Give advice to future pre-meds

[creekland]

To anyone who has had significant (or reasonable) experience visiting doctor offices from the PATIENT'S point of view:

 

Middle son and I were chatting this evening and the topic moved around to thoughts I had regarding doctors and visits.  He mentioned to me that he and his fellow pre-meds do occasionally also talk about such things - but without the POV from the patient.  I asked him if he wanted me to start a thread like this - where people can share their thoughts of things they would like to see in/from their doctors.

 

So here's your chance.  If you have experience (not theoretical please, but actual) and would like to offer thoughts (in a nice way, please) to my guy and his cohorts, here's your chance.  (One of them could end up being your doctor someday!)

[Ottakee]

What types of things is he looking for?  Is he going peds?  General practice?  Specialty?

 

I have way too much experience with doctors.  A few excellent, most pretty good, a few that we said we would never go back to.

 

Are they looking for the basic doctor/patient relationship, the overall office practices that are good/bad?

 

Let me know and I can write him a book :-)

 

[creekland]

Are they looking for the basic doctor/patient relationship, the overall office practices that are good/bad?

 

Let me know and I can write him a book :-)

 

Uh, yes?  They're interested in any tidbit of advice that patients would want them to know.  Between the group, I expect there will be the gamut from family practice to specialists.

 

Definitely the relationship aspects (he tells me).   Those should be transferable to all.  Otherwise he says he doesn't know what to ask for because he doesn't know what he doesn't know.  They can only guess.

[Jen in NY]

Two local-to-UR doctors addressing patient relations issues in interesting and very different ways:

 

http://wxxinews.org/post/connections-why-rochester-doctor-moving-canada

http://good.md/

 

Personally, we just had a great experience at the local orthopaedic practice. We felt attended to, valued, and like all of our concerns were addressed patiently and completely. They didn't rush us into doing the procedure at all and endured an extra appointment with us just to answer our many questions. A++ for patient care. A polar opposite from my Primary.

 

[JenneinCA]

I really like that my son's doctor has email and answers it usually in about 24 hours. My youngest has an ongoing problem that we sometimes need to adjust his meds for and email has been wonderful for that.

[Katy]

The #1 piece of advice I have is that he should not pretend he knows more about a disease than he does.  Especially if it's a rare condition and the patient has had it for multiple years.  My FAVORITE doctors were a nurse practitioner and a general person with a Caribbean degree who recognized that I knew more about the condition than they did, even if they understood pharmacology a bit better.  Both spent time reading up on my condition and came up with the treatment protocols recommended by the best in the field, and when all treatment failed they recommended creative things to make my quality of life better than it had been previously.  Both talked to me about various options and what the tradeoffs were and ultimately made them my decision.

 

Recommending an occupational therapist to increase life quality in the chronically ill is a really good idea, especially with intractable conditions.

 

Absolutely do not be a condescending jerk.  "The best" doctors frequently are, and forget that everyone has human dignity, and many people are intelligent enough that they are capable of becoming doctors, some of us just decided against taking on that much debt because of chronic health issues.

 

Also, if a patient who normally does not present with anxiety issues tells you that they know something is wrong and they are scared, take them seriously.  I once told a doctor that, and even though she could find nothing wrong with me except some vague fatigue and a low grade fever, she admitted me for observation.  That night I spiked a very high fever and it turned out I had double pneumonia and my right lung was 2/3 filled with fluid.  If she hadn't admitted me, I might have been one of those rare cases like Brittney Murphy, who died in the shower of pneumonia thinking she just had a cold.

[JumpyTheFrog]

Even if the doctor is typing notes, she should mostly be looking at the patient. Also, the doctor should restate the problem. "So your symptoms are x, y, and z." My doctor is pretty good at listening, but somehow in the spring she wasn't paying enough attention and thought I had seasonal allergies, rather than year-round on and off sinus congestion.

 

Also, doctors need to make it a point to know the costs of various treatments and tests and help patients prioritize things.

[MotherGoose]

Don't use "doctor language." It's a hard habit to break, I know. My sister is a doctor, and I have a Master's degree: I don't have any insecurities about my education. However, sometimes, when I ask her a simple question she goes into doctor terms that I don't know. Just medical terms. And I consider myself to be a pretty educated person. I say, "whoa you need to speak English please!" So I can only imagine the confusion that goes on for regular people who won't speak up. I used to be a social worker and would have to translate the psychiatrist visits to the parents. People don't understand what they are saying, and are too shy to do anything but smile and nod.

[hellen]

A doctor should give the impression of caring about you. I've had a doctor tell tell me that he doesn't know what's wrong and doesn't care. The next doctor was personable but didn't listen to me. He kept telling me about preventing heartburn which I didn't have. He was apologetic after finally figuring out what was wrong but it took months longer than it should have and an extra surgery.

 

My favorite doctor was one who actually listened to me and wanted to help. He was the only one who made me feel safe. By that I guess I mean I felt like he was competent and caring and would help me through my problem with kindness and thoughtfulness. I don't know why but most doctors I come across tell me that whatever is wrong with me is a mystery or come up with a horrible guess. These are a variety of different conditions and most doctors have no interest in figuring things out.

