Bioethics Discussion Blog: Advice to the Doctor Thread: What is Your Advice to Doctors and Medical Practice?

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Sunday, December 16, 2007

Advice to the Doctor Thread: What is Your Advice to Doctors and Medical Practice?

Throughout these over 500 different threads on this blog, there have been plenty of topics which provided the opportunity for visitors to comment about their doctor’s personal behavior and practice. Many visitors did express their good and bad experiences with their physicians, their pleasure and their disgust with their doctor or the profession. Notwithstanding the opportunity my visitors were given to tell their stories within those threads, I thought it would be a good idea if I put up a thread that dealt solely with general but constructive advice which patients would give to doctors perhaps in the form of some guidelines or guideposts to improve the quality of care that is expected. Doctors, as part of their work are always giving advice to their patients. I think that a blog such as mine should give patients the opportunity to return advice. Hopefully I, myself and other physicians who come and visit this blog will learn and consider seriously the advice given. For the purpose of clarity, keep the advice short and succinct but do include an explanation of the basis for giving such advice. Remember, advice is more easily accepted if it is constructive, civil and understandable. If one visitor agrees or disagrees with the advice presented by another, this can also be expressed. Now go to it.. I am listening. ..Maurice.

12 Comments:

At Monday, December 17, 2007 8:14:00 AM, Blogger Maurice Bernstein, M.D. said...

If some visitor wanted to advise a physician to "practice themselves what he or she preaches", perhaps the visitor should look at the response to "Do as I Say and Not as I Do" thread. ..Maurice.

 
At Monday, December 17, 2007 11:46:00 AM, Anonymous Anonymous said...

OK, I'll start:

1. Treat your patients with the basic respect due another human being. They're not just a "broken arm" or "gall bladder in room 213", they are individuals with feelings and concerns and questions and fears and deserve to be treated as such. Respect their concerns and do you best to accommodate them.

2. Do not be condescending. The days of paternalism in medicine are fast becoming a thing of the past (IMHO rightfully so). The role of the physician has evolved to that of a health care consultant, while as consumers of health care, patients today are more educated and aware of health care issues. It's a symbiotic relationship and needs to be recognized as such.

3. Encourage your patients active participation in their treatment plan and health care decisions. Explain what you have found, the possible alternatives for treatment, and the pros & cons of each. Don't just tell them what, tell them why. If they still need more information to make a decision, point them towards resources that will help them.

4. Never, ever, lie to or deceive a patient. Doing so, even over something minor, will destroy any possibility of achieving or maintaining the level of trust essential in a good doctor/patient relationship.

I could list more, but I think this is a good place to start. There is a common thread that runs through all of the above - mutual respect is, IMHO, an essential component of a good doctor/patient relationship.

Just my $0.02....

TT

 
At Monday, December 17, 2007 2:33:00 PM, Blogger Maurice Bernstein, M.D. said...

TT, your advice is worth over a dollar! I think that a critical advice is #3 "Encourage your patients active participation in their treatment plan and health care decisions." I think part of the problem of "non-participation" is the rush to get along to the next patient. Doctors feel they need to finish the transaction with the patient. To go into further details and particularly wait until the patient fully understands and gets to put in their two cents and then resolving any misunderstanding, concerns or approaches set by the patient takes time and attention by the physician. I think the doctor would rather set the program by him/herself rather than encourage further participation by the patient beyond getting a history and having a physical completed.

If patients are encouraged and allowed to actively participate in their workup and treatment then the issues of respect, condesention and deception all become less likely or indeed absent. ..Maurice.

 
At Monday, December 17, 2007 2:33:00 PM, Blogger MY OWN WOMAN... said...

1. Don't overbook patients. Try to get them in near their scheduled appointment time.

2. Don't tell your patients that you will meet them in the Emergency Department if you don't plan on meeting them there. Also, don't tell your patient's you've called the ER and they are waiting to take you "right in."

 
At Monday, December 17, 2007 2:52:00 PM, Blogger Maurice Bernstein, M.D. said...

My Own Woman, another advice which would go along with "Don't tell your patients that you will meet them in the Emergency Department if you don't plan on meeting them there." would be to remind your patient about a hospitalist, perhaps unknown to the patient, managing their care in the hospital if you are doing only office care. ..Maurice.

 
At Monday, December 17, 2007 4:31:00 PM, Anonymous TT said...

"If patients are encouraged and allowed to actively participate in their workup and treatment then the issues of respect, condescension and deception all become less likely or indeed absent. ."

And I'd also wager that the likelihood of the patient following through with the treatment plan would be significantly higher - after all, they helped create it. Most people don't like being "talked down to" or told what to do, but make them a partner and give them a little "ownership", and it's surprising how much more conscientious they will be in following through.

I agree with you that the pressures of time constraints and patient volume are probably a big factor here, but if spending a little more time up front would result in better outcomes and fewer follow-up visits it would actually be more time efficient in the long run.

