The Visit to the Doctor
The first issue on this blog I would like my visitors to think about and comment is one about the office visit with a doctor. How have you experienced the visit? If this was the first visit, was it as you expected? What was it about the visit that impressed you.. good or badly. How long did the doctor take to get your history? What was the physical exam like? After the exam, did the doctor discuss with you about the findings, conclusion and plan? Were you satisfied that you understood what your doctor was trying to tell you?
These questions deal with the process of the office visit. But how about the appearance and general behavior of your doctor.. were you made comfortable by how your doctor listened and how your doctor talked to you? If not, what would have made you more comfortable?
For privacy reasons, don't identify your doctor's name here but.. have you ever expressed your opinion about the visit with your doctor or staff?
I teach medical students how to take a history and perform a physical examination on patients and how to relate to the patient. I think I know the factors that make up an ideal physician and an ideal visit but I would most appreciate learning your own opinions. ..Maurice.
posted by Maurice Bernstein, M.D. @ 2:38:00 PM
3 comments
3 Comments:
Bobhall wondered how I would feel as a physician if family members or friends accompanied my patient for a visit. My response to Bob would be as follows.
First, I might learn much about the patient's condition by simply asking the visitors why they also came. I would try to obtain the patient's permission for them to remain during the visit. Valid reasons for their attendance would be that such visitors might be essential for history taking if the patient was incapable of providing a useful history or for patient reassurance if the patient was irritable or anxious. Sometimes these visitors have been used as translators if the physician doesn't speak the patient's language but there are some real concerns about such use. The physician must allow the visitors access to the interview and/or exam with caution since the patient may not fully give a history or desire to be examined in their presence because of matters of privacy. The physician should be wise with regard how to ask the visitors for such privacy for the patient's comfort without alienating them for further help. Cultural norms play an important role regarding family presence since in some cultures it is family members who expect to learn the diagnosis and to make the decisions for the patient, sparing the patient the emotional trauma.
With these isssues in mind, there should be no problems.
Dr. Bernstein, I'm hoping to read your archives a bit at a time. I hope it's OK to comment on those which strike me as I go along, although the posts themselves aren't current.
I can't really respond to what I personally would expect a "first visit" to any particular physician should be like, because those are always particularly trying for me, and I don't think that any amount of effort the poor physician could put into the visit would make it more bearable. However, I can comment on subsequent/ongoing visits.
There are 3 factors which I find are almost uniformly lacking in the physicians I've seen, and upon which I, as a patient with a chronic illness, place some importance:
1) Communication - don't notice or wonder about something and not mention it. Just because I haven't said anything, I can still see your expression, and I know when something has caught your attention, but you don't say anything. For whatever reason, I may not feel able to broach the subject myself - your honesty may make it easier.
2) Attentiveness - if you ask a question, listen to the answer. Please. Some of us find answering your questions quite difficult, because we have to share intimately personal facets of ourselves with people we've only seen a few times. Some people find it very difficult to do this with even the kindliest strangers.
3) Continuity - If you tell me I have certain medical issues you're concerned about, and order tests, I'm going to be concerned about it until I see you again. Possibly even very concerned. If you never mention the results or even bring up the issue at the next visit, that's going to shake my confidence a bit, and may even make me wonder how seriously I can take your care.
For that matter, if you are ordering regular testing, some of your patients would like to know the results ... would like to see "where they are" in relation to what your decisions are regarding them. A lack of continuity is especially unnerving for someone with a chronic illness who sees the same physicians over and over.
Finally - not along the same lines, but just as important in its own way, gentle humor also helps ease uncomfortable situations, and may even make a very anxious patient relax enough to be more open with you.
.
As I have noted in later postings, I think the "first meeting" with a physician should occur when the patient is not immediately needing medical attention but should be a survey visit to establish to the patient whether this would be the proper doctor in terms of temperament, ability to comfortably communicate to and from the physician and some degree of insight of the physician's values. If the physician is unwilling to accept such a survey visit, it probably won't be the
physician most patients would want to be their doctor. ..Maurice.
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