 

For pediatricians I prefer somebody knowledgeable that won't treat me like an idiot.

[Dory]

I refuse to go back and see a doctor if the doctor treats me like I'm an idiot that is imagining things with myself or my kids.

 

I might not know what is wrong, but I know my body, and I know my kids, a lot better then the doctor does. If I know something is off, I would like to be taken seriously. I have permanent joint damage because of a strep that went into my joints quickly and would flare up in the evenings. By the time we could get in to see the doctor the flare up would have gone down some. He kept insisting that I was just allergic to something. Meanwhile I spent my nights crying, itching like crazy, and curled up in a ball from the pain. Once my mom found a doctor that would listen and actually check things thoroughly, it was so amazingly relieving. My brother had scarlet fever and the doctor wouldn't believe mom (same doctor). When I took my newborn dd in to the hospital because she was horribly yellow, I had to fight to have them check her bilirubin. I was right, it was through the roof and she was put in the hospital for an extra week.

 

I don't care if they are easy going or a little rough around the edges. I want to know that they care, are interested, and that they take me seriously.

[Kiara.I]

Learn about breastfeeding.
Please.  PLEASE.  More than the 1 hour lecture he gets in med. school.  Learn where to go to look up breastfeeding information he wasn't taught in med. school.   Learn that the first resource for breastfeeding problems is not formula.  Learn that breastfeeding and infant feeding issues deserve specialist referrals too, and that specialist is an IBCLC.

 

Don't dish out parenting advice that isn't medical.  ("Your baby should be able to go 10 hours at night by now.  You should cut out those night feeds!"  :headdesk)  If he really wants to give advice that's "everybody knows" advice, please at least say that's what it is.

 

Assume that your patient has a functioning brain unless proven otherwise.  Assume that yes, your patient CAN find information on the internet and yes, it might even be accurate.  It's worth at least hearing them out, without condescension.

[kiana]

Your patients have bad habits. They know they are bad habits and they should do better. Berating them is unlikely to be useful. It is just going to make them not see the doctor for routine preventative care.

[Jean in Newcastle]

Listen to the patient.

 

Listen to the parents of a child patient

 

If the patient brings up a possible diagnosis from Dr. Google and they are wrong, still listen and then tell them in a nutshell why it can't be that.  (Just dismissing them out of hand makes the patient wonder if they were actually heard and if it could still be X diagnosis.)

 

Be willing to work with alternative practitioners.  That doesn't mean you have to become one yourself, or be for all treatments (because frankly some are snake oil) but be willing to acknowledge other forms of treatment.  If you don't, the patient may just go "underground", still following those treatments without telling you and that can be dangerous.  

 

If a patient or the patient's parent uses medical terminology don't suspect them of Munchausen!  But also realize that while they may have picked up a few key words in their search for answers, they still don't know the entire medical perspective so still explain things.  

 

Don't speak down to the patient even if the patient is only a child - esp. if the patient is a tween or teen.  

 

Don't suspect the parent is a helicopter parent if they homeschool.  And don't suspect them of keeping the child from all socialization opportunities! 

 

If there is a valid choice between treatments, by all means explain the choices and help the patient decide.  Don't just say "should we do A or B" without any further explanation.  On the flip side, if there is a valid choice between treatments, don't just choose the choice you're more comfortable with without at least presenting the other choice.  It's ok to say that you are more comfortable with one choice - that is part of the information we need - but be willing to learn to do the other choice if that is what the patient wants.

 

If the patient has a not easily diagnosed condition, be a bulldog, don't just shrug your shoulders.  But don't feel like you have to address everything at once either.  Outline a program where you first check for the most common causes, while promising follow up if that doesn't come up with anything.  

[itsheresomewhere]

Learn to not act offended if the patient questions you.

 

LISTEN to the patients- we know our bodies well and know when something is not right especially when it is not obvious.

 

 

My favorite doctors are the ones who admits that they does not know everything. 

[Hannahs4]

Please never forget that medicine is a service industry. As in, I pay you for advice and services, I need to be a part of the decision making process, and I have the right to decline or disagree.

[ocelotmom]

Respect personal and parental autonomy. Don't lie. Don't overstate statistics. Don't try to scare me with bad information or highly unlikely outcomes. I more often than not end up going along with doctors who explain their reasoning but leave the ultimate choice to me, whereas railroad tactics or deliberately inaccurate information is just going to make me distrustful.

[creekland]

Thanks all (and Merry Christmas!)!

 

To anyone still reading, you have until sometime in early Jan to respond when he can read directly (before he heads back to school).  Last night he was reading responses during commercials while we watched Elf.  He got a chuckle out of the homeschooling/sheltered comment, and said, "But wait, isn't that one true?" :lol:   Right now, he's still asleep.  ;)  I didn't pass on my early rising genes to any of my offspring.