Once the lines of communication are open, it doesn't all have to be "face time". A lot of routine followup's can be accomplished through telephone appointments or via email where appropriate - both much more efficient than in office visits.

IMHO, the core of a good doctor/patient relationship has to be based on trust, and for me that requires a certain level of mutual respect. You're not always going to agree, and there are going to be times when you'll just have to agree to disagree, but if the mutual trust & respect is there it won't affect the integrity of the basic doctor/patient relationship

 
At Monday, December 17, 2007 5:58:00 PM, Blogger Maurice Bernstein, M.D. said...

TT, when we advise the physician but also the patient that "mutual trust and respect" is essential for a working doctor-patient relationship, this trust and respect may take time to develop. Perhaps the patient, through information by family, friends or others or even the media is aware of the accomplishments and behavior of the doctor so that trust and respect can grow from that insight. In the case of the doctor, the patient is usually an unknown entity except perhaps for knowledge of the chief complaint symptom. It may take time for the doctor, after observation of the patient, to develop that trust and perhaps even with regard to respect especially if the patient, at first, appears as a stereotype to what the doctor considers an unhealthy personality (such as devious, demanding or excessively dependent amongst other traits). This delay, also sensed by the patient, hinders the development of an effective relationship or even prevents the partnership from developing. ..Maurice.

 
At Wednesday, December 19, 2007 3:16:00 AM, Anonymous Justine said...

I'm a nursing student and one of the things that I tend to notice is poor bedside manner.

For example, during my OB rotation, I was with in antepartum (when you're pregnant and having medical issues) and a lot of extended family was in the room. The doctor came in and started talking about her genital warts and herpes in front of them. Patient confidentiality much?

I don't know how you give advice for this kind of thing since it seems like common sense.

Closing the curtains when doing a complicated dressing change, asking the patient if they have any questions, etc.

I guess, just stop, think about what you're doing, put yourself in their shoes. How would you feel if you were that patient?

 
At Wednesday, December 19, 2007 8:38:00 AM, Blogger Maurice Bernstein, M.D. said...

Justine, you brought up an important issue and an important advice for physicians. This lack of concern about the historical and physical privacy of patients are also not uncommon on hospital teaching rounds with a group of student, interns and residents. A lot of this behavior, I think, has to do with the ego of the attending physician who feels he or she is important enough and what is said is important enough that every word should be heard regardless of any lack of patient privacy. When a doctor pays more attention to their own words and their expression and with no attention to the environment and the patient, patient confidentiality and privacy is gone. That is why I think that doctors have got to be more modest and realize that each of their words and interpretations are not diamonds which need to be preserved and treasured. A little more attention to the patient and the surrounding world and less to their own ego would be highly constructive. ..Maurice.

 
At Wednesday, December 19, 2007 7:38:00 PM, Anonymous belinda said...

I have one gripe: the tolerance of dishonesty in hospitals.

this is anecdotal, but during my recent 5 day hospital stay, every person who entered my room (save nurses) introduced themselves as 'doctor'.
Trustful me, I actually believed they all were doctors, until I overheard one of them outside my door ask the nurse for help on what I thought should be very basic medical knowledge.
When I expressed concern later to the nurse that she knew more than than that doctor, she said "it's because he's still a medical student". Asked why this person identified himself to me as a doctor, the nurse very casually replied "oh, that was just to put you at ease".

That deception, and the patronizing excuse for it, has made me a cynic. The nurse's unconcern that I was lied to led me to google if any rules had been broken. This is a just a bit of what I found.
The American Medical Student Association only "discourages"
students from introducing themselves as doctors.

http://www.amsa.org/about/ppp/pr.cfm

The Western Journal of Medicine claims that the practice of introducing medical students as doctor or pretending that they are physicians is common. But they only "recommend" truthfulness.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1071436

Why no mandate for honesty?
These people in white coats who have called themselves "doctor" had my trust when I confided my serious health concerns and had my body for intimate exams without supervision. Why is it considered benign for medical students to steal their learning from patients? I wonder how far up the medical food chain dishonesty is tolerated?

 
At Wednesday, December 19, 2007 8:58:00 PM, Blogger Maurice Bernstein, M.D. said...

Truthfulness leads to trust. Belinda,your advice is that those who are part of the healthcare community should be truthful in how they identify their role. I already presented the issue of whether students in medical school should have the word doctor in their title. I wrote there "My own opinion is that that 'student doctor' or 'student physician', as examples of student titles, are deceptive and only medical student should be used". ..Maurice.

 
At Wednesday, April 23, 2008 7:32:00 AM, Anonymous Online Doctor said...

Be Fair - That means don't push patients out the door when you know they don't understand what you have said

Be Honest - Don't overbook patients and tell them that "a few patients ran over"

Be a Listener - Patients see a doctor so they can tell them about their problems not hear what is going on with the doctor's life.

 

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