What Your Doctor Really Thinks: Diagnosing the Doctor-Patient Relationship by Ian Blumer
by Ian Blumer, M.D.
Copyright © 1999 by Dundurn.
Excerpted with permission of the publisher, Dundurn.
Chapter One: Fatigue, Neutrality, and Greed
Doctors read about you. We read about you when you are changing into your examining gown. We read about you when you are changing back into your clothes. We read about you when we go into the next room to get a prescription pad. And we read about you when we’re in the bathroom. It’s true. Some doctors keep a veritable library scattered in the different rooms of their office so that they can readily access some information in a discreet way. Way back when, having recently graduated from medical school and having completed my residency (specialty training), I believed that patients in this age of well-informed public realized that doctors had need to frequently refer to reference materials. And I was right. People do realize this. Patient X knows that I have to go back to the books to figure out what is wrong with Patient Y. And Patient Y knows that I have to go back to the books to figure out what is wrong with Patient X. What Patient X does not generally want to accept is that I have to go to the books to figure out what is wrong with Patient X.
One day I was feeling unwell and went to see my own doctor. “Don, I’ve noticed my eyes are looking a bit yellow at times. Do you think it could be related to my hemoglobinopathy (a disorder of hemoglobin – the molecule that carries oxygen in the blood)?” I asked him. “Gee Ian,” Don said, “I don’t know. I’ll have to go look it up.” And he did. Right in front of me! I couldn’t believe it. Didn’t he know the answer? Could I trust him with my health if he had to go running to the books? Hey, what kind of doctor was this? Now, intellectually I recognized that I was actually best off with a doctor who realized his limitations; knew what he knew and equally (or even more) importantly, knew what he did not know. Only a fool of a doctor would pretend to “know it all.” Oh, I recognized that well enough. But I was still left with a most uncomfortable feeling. I knew that it was irrational, but it was the way I felt. And recognizing that feeling in myself, I could certainly imagine that my patients might have similar sentiments. Hence, doctors end up trying their best to maintain an air of wisdom that at time outstrips their true knowledge.
Chapter Fourteen: High Blood Pressure, High Overhead, and Highly Important Assorted Miscellanea
Not infrequently, people will complain about having had to wait several weeks to get an appointment to see a specialist. To hear such a complaint is quite frustrating. Do people think that doctors derive pleasure from making people defer getting seen? I did, however find a great way to deflect such criticism. In the truest sense of, ahem, spin doctoring, when patients disparagingly comment that “you sure are busy doctor, it took three weeks to get in to see you,” I simply reply “yes, you’re right. But would you want to see a doctor that wasn’t busy?” Works like a charm.
Speaking about waiting, have you wondered why it is that you wait (and wait and wait and…) in a doctor’s office? Although there can be a multitude of reasons some factors are much more common than others:
Tales of the Unexpected: Before most patients walk into the office the doctor rarely knows if the person is there for a minor complaint or for something which initially seems to be minor but in fact turns out to be much more serious (and time consuming) than expected. As such, patients are typically booked at fixed intervals and when the unexpected happens, that delays everything. “Why,” you might ask, “would the doctor not just book more time with each patient so that if the unexpected happens, there will be time to deal with it?” Good question. Glad you asked. The answer is twofold: Firstly, to book extra time between each patient would cause the physician to spend a lot of time twiddling his or her thumbs (and boredom doesn’t pay well under the fee schedule). Secondly, it would increase the length of time to get an appointment to see the doctor in the first place. I should also add that obstetricians always have the perfect alibi; I mean who could possibly deny their right to be late to the office because they were in the process of catching a baby? The fact that perhaps what they were actually catching was some gossip in the doctors’ lounge; well, who going to know, eh?
Disorganized? Who, Me?: Some doctors have all the smarts in the world, but are terribly disorganized. They lose track of the time when they are seeing patients or when they get called to the phone. Some such individuals cope only because they have that most important of assets, an organized secretary. Often however, organized secretaries quit these offices out of sheer frustration.
Looking Out for Number One: My father-in-law, a very meticulous individual, has never been late for an appointment in his life. And he expects to be treated likewise. So it drove him around the bend when he was referred to a specialist, got there at eight in the morning (he was scheduled for the first slot in the day) and walked into a waiting room full of people booked for the same time. It wasn’t a scheduling error. No, the doctor was of the mind that in case someone didn’t show up (and no patient, no money) best to have ample back-up. More than ample in fact. It didn’t even occur to him that other people considered their time as valuable as his was.
My Mother Taught Me to be Polite: My wife is a physician. Although she works the same number of hours per day as most doctors, she sees about half the number of patients. That way she can spend twice as much time with each one. She listens to their complaints patiently. She listens. And listens. And listens. She knows that they have a story to tell and she lets them tell it. She does not believe in rushing her patients. So despite booking longer appointments with patients than most any other doctor would dream of doing, she still end up running late (often, very late). Her patients love her for her patience and rarely complain about waiting to see her because they know that once they are in her office they too will be able to say their piece, have all their questions answered and will come away feeling satisfied with the attention and care they have received. Having three kids, a mortgage, and a car loan, it is a very good thing that my wife is married to a doctor.
The Combo Platter: Most patients wait. Most doctors keep them waiting. And assuredly most doctors do not pigeon-hole neatly into one of the categories above. Rather, it is often one reason one moment and another some other time. Some days we are disorganized. Some days were stuck at the hospital with a sick patient. Some days the computer crashed and we know that, gee well, if we try this or maybe that, you know, it’s going to be running in a second and I’ll get right to that next patient. And some days, like today, you’ve just got to finish one more paragraph of that book you’ve been working on.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...