Sunday, September 22, 2013

If I could ask my doctor for a few things. . .

Unfortunately, on occasion, doctors get to be patients.

Over the last several months, I have had the irritating experience of being a patient more than I ever have been in my life. Though my job as a family doctor is high-stress and often exhausting, I must say that I definitely prefer being a doctor to being a patient.

"Being a patient" means spending inordinate amounts of time rearranging my life to get to appointments, camping out in sterile waiting rooms reading stupid magazines, sitting half-naked in chilly uncomfortable exam rooms (still reading the same stupid magazines), standing in tortuous pharmacy lines late at night because that's when I find them most bearable, trying to remember to take my annoying  medication as prescribed, impatiently holding on the phone line waiting to speak to a real live person (who may or may not talk to me like I am a real live person), refreshing my email neurotically to see if the doctor wrote back yet, and-- perhaps most frustrating of all--just wondering and worrying is everything going to be okay?

During many of these special hours driving back and forth between being a doctor and being a patient, I have compiled a list of things I wish my doctor would do when I come to see her.

Here's my analogy: birth plans. My pregnant patients regularly come in during the last weeks of their pregnancies with a written document called their "Birth Plan".  A birth plan is an outline of what a woman (or a couple) want for their birth-- essentially a list of requests about what happens before the baby comes (e.g. music, lighting, opportunities for movement), when the baby is born (e.g. who cuts the cord, who identifies the gender), who the family wants in the room (mother-in-law, yes or no), who bathes the baby, whether they want the baby to get eye ointment, and any other range of requests that seem right to them.

Some providers roll their eyes at birth plans; some consider them offensive and silly. But I love to see what my patients write down-- because it gives me good insight as to what they actually value and what they fear. I also want to know what they want from me, so that I can do the best to give them the experience that they want to have.

I'll stop here and remind you that I am imperfectly human (my patients are already well aware of this fact). I run late. I don't always listen. I rush people more than I'd like. I don't always model the kind of care I would hope to have.  And, therefore, it's probably a really good thing to regularly be reminded about what it feels like to be a patient. After all, then I can be a better doctor. (In a similar vein , my medical assistant recently had a gynecological exam in which her provider warmed the speculum; it was such a positive experience that she is now a consistent speculum-warmer for our patients. Thanks for that!)

What follows, below, is my personal version of "A Birth Plan for A Routine Patient Encounter". I'm sure your version would be different. I'd be curious to hear, in fact, how it would differ.

For clarity, the first bullets are so critical, I think, if my provider couldn't manage them, I might just get up and leave (naked  butt, ugly gown and all). The second part is my dream state, my fantasy, my paradise, my utopia of relationship-based health care.
_________________________________________________________________________
Doesn't matter if I come to see you because it hurts to pee or because I broke my wrist or because I am feeling down. At bare bones minimum, please, provider, when I come to see you about whatever medical issue I deem important enough to be here:
  • Be kind
  • Take a good history
  • Think logically
  • Speak in language I understand
  • Explain clearly what you are thinking and why
  • Order the appropriate lab tests and imaging studies to evaluate my diagnosis
  • Interpret results of those tests and studies correctly and in a timely matter
  • Help me understand the results and how they influence your initial diagnosis
  • Develop an appropriate treatment plan
  • Evaluate how that treatment is working (or not working)
  • Re-evaluate and start again.
And because you already do of all the above, dear provider, and because you are not the random urgent care person that I am only going to see once and never again, provider, now, can you try being even better than a good clinician? Can you try to treat me like you want to be treated? Or even better, like you want your child to be treated?

Please,


1-Sit down. Yes, sit down. Take your hand off the door knob, grab a seat and sit with me. When you stand over there by the sink with your arms crossed across your body, you make me feel like I am contagious or dirty or risky. When you hover over me while I lay vulnerable on the table, you make me feel small and powerless. I know you're busy--your staff already made that clear-- so am I. Sit down, please, and take a moment to talk to me, eye-to-eye. Person to person.

2-Listen to me, particularly the subtleties of me, the parts of me that are not the same as the last patient you saw. I am unique and special. No one knows my subtleties better than me, so if you don't stop and listen, you are missing out on a serious opportunity. This is not just about not interrupting me (we doctors have all been quoted the studies that, on average doctors wait 23 seconds before they interrupt their patients). This is about not talking and actually listening.

3-Remember my name. And if you don't remember my name, act like you do. When you remember my name, I feel immediately like a person. And feeling like a person makes our interaction so much better than me feeling like a number and you feeling like  a computer.

4-Call me by name. See #3. I am Veronica, after all, that's what you should call me.

5-Apologize for leaving me half-naked in a room for thirty minutes (or 3 minutes that felt like 30 minutes) because it's the nice thing to do. If you were sitting like me instead of standing there like you, you'd be uncomfortable too. The rooms are breezy, the paper gowns are humiliating, and everyone knows I've been waiting longer than planned. I do know you're busy, and I had a lousy magazine to read, but an apology from you means the world. It makes me feel respected.

6-Ask about my 3-year-old.  He's the most important thing on my planet. My entire world revolves around him. I spend every possible moment with him, and this visit replaces that time. Plus, when you ask me about my son, it shows you actually care who I am when you ask. You don't have to remember all the nitty-gritty details of my life. But remember this one, it's the most important to me.

7-Acknowledge that I drove 2 hours for this 15 minute appointment. This ties back into #3. If you remember my name, you may also remember that I live sixty miles from this clinic. And not only was the traffic on the bridge horrible but it took me 20 stressful minutes to find a parking space that wouldn't cost me an arm and a leg. So ask me about the traffic or parking or the seventeen other things I had to juggle to make this happen.

8-Touch me. I don't care if it's a quick hug, a shake of my hand, or a pat of my shoulder. But please do something more than put that cold metal thing in my vagina. Touch is healing.

9-Ask me if I have any questions and act like you actually want to answer them. If I don't have one right on the tip of my tongue, don't dash out the door in relief; stand there for ten whole seconds to see if I can come up with one. Because once you disappear, you are virtually impossible to get a hold of. You have a battalion of folks standing guard in your honor.

10-Finish the visit with a healing sentiment, or at least something encouraging. Let me give you some examples. I am not asking for poetry: "I am sure this is going to work out okay" or "I really feel you are going to get better" or "I will be thinking about you this week". You don't have to lie to me or give me false hope. But you can encourage me. And the sentiment you leave me with, sets my tone for my two hour trip home. And for the next two weeks. And until I see you again.

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