Good doctors and Good patients
What makes a good doctor? The answer probably depends on your needs. For one person, a good doctor may be one who calls out an antibiotic if she calls complaining of UTI symptoms. For another, a good doctor is one who is able to schedule you a same day appointment to have those symptoms evaluated in person and to run a urinalysis. One patient may be looking for a physician who listens about not only his ailments, but also asks about his grandchildren. Another patient might not care to have lengthy explanations or to know every possible medication side effect, but just wants the doctor to tell him what he should do to get better. We all have different needs.
So what makes a good doctor? I would argue that a good doctor is somebody who is able to meet your personal needs, while still practicing quality medicine. (Notice that caveat?) Most people know their needs. Some truly don't, due to denial or lack of education or incapacity to understand. That can be a future blog post.
What is quality medicine? Like everything in medicine, the answer is both simple and complex. There are quality studies and professional society guidelines that essentially form a standard of care. Yet I would argue those standards do not apply in every situation. For example, if I have a new patient with no history of heart disease that comes to see me at 95 years old, and she recently had her cholesterol checked at a health fair, and it was found to be mildly elevated, am I going to start her on a cholesterol-lowering medication? Most likely not. I'd recommend a low fat diet. Whatever she has done to get her to age 95 likely has been working pretty well, and I would be afraid that the risks of starting a new preventative medication outweigh the benefits. The same scenario in a 50 year old likely would lead to a different recommendation from me.
If a patient has dysuria (discomfort with urination), then gets treated with an antibiotic at an Urgent Care, yet continues to have pain, I would suggest the solution isn't just prescribing more antibiotics. The patient should be evaluated in person. The urine should be tested. The pain could be from a bacterial infection, a vaginal infection (in women), prostate inflammation (in men), a kidney or bladder stone, or from scores of other causes. Throwing additional antibiotics at symptoms without a reevaluation likely isn't doing the patient any favors, even though it may seem to meet his or her needs.
I once saw a patient who lived two hours away from my office. She was seen by her local doctor "at the lake" (where she lived with her husband) for enlarged lymph nodes in her neck. She was treated with antibiotics, twice, yet continued to have discomfort and swelling for many weeks. She and her husband came to see me for a second opinion. What was the patient needing? An opinion and pathway to figure out why her lymph nodes were swollen. What is good medicine? Not repeating the same care plan that hard already failed twice (prescribing antibiotics again). I ordered an ultrasound of her neck regarding the swollen lymph node, which was abnormal. I arranged for a biopsy that day, and ultimately she was diagnosed with cancer. My office arranged for ENT and oncology consultations, and I'm happy to report that she did great and is now cancer free for 3 years.
So what makes for a good patient? In my opinion, it is somebody who takes an interest in his or her health. Primary care doctors often manage patients with multiple chronic medical issues. If capable, patients should know the names, strengths, and directions of their medications, as well as the purpose of each pill. A good patient is compliant with taking medications, with eating right, and with exercise. A good patient communicates questions and concerns to his doctor. A good patient makes the doctor aware of any barriers to care. If a patient is on a very fixed income, I will try to find the least expensive medications necessary, and minimize referrals to consultants unless absolutely necessary. If a patient is unable to prepare meals and lives alone, then we need to discuss with family or arrange community resources like Meals on Wheels to assist the patient.
A good patient will bring the most important item to discuss to my attention at the beginning of the visit. I can't count the number of times that after discussing trivial medical issues and performing an examination, a patient will say on the way out the door something such as "Oh, and by the way, I passed out yesterday" or "I forgot to mention that I am having chest pain and shortness of breath every time I go up a flight of stairs." These are the things that drive doctors crazy.
If a doctor has no bedside manner, does that make him a bad doctor? Depends on your needs. If a patient misses an appointment, does that make him a bad patient? Depends on the reason.
Medicine is complex. Personal interactions are complex. Individual needs are complex. Couple these things with laws, regulations, insurance companies, business pressures, competition, staffing, technology, medical research, innovation, and information technology, and you're looking at just some of the challenges of modern American healthcare. So do your best to be a good patient, and I'll do my best to stay on time.
What is quality medicine? Like everything in medicine, the answer is both simple and complex. There are quality studies and professional society guidelines that essentially form a standard of care. Yet I would argue those standards do not apply in every situation. For example, if I have a new patient with no history of heart disease that comes to see me at 95 years old, and she recently had her cholesterol checked at a health fair, and it was found to be mildly elevated, am I going to start her on a cholesterol-lowering medication? Most likely not. I'd recommend a low fat diet. Whatever she has done to get her to age 95 likely has been working pretty well, and I would be afraid that the risks of starting a new preventative medication outweigh the benefits. The same scenario in a 50 year old likely would lead to a different recommendation from me.
If a patient has dysuria (discomfort with urination), then gets treated with an antibiotic at an Urgent Care, yet continues to have pain, I would suggest the solution isn't just prescribing more antibiotics. The patient should be evaluated in person. The urine should be tested. The pain could be from a bacterial infection, a vaginal infection (in women), prostate inflammation (in men), a kidney or bladder stone, or from scores of other causes. Throwing additional antibiotics at symptoms without a reevaluation likely isn't doing the patient any favors, even though it may seem to meet his or her needs.
I once saw a patient who lived two hours away from my office. She was seen by her local doctor "at the lake" (where she lived with her husband) for enlarged lymph nodes in her neck. She was treated with antibiotics, twice, yet continued to have discomfort and swelling for many weeks. She and her husband came to see me for a second opinion. What was the patient needing? An opinion and pathway to figure out why her lymph nodes were swollen. What is good medicine? Not repeating the same care plan that hard already failed twice (prescribing antibiotics again). I ordered an ultrasound of her neck regarding the swollen lymph node, which was abnormal. I arranged for a biopsy that day, and ultimately she was diagnosed with cancer. My office arranged for ENT and oncology consultations, and I'm happy to report that she did great and is now cancer free for 3 years.
So what makes for a good patient? In my opinion, it is somebody who takes an interest in his or her health. Primary care doctors often manage patients with multiple chronic medical issues. If capable, patients should know the names, strengths, and directions of their medications, as well as the purpose of each pill. A good patient is compliant with taking medications, with eating right, and with exercise. A good patient communicates questions and concerns to his doctor. A good patient makes the doctor aware of any barriers to care. If a patient is on a very fixed income, I will try to find the least expensive medications necessary, and minimize referrals to consultants unless absolutely necessary. If a patient is unable to prepare meals and lives alone, then we need to discuss with family or arrange community resources like Meals on Wheels to assist the patient.
A good patient will bring the most important item to discuss to my attention at the beginning of the visit. I can't count the number of times that after discussing trivial medical issues and performing an examination, a patient will say on the way out the door something such as "Oh, and by the way, I passed out yesterday" or "I forgot to mention that I am having chest pain and shortness of breath every time I go up a flight of stairs." These are the things that drive doctors crazy.
If a doctor has no bedside manner, does that make him a bad doctor? Depends on your needs. If a patient misses an appointment, does that make him a bad patient? Depends on the reason.
Medicine is complex. Personal interactions are complex. Individual needs are complex. Couple these things with laws, regulations, insurance companies, business pressures, competition, staffing, technology, medical research, innovation, and information technology, and you're looking at just some of the challenges of modern American healthcare. So do your best to be a good patient, and I'll do my best to stay on time.
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