 

In general, many of you are supporting what I've been mentioning to him with respect to my visits, but when he asked me last night to write an article about it for them to go over, I told him I could do even better by putting a thread on here and accessing the minds and experiences of many rather than just my thoughts.

 

I like that they are young idealists to be honest.  Real life might corrupt them.  The system might dictate the time they can spend, etc, but I'm still glad to see they are getting started wanting to join that ideal medical world I recently talked about.  But I'm glad to see them wanting to try.  (And this idea - overall - was truly his/theirs - not my suggestion to them.  It was only my suggestion to glean thoughts from many - not just myself, as my experiences are limited.)

 

In case you were curious, the latest thing I had mentioned was to remember that they can't truly understand what a patient is going through.  They can be taught what to look for and what key words to listen for, then try their matching test, but they don't really KNOW what a patient is feeling (with the exceptions of when they have BTDT maybe).  Therefore they need to listen to everything and not assume once they hear a key word or two they have it all.  They need to actually believe what they are hearing (at least in most cases).  They need to ask if there are gaps - ask specific questions - as we don't necessarily know to give them what seems to be non-important info.  And they need to understand that language is an awfully difficult way to convey what is being felt at times.  How does one put those things into words that can convey correct meanings?  And do this while under stress on the spot?  Great writers put tons of thought into their writings.  Rarely is their rough draft exactly what they want to say.  But it's still not the same when the reader assumes what they feel should be there.

 

Keep adding more as you have them - or seconding/thirding, etc, others if you'd like to stress importance.  He'll be compiling in early Jan and returning with the data for their discussions.  (He also has books like Letters to a Young Doctor, etc.)

 

Perhaps we can fine tune some idealists who can remain that way in spite of the system.  Who knows?  As long as they are asking, it's worth a try IMO!.

 

 

[Pawz4me]

First of all, I'd like to say that I have great respect for doctors and for the most part we've had very good luck with the doctors we've had.

 

I can only echo what others have already said -- Listen to and respect the patient.  Yes, we know you're smart.  Or at least we hope you are. ;)  We know you've put all those years and dollars into your education.  But we know our own bodies better than you do.  Only we know what we're experiencing.  And if we're bringing in our babies or young kids -- we know them better than you do.  In all likelihood they're telling us MUCH more about how/what they feel than they'll tell you.  So . . . listen.

 

I'd also like to say that yes, we get it.  We know some people really aren't very bright.  We know some people come to doctors and don't tell them everything, 'cause they think that if the doctor can't "see" it or find it, then it's really not a problem (my dad was one of those people).  We know some people have quack ideas they take as gospel.  But please don't get to the point that you assume ALL people are like that before you get to know them.

 

Respect senior citizens.  Don't patronize them or condescend to them.  Remember that they were once active, vibrant, productive people.  Hard as it is to comprehend, some day you too will be old.  And you'll want to be treated with dignity and respect.  Even if the older person doesn't really notice your attitude (whether it's great or awful), the younger person who may be accompanying them certainly will.

 

Good luck!

[Tap]

I am a verbal processor, so I totally understand this about like minded doctors......but

 

It drives me nuts when doctors don't wait to hear the entire issue before making comments on potential treatments.  It usually leads to them contradicting themselves and that makes me have less faith in their treatment plan.

 

Convo goes something like this:

 

Pt goes to doctor coughing

Dr says" wow that is a bad cough, sounds like it may be bronchitis."

Then the dr, listens to the  pts chest/back

Dr says: I think we need an xray, Based on chest sounds, I'm worried about pneumonia

Xray comes back fine.

Dr says, "well must just be a virus. It can take 2-3 weeks for the cough to go away. Take some  over the counter cough meds and if your not better next week, come back."

 

Which always leaves me wondering if the cough will last for 2-3 weeks, then why do we need to come back next week if it hasn't gone away yet?  And how did we go from bronchitis to pneumonia to virus? I wish they would just listen to the patient, and get the tests results, before throwing out diagnosis.

 

 

[OnTheBrink]

I think most of my negative experiences with doctors all had a common theme: They thought they knew it all. 

 

Don't blow off a patient's concerns. If your answer doesn't satisfy a patient, be willing to refer for a second opinion or to see a specialist. You don't want to be THAT doctor whose patient died from malignant melanoma because you didn't think the weird mole was anything to worry about. (I actually had to DEMAND a referral to a dermatologist--this doctor was that convinced the weird mole that was bleeding and tender was "nothing to be concerned about.")

 

Don't belittle your patient's efforts and for the love of all that's holy do not ever tell your patient that a high-risk, invasive, life changing surgery would make your life easier when they came to you for something small and easily fixed. My hernia issue was way too complicated for this surgeon who wanted me to have bariatric surgery first, to "make it easier" on him. And, if an overweight patient tells you she's doing WW, do not snort because your bread and butter (ha!) is in bariatric surgery. 

