

Shake hands.  One thing I like to do when I meet a new physician is introduce myself–with a handshake.  Some doctors don’t like to shake hands.  Advice: shake the hands of your patients.  If you’re a germ-o-phobe get an MBA.  In addition to managing the disease you need to manage the relationship, so get it started off on a good footing and one of mutual respect.  A handshake is as much a greeting as it is an agreement to be a partner in this relationship.   I am not just a breast with googly eyes on it, I’m a person.  So put it out there and shake at the beginning and at the end; even if the patient doesn’t do it first.

Apologize.  If our appointment was scheduled for 10:15 and I don’t see you until 11:30, please apologize for the delay.  Most patients would never begrudge a physician for being late.  I want to be sure that s/he is being just as thorough with me as with everyone else.  But an apology is just the right thing to do and your patient is apt to be more cooperative.  You wouldn’t think twice for charging me for a missed visit, so please know that my time is just as valuable.

Respect Privacy.  If you have a patient in the waiting room and it seems a convenient place to follow up with them about their treatment, please know that it’s a bad idea.  Indeed, it is wholly classless.  Don’t walk your patient into the hall and talk disease management.  Walk  to an exam or consultation room and treat that person with respect and ensure their privacy.  When I see this happen I lose my mind.  It matters not if the news is good, bad, or indifferent, there are not only human rules of general respect and decorum that one should follow, but federal laws about patient privacy.  Please.  It will take you mere minutes.  I had an experience recently where the  physician came over to tell me good news at the reception desk and caught himself mid-sentence.  He stopped and motioned for me to follow him to his office.  I really appreciated that.

Be open to win-win negotiation.  Realize that when a patient is fearful, they do know that the reaction is not a rational one.  Doesn’t matter!  If your patient is terrified of a procedure for whatever reason, be patient, find out why, and negotiate with them.  Sometimes we just need to know why something has to be done following a particular protocol.

If your patient/client expresses doubt or has questions for you, don’t get defensive.  Patients know that you’re the expert, we’re only doing what we have been told to do for years: get informed and take charge of our healthcare.  In some cases the availability of knowledge is a double-edged sword.  But use their questions or protestations as a teaching moment: educate your patients.  Don’t dismiss them outright.  You can say that you don’t agree, but negotiate.  It’s never all or nothing when it comes to information.

Get online.  It would behoove you to read some blogs authored by those who manage breast cancer.  This will allow you to at least get a read on the social media landscape and become acquainted with some of the issues that are discussed regularly.  Get on Twitter and be traumatized by a TweetChat to see what people are up to on the topic.  Maybe even have a regular pow-wow with your colleagues on what is going on in the world of social media.  It certainly can’t be detrimental to be more aware.

Be a partner.  My general practitioner is a great guy.  I have a lot of respect for him as he takes very good care of me seeings as I don’t take such good care of myself.  But whenever I’ve met with him he’s always taken a moment or two to get to know me.  When I went to see him shortly after receiving my diagnosis, I was able to talk things out with him and discuss this entire thing in a big picture kind of way.  It was so helpful to talk this over with someone with whom I had an established relationship and trusted.  I know that he really cared because he took the time to know Scorchy and not Patient X.  That gives me confidence in him.  It’s all about trust and respect.  And when you share that, you have a true partnership and can make good decisions.

If your patient/client tells you that the front office staff is a problem, then damned well listen to them.  Ask them why and to explain the issue.  Just because you like your office manager, it doesn’t always mean that s/he has a good grasp of what needs to be done to represent you in the best light.  And if your patient/client sends you a letter in good faith to inform you of a problem, then damned well take the time to personally contact them to make it right.  Reputation doesn’t get built solely on knowledge and experience.  If you’re a genius and people tell others you’re a dickweed, then what have you gained?

Sweat the small stuff.  And sweat it often.  Make sure the front end of your office is managed as effectively as the back end.  Ensure that your patients have a comfortable and calming environment as they wait to see you.  Appearances and efficiencies are essential investments in your practice and reputation.  They are not inconsequential fluff.  If you don’t have the time to do it, then hire an anal retentive perfectionist who can.  (Sorry.  I’m taken.)

