Ten Things Medical Doctors Are Not Good At
by Gary Cordingley, MD, PhD
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Here is one doctor's take on what physicians need to do to improve
their services. Of course, I'm not referring to your doctor
who, like Mary Poppins, is practically perfect in every way. But let's
just say that the rest of us physicians have things we could do better...
1. Taking time to actually stop and get to know the patient.
I know one lady who says she has a better relationship with the
checkout clerk at the grocery store than with her physician. It's true
that doctors have a legitimate need to see a certain volume of patients in
order to cover practice-expenses and still have money to take home. This
translates into a limited amount of time per patient. However, some of the
time-pressure doctors feel they are under is of their own making, and even
the same amount of time might be better spent. How is this any different
from what a restaurant owner has to do? The restauranteur has to supervise
employees, handle deliveries, and oversee the preparation and serving of
food, yet still finds time somehow to chat with the customers.
2. Sticking to appointment schedules.
Yes, medicine is unpredictable and doctors must meet the medical
needs of the patients in front of them before moving on to others.
Patients understand this. But scheduling ten different patients for a 1:00
p.m. appointment is inexcusable.
3. Remembering what happened at the last visit, what test they asked
for and why they asked for it.
Need I say more
4. Dealing with more than one chief complaint
per visit
This is a variant of the time-pressure issue. With the allotted
time being only just adequate to cover one problem, woe to the patient who
has two or three. There is no easy solution apart from scheduling another
visit to handle an additional problem. But if you're the patient, it's in
your best interest to prioritize your problems and take control of the
agenda. Get the most important issue out on the table first thing and
before the doctor launches into an unrelated and time-consuming tangent.
5. Diagnosing conditions for which "objective" tests are not
available.
Even modern medicine doesn't have good tests that show every
condition as an abnormal blood-level or as a spot on a scan. But that
doesn't mean that the untestable conditions don't exist or are somehow
less credible. For example, there is no confirmatory medical test for
migraine, but unless the 12% of the population experiencing this problem
is lying, there are a lot of folks out there for whom the tests might be
normal, but they aren't.
6. Staying interested in you when there are no more tests to order
or procedures to do.
This is not a good time to drop the ball. Regardless of the outcome
of a test or procedure, there is still some unmet need to be addressed.
7. Delivering on promises.
This one seems so needless. For example, why would a doctor promise
that records and films will go to a specialist and then not follow
through? Better not to make such promises in the first place.
8. Picking up a telephone to call another doctor.
I don't understand why this occurs, but physicians often seem
incredibly reluctant to phone another doctor to sort out a question
concerning their shared patient. Sometimes they order a nurse or clerk to
do it instead, or leave the issue unresolved.
9. Respecting boundaries.
This bears explaining. Boundaries refer to the lines at which one
person's rights and responsibilities end and another person's rights and
responsibilities begin. Crossing a boundary without permission usually
leads to grief and resentment. An example of one doctor not respecting a
boundary with another doctor is when doctor #1 tells the patient to change
the dose of a medicine prescribed by doctor #2. This leaves the patient
caught in the middle.
10. Calling you back with results of procedures and tests.
Once patients have had, say, a scan, a colonoscopy or a blood-test,
they start worrying about all the most dangerous things that might turn
up. A simple phone call to the patient that nothing bad turned up on the
tests and that the details can be discussed at the next visit--even if it
comes from staff--prevents a lot of worry and sleeplessness.
There seems to be a recurring theme here. Perhaps I'm revealing my age
when I say I am reminded of the chain-gang boss in Paul Newman's "Cool
Hand Luke" movie who drawled, "What we have here is a failure to
communicate!"(C) 2005 by Gary Cordingley
ABOUT THE AUTHOR
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and
researcher who works in Athens, Ohio. For more health-related articles see
his website at: http://www.cordingleyneurology.com/
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