 

Do have empathy and put your patient's emotional well-being as a priority.  One of the best doctors I ever saw was the ob/gyn who saw me through my miscarriage. He listened to me, he kept me calm, he acted swiftly. I didn't know until it was all over how close to death I was during that m/c. He never flipped out, he never lost his gentle tone, but he got me from his office and into an OR within 30 minutes. I was very sorry when he retired. 

 

And, you didn't ask, but I'll give you a POV from a hospital HIM staff person. Do not hack off your medical records people. We aren't stupid. We can make your life a living hell if you get high and mighty with us (not that we WOULD, but we certainly COULD). Do not yell at us. Do not deny someone is your patient when your name is all over their chart. Do your H&P's and DC summaries within the allotted time frame. SIGN YOUR ORDERS. SIGN YOUR ORDERS. Did I mention, SIGN YOUR ORDERS. When you dictate, do not make every note you dictate a critical priority unless it actually is. If the HIM team calls you and says your documents are incomplete, COMPLETE THEM. Don't argue. Don't say you "thought" you did a 12 point ROS. Just complete it. You do your paperwork, we'll do our paperwork so coding can do theirs, and then the hospital (and YOU) gets paid. See how easy that is? ;)

[Halftime Hope]

For the love of Mike, in conversation with patients, don't minimize the recovery and pain expected after a procedure and/or surgeries.  It can seriously impact a patient's well-being, and that of their family, and their ability to plan their recovery well.  If it recovery time/difficulty truly is variable, say so, and give ranges.  As the new docs learn, grow, and develop relationships with patients, they should ask their (former) patients if they would be willing to be volunteers to talk to new patients about their experience with that same procedure or surgery.

 

In our family, we pointedly tell doctors that we want to know--HONESTLY--what to expect, and give them a very serious "please tell me the truth" look.  We've learned to do that the hard way.

[Lizzie in Ma]

Here's a good one.  Just because your patients symptoms are subjective and can't be tested, quantified or seen, doesn't mean they are not real.  Many Lyme patients get labeled crazy and fobbed off with psych meds when they have a REAL disease that is in their brains causing chaos.

 

The medical field is not infallable and neither are you.

 

The medical field is often political, don't fall for the party line, do your research.

[elegantlion]

Breath mints.  :D 

 

 

If you're dealing with one chronic issue with a patient, don't discount symptoms that might point toward another issue. My dad's primary care doctor pushed to get my dad on insulin (type 2 diabetes) and blew off the fact he had blood in his stools and swelling in his legs. This was done over several visits. My dad had polyps on his colon and ended up having most of his colon removed this fall, an issue his PCP NEVER addressed, never suggesting a colonoscopy. Thankfully his care his fall was through another doctor. The swelling and pain in his legs the PCP said was from the diabetes medication went away after surgery. 

 

 

[lllll]

..

[KungFuPanda]

My big one is "Not all kidney infections present with back pain." I ended up in the hospital over that last year.

 

If a mother drags herself into your office, something is WRONG with her. The last think she makes time for is her own health. She's likely already tried letting her illness run its course.

 

Spend MORE time looking at the patient than you do your computer screen. Our best doctor actually has someone doing his notes for him, but I'm guessing not everyone can be staffed as well as pediatric neurology at Johns Hopkins :-/

[Jean in Newcastle]

Thought of a new one:  If you patient gives you a vague symptom like "fatigue", ask for concrete examples.  I've gotten a lot better care once I realized that the doctor's idea of what I meant by fatigue changed a lot when I explained that I had to sit down to rest every ten minutes.  

[elegantlion]

Another which is probably more applicable to an office setting. Sit down to talk to a patient. I feel like I matter to a doctor when they actually sit and look me in the eye during a conversation, especially if I'm sitting there in a gown. 

 

For a hospital setting, introduce yourself to the patient and remind them what you're there for. My dad saw several doctors and at some points he couldn't remember which doctor did what. He would also forget names as the initial introduction was done when he was barely coherent and we were in various stage of distress. 

[hornblower]

I saw a doctor recently who was so nice and when I thought about it, what made him nice was that he was calm and accepting. He really created a space that was free from judgement. It was a walk in clinic in a bit of a rough neighbourhood and I suspect that had something to do with it. But it was so refreshing to be in a room with someone who you got the sense you really could say anything to.

 

So my tip is this: practice acceptance and non-judgmental tolerance. Practice a calm, open demeanour. Your patients are probably not telling you everything. they might not be telling you really important things about substance abuse or habits or mental state or poverty or s$&ual practices that might be impacting this person's health but that they're too ashamed or embarrassed to tell you.

 

Create the safe space for people to tell you things so you can treat the whole person with all important data taken into account.

[G5052]

For chronic issues where you're seeing a particular doctor on an ongoing basis, the doctor is not the be-all and end-all.  If the office staff, medical support folks, and hospital is nice to deal with too, it makes a big difference.  And the doctor does indeed have an influence over these factors.

 

One of our specialists is very picky about that part, and we appreciate that.  He has a national reputation, and basically approached a particular hospital with his priorities and requirements and set up his own clinic. It is a major hassle getting there and dealing with the large hospital complex, but when we're in the clinic it is all familiar and orderly. When we see him, he is all "there."