Lastly, take the time to make sure your patients are supported.  I am a very proactive person.  As soon as I heard the words “It’s a carcinoma” my mind started to tick off one task after another.  It wasn’t about taking control for its own sake, it was about steering my own ship and making sure that I had a good support system medically and emotionally.  But not everyone is capable of doing this and dealing with that diagnosis too.  Once you tell a patient they have cancer, don’t just say goodbye and tell them to make a follow up appointment.  Point them in the direction of resources–even if it is as little as handing them a brochure and circling a name.  Not everyone is strong or clear thinking in that moment.  Take the few moments that it will cost you to set up your patient for as successful an outcome as you can manage.

To manage breast cancer, one needs to work with professionals who are knowledgeable about the biology of that disease and the methods–both surgical and chemical–to treat it.  But you can’t successfully manage that disease unless you pull back and appreciate a larger picture.  Mutual respect and trust is the foundation of everything that will come after that first appointment; it needs to be as much a part of the overall approach as any scientific knowledge.

© CartoonStock.com. Used with permission.

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13 Responses to Physician, Know Thy Patient

  1. Excellent post!! Love the way you write… the substance as well as the style. You covered so many of my pet peeves… and on the plus side, reminded me about the sometimes “small” but gigantically crucial things that make my doctors (those I have chosen to stick with) so wonderful.

  2. All doctors should recognize and accept this line: “If you’re a genius and people tell others you’re a dickweed, then what have you gained?” ROFL! So true. SO true!! Great list Scorchy!

  3. Dr_Dana says:

    Thank you for that. I have to confess, I also feel that all of those items are important. I just won the Josetta Wilkins Award in the Professional category for taking such good care of my patients. I would add a couple of things: It’s not the mistakes you make, it’s what you do about them. Always be totally straight-up with patients. They realize that everyone makes mistakes. Just tell them what’s going on and how you’re going to follow-up. Also, as your BC patients go through the beginning of this scary journey, make sure they are progressing through the stages of grief. If they get stuck in denial, or anger, give them the added attention, medicine, whatever, to help them get to the coping stage. Allow time for issues to be brought up and discussed. Don’t be afraid of the tough answers. Patients want to know the truth…. Just my two cents:)

  4. Sara Pomish says:

    Well said. I have fired an oncologist who cancelled my appointments and promised to follow up by phone and never did, and who wanted to treat my tamoxifen side effects with more pills. I then fired an orthopedist who told me that I should feel “lucky” because my “range of motion was better than most breast cancer patients.” This after keeping me waiting for 90 minutes without so much as a “sorry for the wait” from him or his office staff.

    I fired them both with sarcastically scathing letters that were faxed to their offices and posted on FB. To the orthopedist, I suggested that in addition to being condescending he was apparently also clairvoyant since he was able to diagnose me without an exam, and suggest that if that was the case, then perhaps he could also give me this week’s powerball numbers.

    It’s ugly out there. We have to take a stand for ourselves, and I hope more women will read this and do just that.

    • Scorchy says:

      Honestly, it takes all kinds out there and we have to be on our game to find the good eggs–and there are lots of good eggs.

  5. Scorchy….
    I swear to GOD I am printing this up to give to someone who just presented at a meeting ….. Love how this is right to the point and covers EVERY point.

    Now, let’s pop a bottle of something and work our way toward a Pinkover. I’m thinking we can do a film short…. ala the Hangover? You in??

  6. Acacia says:

    This should be required reading for every medical student, every day. Beautifully written darling Scorchy

  7. Knot Telling says:

    Way back at the beginning, I narrowed down my search for an oncologist to two women, both BC specialists with good reputations. One was head of the department, the other a junior attending. The head of department was known for technical excellence and for her no-nonsense approach. The junior was known for her sense of humor and for relating to patients as people. Obviously, I chose the junior. Sense of humor was the deciding factor for me.

  8. Good doctors — far and few between. I’m currently struggling with finding one that is human…and I dont even have significant issues.

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