Monday, January 13, 2014

It Goes Both Ways

Sometimes, its hard to get back in the swing of things.  I've been writing every day (and some of it is publishable but of the dry medical case report type) but I miss public writing in general.  I miss putting the words together in a way that makes others want to read on to the next sentence.  Sometimes, the only way to get started again is to ride in on someone else's coattails.  That's what I'm going to do today.  Hopefully it will continue to lead to more thoughtful and original content in the near future.

Hang on with me through the next sentence.  I recently read a blog post (full disclosure: written by my program director on his blog, Glass Hospital) that was an intro to a piece he wrote for Shots on NPR ... all about bedside manners.  The end of the initial blog linked to NPR's Facebook post asking what patients' want from doctors.  The answers were somewhat varied ... some were funny, some were crass, most were heartfelt.  Many simply aren't reasonable.

I spent the last 45 minutes addressing the unreasonableness of many of them.  But you know what?  None of the words I wrote really matter.  I do what I can to show patients I truly care and that their time is valuable to me.  I do what I can to show patients I'm invested in their health outcomes.  I do what I can to show patients that I am not only listening, but that I am truly hearing what they are saying.

I think most of my patients think I do a decent job.  They don't all ... but I have to be okay with that because I am unwilling to sacrifice my own morals and ethics to please everyone.  I think the majority of my patients respect this.  The ones who don't ... well, there are plenty out there who will.

However, I only think its fair if I get to respond with a few of the things I wish patients would do/bring/provide/ask/tell/etc.

  1. Be honest.  I'm not going to tell anyone what you tell me*.  And if I ask you a question, its important and might change the course of treatment.  Believe me, I will not judge you and do not care about your social life (i.e. drug/sex/alcohol history) on a personal level.  
  2. Bring your medications (or an accurate list) from all your doctors with you.  Include all the vitamins and alternative medications you take.  
  3. If you can't afford a medication I've prescribed, please tell me.  I have no idea how much different medications cost for different people because EVERY SINGLE PERSON PAYS SOMETHING DIFFERENT.  For almost all drugs, there are substitutes.  Just let me know.  I just want to make you better.  
  4. Don't be offended if I don't shake your hand.  You have the flu.  Nowhere else on the face of the earth is the expectation to shake an obviously ill person's hand.  I'm practicing self-preservation.  
  5. Put your phone away.
  6. If you don't take the medication I prescribe or don't implement the changes I recommend, don't be mad at me when you don't get better.  If you feel they are unreasonable, say so.  However, I can't fix you with magic.  Getting sick usually takes time.  Getting better usually takes time and effort, and the effort can't be all mine.
  7. Be polite. You want me to say hello.  You want me to be on time. You want me to listen to every word you say.  You want me to ignore my phone and pager.  It's nice when you do the same.  See #5.

I could go on and on, but basically the things you want from a doctor, the doctor also wants from you.  And while I am sure that you, as a patient, do all of the aforementioned items, there are loads of patients who don't.  Basically, it all boils down to the Golden Rule.  Respect needs to go both ways.

*I won't tell anyone what you tell me unless I get the impression that you are at risk of harming yourself (suicidal), harming anyone else (homicidal), or if it involves child or elder neglect.  Legally (and ethically), I'm responsible to take those issues outside of the room.