[applethyme]

Be very careful about labeling a patient non compliant.  Often times there is other reasons.  Such as an inabliltiy to afford the med, meds ordered at times that just do not work for that patient, misunderstanding of the instructions.  LIfe is not simple especially with a child with chronic illnesses.  It impacts the whole family.  The reason my son was not getting better was not because of "poor parenting" he was intolerant of the tube feeding formula that was ordered for him.  A year later, two new doctors and a different tube feeding formula and he became a whole different child.  He became happy, healthy and was able to grow.  Had his original doctor listened to what I was saying we could have save him a lot of misery.

[JumpyTheFrog]

Have a rating chart patients can use to rate symptoms. I have fatigue issues and my doctor has used a chart with a scale from 0-10. Zero meant totally bed-ridden all the time, ten meant completely healthy, and I think a seven meant able to work full time with difficulty. Having a chart where I had to rate my fatigue each time made it much easier to see which treatments weren't working and which were.

 

She also uses a "sense of wellbeing" score. That is much more subjective, but also helpful. It helped me realize that often my motivation would return shortly before some improvement in other symptoms. Likewise, a loss of motivation would preceed a relapse.

 

Doctors and nurses need to learn about how habits are formed. Telling a patient to do X may be easy, but often patients have no idea how to stick with dietary or other changes because their environment works against them. I think an effective doctor would have some sort of support system and coaching available to help patients learn to change their unhealthy habits.

[JumpyTheFrog]

For family doctors, always have a copy of lab tests to give to the patient and a pad of paper to take notes. Encourage them to keep a binder with dated labs and notes and treatment recommendations from each appointment. Also offer a summary of this info as a handout, especially for elderly patients. My dad goes crazy because his dad will say "the doctor said x was fine," but he never has a specific number to give. Well guess what, not all doctors are current on what the proper lab ranges are.

 

Good doctors need to make time to read, read, read the medical journals. So many are decades out date with their knowledge of most effective treatments and lab ranges, even for basic conditions like diabetes and hypothyroidism.

 

Don't throw antidepressants or sleep drugs at people without checking for other conditions. So many people feel down and unmotivated because they are tired because of some other problem.

[creekland]

This is Creekland's son here: Thank you all so much for your responses!  In light of the advice given, I may choose to avoid most of these potential problems by changing my life goals from doctor to living in my parent's basement watching MASH videos.  

 

Or, if (since?) my parents are serious about living in my basement one day, I'll commit to taking all of your advice to heart.  This way I'll make sure to end up being one of those wonderful doctors I keep hearing people feel comfortable visiting.  

 

Please keep the advice coming in and I'll keep reading it and then share it with my pre-med group!

[Barbara H]

Lots of good suggestions. I'll add my two cents... When an office is really well run (short wait times, prescription refills called in quickly, easily accessible electronic records, phone calls returned) it makes a big difference to the patient experience. So my advice is take time to learn a bit about business management and invest in a really good staff that makes it so you can do your job well.

[saw]

Here's a nitpicky one -- I never understand why doctors think they should be addressed as "Dr. So and so" while addressing their patients by their first names, regardless of age difference. I know not all doctors do this, but I have seen it happen and find it disrespectful.

[Ottakee]

We have had a lot of different medical experiences here.

 

The whole family sees a family practice office.  Almost all of the time we see the nurse practitioner (NP) or physicians assistant (PA) as we honestly like them better than the doctor and they often have more time to spend with us at each visit.

 

There is a huge difference between a 15 minute appointment and a 20 minute one.  I love that our office has almost all 20 minute ones (and 40 for physicals).

 

For my one special needs daughter in particular, I want the doctor to do the exam and then we send her out to the waiting room while we discuss any findings/changes, etc. for most things.  She can get extremely anxious about something being "wrong" with her and it is just so much easier for the doctor and I to discuss med changes, her special needs, etc. after she leaves the room.  Our neurologist will follow my lead on this.  he certainly talks to her and answers her questions but saves the nitty gritty and any bad news until after she leaves the room.

 

One of the neatest things I saw a doctor do was a few weeks ago when my special needs daughter went in to have a few moles removed from her stomach.  Unsedated on a high anxiety teen with cognitive impairment this could have gone wrong, very very wrong.  First thing the PA did when she came in the room was haul out her ipod/iphone and ask my daughter what kind of music she liked .........and promptly found Queen of all things on Pandora.....turned that up, and THEN started the procedure while they discussed various songs by Queen and which one was best and not so good, etc.............she established a good report with my daughter and got her mind off the procedure.  My daughter then laid there perfectly still for the 3 numbing shots, removals and 3 sets of stitches.......all while discussing music.  This is a child with a history of kicking and hitting doctors, fleeing the room, throwing stuff, etc. if she feels trapped/high anxiety.  I honestly think now that she would let THIS PA do just about anything as she has her trust and has built that relationship.  The eye doctor on the other hand, is not so great with this and instead of trying to work with me and be understanding basically said he didnt' want her back.

