Fw: Physicians should go back to basics with their patients

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----- Original Message -----

From: " Kathi " <pureheart@...>

Sent: Monday, September 30, 2002 1:33 AM

Subject: Physicians should go back to basics with their patients

> OPINION

>

> Physicians should go back to basics with their patients

>

> Commentary. By , MD, AMNews contributor. Oct. 7, 2002.

>

>

> At a time when there's never been more known about health and disease,

> Americans have never seemed more confused about what they want from

> their doctors. It's a bit like the anomaly of what people expect from

> their politicians: more services but less taxes.

>

> Although we find bumper stickers that say, " I love my country; it's my

> government I hate, " we don't quite get that love-hate connection with

> our patients. But in my opinion, the doctor-patient nurturing

> relationship, developed over the centuries, is basically gone.

>

> Oh, there are surely small towns in Iowa, coastal villages in Maine and

> remote settlements in Texas -- and elsewhere -- where doctors still

> bleed for their patients, but in general, in this new century we've

> practically bled out. It's a shame we've lost what was always so

> precious to the sick: caring, compassionate, personal physicians who

> knew their patients well and were full of the milk of human kindness.

> That the milk would appear to have gone sour is only partly the doctor's

> fault; there are two persons connected to a stethoscope, one at each

> end.

>

> For our part, we permitted the insurance companies to intrude into what

> is essentially a very private relationship and, surprisingly for a group

> considered to be so entrepreneurial, we rolled over when managed care

> became the New Deal. And we allowed, even caused, medical care to become

> a business. Big business.

>

> But I blame our patients more, only partly because, like many people, I

> don't always care to look in mirrors. I blame patients because they are

> so ready these days to believe the worst of us collectively. Maybe they

> are that way because they are bombarded by the media. They read

> magazines that exhort them to take charge at the doctor's office, or

> articles that tell how to haggle with doctors over fees.

>

> And they ponder cartoons in glossy magazines that show, for example, two

> couples driving around glitzy winter resorts in Florida in a flashy

> convertible. And as they pass all the beautiful people, one wife says

> brightly to the other: " Look at all those people! Now my 's a

> doctor, and so is your , but how can those other people afford

> all this? "

>

> If we want to win back patient trust, we have to go back to basics. We

> need to give patients what they want. And what they want is no mystery.

> Patients have been telling us what they want for years all through the

> long decline of our association with them.

>

> It goes without saying that they expect accurate diagnosis and proper

> treatment; they usually get that in a high-tech, somewhat offhand way.

>

> What else they want is less tangible but just as easily understood.

>

> It's what many of my doctor friends acknowledge they want when they are

> patients. They want:

>

> To be seen on time. Sure we have emergencies, but that's not the usual

> reason for running late. We have to get better organized.

>

> To be acknowledged as a person. Patients who have made several visits to

> a doctor, even a subspecialist, feel that the doctor should surely know

> something about them by that time and should be able to find something,

> anything, to say to show doctors don't just see them as numbers.

>

> To be listened to. Yes, doctors have their agendas, but patients do,

> too.

> The visit, like a good marriage, has to be a compromise. Patients claim

> they wouldn't doorknob the doctor if the doctor didn't try to open the

> door and escape before they, the patients, were finished. This is a hard

> one. I've not had many patients, especially elderly ones, who could come

> to the point quickly and prioritize their problems objectively.

>

> To be reassured. Part of the value of any visit is to be told the

> condition is not serious, not cancer -- if indeed the patient is worried

> about those issues, and usually patients are.

>

> To be advised later with test results even if the tests are negative.

> Every chart, in these days of answering machines, should have a notation

> saying whether it's OK by the patient to leave tests results on the

> machine. If yes, that solves the doctor's problem of reporting negative

> tests.

>

> To be discharged from an acute problem when it's over yet,

> paradoxically, to have a distant future appointment to play it safe.

> They've read that a personal physician offers the value of longitudinal

> care, so they are surprised when, unlike their dentist, the doctor

> dismisses them from care as if from his or her point of view, they don't

> need to come back until the next century. They don't like that. They

> want the security blanket of a check-up visit sometime next year.

>

> They are tomorrow's patients, but they want to be treated like

> yesterday's. And who can blame them? Yesterday was a lovely day.

>

> Dr. is a family physician in a 300-doctor group in San Diego.

>

> Copyright 2002 American Medical Association. All rights reserved.

>

>

>