 

 

As a male, I would be esp. sensitive to women, teen girls, etc. esp. those that might have a negative history with abuse, etc.  Having a nurse in the room, etc. can help a lot.  I have a child that has a terrible time with male doctors (although she now likes the neurologist after about 12 years of seeing him).  Many things they need to do--hand on chest and back at the same time, lay down and push on the abdomen, etc. all put her in a position where she feels very vulnerable.

 

If you see a patient with special needs, find out from the parents how best to handle certain things.  One doctor can't even listen to my daughter's heart while another one in the practice did unsedated mole removal on her without her even flinching........bedside manner and following my lead was the major difference as they are both very good.

 

Always consider side effects of a med instead of just adding more and more meds.  My dh had terrible back pain so they sent him to physical therapy and the doctor mentioned it was likely due to his weight but in reality it was a rare side effect of one of his meds and once he stopped it the back pain went away.

 

Don't be afraid to say you just don't know and refer on to a specialist or consult with another doctor.  We see our primary for physicals and very minor things.  Almost all of the care my girls and husband get are through their specialists.  It is nice to have a local point person but they will freely admit that multiple mitochondrial disorders along with seizure and pysch meds are way beyond their expertise.

 

Find out if med compliance will be an issue before you send them out the door.  It is very hard for a school age child to take a med 4 times a day so see if a 2-3 times a day one would work as well and be easier on the parents.  Prescribe a lower cost med if it is as effective as a higher cost one......but be willing to help a patient with samples or another pharmacy if the pricey med really is needed.  Our doctors office told my mom to try Costco for one of her meds and it was 75% cheaper there than her typical pharmacy. She would have never thought of that herself.

 

If the parents come in and say something is very wrong, believe them.  More than once i have been in ER with a child that "looked" fine on the outside only to be admitted for something not so fine.  I had one pediatrician send me on my way saying that 4 month old was fine (after our family practice sent her there right from their office) and he was shocked to see me the next morning in the HOSPITAL cafeteria...........well, mom was right and child was admitted for a week stay.

 

 

 

 

[AmyontheFarm]

I live in Ontario, Canada.  Below are the 5 major events I would comment on.

 

Number 1:

Don't be afraid to go to bat for your patients.  When my dr. started her practice she was so young and the older guard didn't like this young, female whipper snapper!  She is a fierce woman!  When other doctors told my friend that it was just a migraine headache, this young dr dug deeper and discovered it was a brain tumor the size of a golf ball!  She fought for my friend and they won!  Now this Mom of two is healthy, jogging around town instead of sitting in a wheelchair planning her funeral.

 

Fight for your patients like they were your Mom!

 

Number 2:

We've encountered a few health professionals that don't approve of me going with my dd21 to her medical appointments.  My dd21 is bipolar.  I attend to take notes so that when my dd is freaking out that the dr's are trying to kill her, I can rationalize (sort of) with her and convince her that taking her meds is in her best interest.  Telling my bipolar daughter that moving out on her own, away from her support system, away from her family is not helpful when you have only met me for 3 minutes and during that time I kept my freaking mouth shut!!! 

 

Please don't assume that all mental health patients should be separated from their families.  Some young adults actually like their parents and their parents actually like them and together the doctor, patient and parents can help the patient learn to manage their illness.

 

Number 3:

 

When a mother with two kids at home, tells you within 36 hours after giving birth to number 3 that something is wrong with her child because the child isn't nursing right.  Don't look at the chart determine the mother is 32 years old and that her milk is just not coming in yet, and then suggest formula.  Sit down ask her what she means.  Remember she just gave birth, her brain is foggy but for her to speak up it means something is really bothering her!  Ask questions, check back later that day and the next.  Don't roll your eyes and walk out of the room because when it comes back that the baby has a global muscle delay, ends up with leg splints, physio therapy for 10 years just to learn to walk and run, use a pencil and feed themselves, well man, you'll feel like an idiot that a Mom knew something that you wouldn't even look into.

 

Listen to the "Momma Bear" or "Mother gut" feelings.  If nothing else you will win the approval of every mother you work with because you heard her out.

 

Number 4:

Over a six month period, I entered the emergency room 8 times for pain that ended up being my gall bladder.  Each time they injected me with a pain killer to help with the pain.  I was never given a script for pain to take at home, just told to come back if the pain returned.

 

On the 9th time, I entered the emergency room, I told the triage nurse the pain wasn't the same.  I told her that I was swinging from violently shaking with extreme cold and then sweating profusely.  My gall bladder NEVER presented like this.  They took a blood draw and a urine sample, left me in a room for 6 hours and when the dr finally came back in he told me that he suspected I was addicted to the pain meds and that he couldn't give me any more.  By the way, I hadn't had any on this visit, they never offered me any until I was later admitted.  He then told me that my blood draw was clean and my gall bladder wasn't acting up.  I told him I agreed!  I knew it wasn't my gall bladder.  I asked about the urine sample and he said it was never tested.  He then got indignant with me asking me what I thought was wrong with me, if it wasn't my gall bladder!!! I told him, he was the dr, it was his job to figure it out.  As we are talking I went from sweat rolling down my face to so cold I couldn't talk.  They take another urine sample and then 2 more rounds of blood work.

Turns out I had a horrid bladder and kidney infection.  I ended up admitted and on antibiotics for 2 days. Praise God everything healed great.

 

Don't assume that a 40 year old woman in emerge for pain - needing pain killers is just addicted.

 

Number 5:

When presented with a 2 year old with a temp of 104.5.

An elderly dementia patient who left the house without a coat in 50 degree weather.

And a teenage girl with a hot dog shoved up her vagina, who is now contemplating suicide because of the embarrassment.

 

Damit!  Tend to the 2 year old first, medicine to bring the temp down would be nice!  Give the old lady a cup of tea until family arrives and lock the teen in a safe room until a woman can remove the damn thing.  Don't sit at the desk, hitting on the two young nurses, talking about what you did that weekend and then look shocked when the mother of the 2 year old throws a hissy fit because her kid's temp has now reached 104.8!

 

Prioritize to save life.

 

 

 

 

 

 

 

[happypamama]

Learn about breastfeeding.

Please. PLEASE. More than the 1 hour lecture he gets in med. school. Learn where to go to look up breastfeeding information he wasn't taught in med. school. Learn that the first resource for breastfeeding problems is not formula. Learn that breastfeeding and infant feeding issues deserve specialist referrals too, and that specialist is an IBCLC.

 

Don't dish out parenting advice that isn't medical. ("Your baby should be able to go 10 hours at night by now. You should cut out those night feeds!" :headdesk) If he really wants to give advice that's "everybody knows" advice, please at least say that's what it is.

 

Assume that your patient has a functioning brain unless proven otherwise. Assume that yes, your patient CAN find information on the internet and yes, it might even be accurate. It's worth at least hearing them out, without condescension.

Goodness, yes, especially to the breastfeeding part!

 

Along those lines, if you're seeing pediatric patients, and you're a brand new doctor in your early thirties, with no children of your own, and you see a mom bring in her fifth child for a routine well check with no major issues, treat Mom like she knows what she's doing. Because she probably does. She likely has her own protocol about starting solids and weaning from the breast or bottle and infant sleep, and if she has a question about something along those lines, she'll let you know. Don't ask, "Does the baby sleep through the night?" Ask, "How is the baby sleeping?" or "Do you have any sleep concerns?" Experienced mom likely knows that teething babies wake a lot, and/or she isn't bothered by nighttime nursing because she cosleeps and sleeps right through it. She'll let you know if something is bothering her about the baby sleeping and if she wants suggestions. (And if you have a general reminder sheet that mentions safe cosleeping or rear facing car seat usage, she's likely not to be offended because she knows that less experienced moms may need that info.)

 

In the same vein, if that same mom brings in her child and asks for a specialist referral, trust her judgment, and write the referral. Something seems amiss to her, even if may not to you.

 

My family doc is all that and a bag of chips. She writes referrals when I ask and doesn't give parenting advice unless I express a concern. She's lovely!

 

I also agree with the PP who says to have some idea of costs for meds and procedures. If you suspect someone may have trouble paying for an expensive item, see if there is a lower cost alternative that might work.

[creekland]

Bumping in case our after Christmas members have advice they'd like to add.

[DawnM]

Well, this is from a doctor's point of view, but I believe my father is a very good doctor.  His motto is, "If you listen to the patient long enough, he/she will tell you what is wrong with him/her!"

 

He saw far too many physicians diagnose before really listening or asking enough questions.  Often it lead to a mis-diagnosis or incomplete diagnosis.

 

 

[Catherine]

I have a few ideas.  I think it's hard to know what an experience is going to be like before you do it and for college students planning to pursue medicine, the unknown is huge.  It's good to plan ahead, before you have experienced "role induction" which tends to erase your earlier ideas.   

 

1. Learn good communication skills.  Many of the complaints I see upthread can be boiled down to poor communication skills.  Honestly, there is no higher share of jerks and idiots in the medical community than in any other part of the population, but poor communication can certainly make a person *seem* like a jerk or an idiot.  And IMO task #1 in good communication is learning how do listen actively.  It's a very specific skill and can be taught and learned.  Another important aspect of good communication is setting limits, enforcing boundaries, and setting up structures for continued communication. 

 

2. Hang on to your humility.  Or somehow get some if you never had it-not very likely LOL.   It can be very difficult the first time you say that you don't know something, but once done, it grows easier.  AND, remember that admitted you were wrong, or that you didn't know something, is only the beginning...once that is done, then you need to take the next step-find an answer, or find someone who knows the answer. 

 

3. Develop canned talks for things you will need to say very often.  "I'm sorry, we did everything we could..."  "So you are starting to have sex..."  "I wish I had better news for you..." "Yes hypertension is really the silent killer..."  etc.   You can play around with the words and the order, just make sure you cover it all. 

 

4. Develop a supportive network.  That means people in the medical and non-medical community who you may need to call on for expert advice, help for patients in unusual situations, or "stumpers". 

 

5. Don't ever say something is definite when it isn't, whether that be how much time something takes, what a given test result means, or the course a particular problem will take.  It seems obvious but when patients are surprised, that is almost never good. 

 

6. Don't badmouth other medical people, or anyone for that matter.  You don't know for sure the circumstances of the given situation.  It's unprofessional and at the end of the day it makes you look worse than your (possibly) incompetent colleagues.  Sorry to you nurses out there, but nurses are the biggest offenders in this category! 

[Ottakee]

Speaking of nurses,,,,,,,,,,,make sure you are nice and polite to them and treat them as a valued member of the team.  Esp. in a hospital setting they have way more contact time with the patient than you do and might have some great insight as to what is going on, etc.  When you first start out the nurses will likely have way more hands on experience than you will in dealing with certain things.

[Laura Corin]

If you are telling someone that they need to make a massive change in their lives, don't make a joke out of it: you may think that you are lightening the mood, but it can just come across as being unfeeling.  And rather than just telling them to make the change, talk through the options

 

When a doctor said that me that I had to give up gardening (which I had already explained was my major hobby and fairly unavoidable on our three acres), he said, 'Never mind - change is good!'  I was at a fragile point in my life (not long settled in Scotland after many years overseas; husband unemployed and heading for permanent unemployment due to his age; trying to build a career myself whilst children were getting ready to leave home) so the last thing I needed was more change.

 

As it was, I was able to work through the options with Husband and alter my gardening habits to take my medical condition into account.  But I was left very shaken by the doctor's attitude - I felt as if I wasn't a real person to him, but simply an ailment.  I wrote him an email a year later, explaining how he made me feel.  I never sent it, but writing it made me feel better.

 

L

[PinkTulip]

I would say to show some empathy when your patients get a hard diagnosis. My son had hip dysplasia and just underwent the second of two very painful and difficult surgeries to fix it. (Periacetabular osteotomy - look it up!) When I told my pediatrician about what my son would be going through, he took a deep breath, looked me right in the eye, and said, "I'm so sorry that you're going through this. If there is any way I can help, please don't hesitate." It was so sweet and so non-clinical. He was the first medical person to say that to us after the diagnosis and it really meant a lot.

[Jean in Newcastle]

My very best doctor invited me over to play Pickle ball!  But that might not be an option for you. :lol:

Wow!  How wonderful that he has the instinct to ask this question at this phase of his training.  He's gotten great advice, I'd just add that it would be good if he could keep asking this question every few years throughout his training and practice.

[kbutton]

Don't offer dumb explanations when you don't have a good explanation for something odd. Investigate and/or note the symptom without offering an explanation that just doesn't fit. (What not to say, "That newly swollen lymph node couldn't possibly be from the allergy shots you just started, that are injected into that arm, and that cause silver dollar sized welts on your arm--it must be from the breastfeeding you stopped a year and a half ago.")

 

Don't make patients feel bad for having odd symptoms or presentations--if they feel bad, investigate further, look for patterns, or listen to them when they tell you they are seeing a pattern themselves. I almost never have typical symptoms of whatever is actually happening in my body, even in life-threatening situations like postpartum hemorrhage or asthma flair-ups, and then I tend to decompensate very rapidly once more typical symptoms do show up (if they show up at all). 

 

[Truscifi]

Seconding, or thirding or fourthing or whatever, listen to your patients. Don't cut them off or tune them out because you think you know the answer already.

 

Also, if you are doing a physical exam, say what you are going to do before you do it. Some of us need a moment to prepare for someone we don't know well touching us. Just a small heads up makes a world of difference.

[Beaniemom]

Don't be afraid to tell the patient you need to do further reasearch...and DO the research. It could be as sime as what happened with us: my son has a cochlear implant. His implant center told us he should get the Prevnar 13 vaccine because he is now at greater risk for meningitis. Our family doc knew this was typically for older adults but he did not dismiss me just told me he'd go research it quickly. He did, acknowledge the need for the vaccine, and thanked me for my patience. This let me know he was actually listening and not assuming that his knowledge was always correct.

[Ottakee]

Such great advice here.

 

One of my girls has 3 different mitochondrial disorders and so far, is the only known case in the world to have all 3.  They are not really that rare in the mito world but rather the fact that she has 3 different ones is rare.  That basically means that we treat the symptoms as they arise and learn as we go.  I am SO thankful that our primary neurologist said that this was beyond him and sent her to a top mito specialist.  That doctor ended up agreeing that our reg. neurologist was on the right track but I am glad that he was willing to say it was beyond him and suggest a 2nd opinion himself.

 

Work with the patient to develop a realistic treatment plan that is likely to be followed.  With open communication it is easier to know if the patient just can't/wont be able to do x but find that y is very doable and much more likely to be followed.