10 Things Patients Love To Hate About Their Doctors

Patients have a love/hate relationship with their physicians.  They love some things and hate others.  Here is a list of things they hate, and actually take as a sign of incompetence, rather than just poor bed side skills.

  1. Being a slouch.  Patients take the lack of eye contact, hands in pockets and crossed arms as a signal your aren’t listening.  Lack of eye contact finishes it off. ( If your kid did this, would you feel they were listening?)  Lack of eye contact is the NUMBER ONE behavior that patients hate the most.
  2. Standing when the patient is sitting (or laying.) Sit down and look at the patient. 
  3. Standing far from the exam table/bed.  Patients are apt to think that YOU think they smell!  Seriously!
  4. Not being available.  When calls aren’t returned, patients hold it against you.  This also goes for being available while you are in the exam room.  I try to delay answering pages while I’m examining a patient, as I need to BE present for the patient I am examining,
  5. Giving the perception that you are rushing,  Please notice the word perception.  You may be hurried (harried?) but sit down, smile, and use humor if appropriate.
  6. Using technical terms.  Patients are intimidated by the words we throw about.  Speak simply. I don’t know anything about car engines and my eyes glaze over when the mechanic mentions words like “catalytic converter” or “repack the wheel bearings”.  Patients feel similarly about words like “congestive heart failure” and “synovial fluid.”
  7. Not answering questions.  If you don’t know the answer, tell the patient you will get back to them, or ask Dr. Bigg Bux, the orthopod, to explain exactly how the hip will be replaced.
  8. Don’t automatically say no, especially with out a reason.  I am ashamed to admit that I reflexively said no to a family request this past week, thought about the request, and then came back to tell them I could do what they asked.  Why was I so quick to say no?  Arrogance, time pressure, all of the above.  It took more time to change my mind then to do what they asked!
  9. Talking down to patients.  It is difficult to hit the sweet spot.  You want your conversations to be easy to understand but not juvenile.  You never know how patients will take what you say, but being flexible is helpful. 
  10. Mistrusting the patient/type casting the patient.  The book, How Physicians Think, by Jerome Groopman, has an excellent chapter on how physicians make mistakes when they stereotype patients.

Patients will also be less likely to trust you if you are of a different ethnicity, sex or culture.  These are harder to over come, and patients perceptions can be tough to change in these areas.  I still haven’t found a way around the fact that some patients prefer a male physician.  I happen to be female, and that’s one thing that ‘s not likely to change!

Resources: How Doctors Think, and Trust and Distrust in Organizations

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Walk the Talk: the Patient Encounter

I am fascinated by how we physicians communicate (or not) with each other and with our patients.  As a medical student and resident NO ONE ever thought about how physicians communicated with patients.  We were always so focused on nailing the disease process and treatment that the patient was nearly ignored.  I don’t think I had a single attending that excelled in talking and listening to patients.  I have tried to self educate (isn’t that what most of medicine is?) and found a thoughtful curriculum for residents on line, from the University of Washington.  I will reproduce the salient points here:

  1. Have an opening introduction: “Hi, Mrs. Marlboro, I’m Dr. Pookie.”  (Hand shake, sit down, look at patient.)
  2. Allow the patient to complete their opening statement.
  3. Attempt to get the patients full agenda: “Mrs. Marlboro, what is the most important thing we need to work on today?” At this point, prioritizing the patients concerns is key.
  4. Set the ground rules: “Mrs. Marlboro, it sounds like stopping smoking is what we should focus on today.  Is that right?”
  5. Gather information, with a  mixture of open and closed ended questions.  Summarize and clarify with out interrupting.
  6. Actively listen, using non verbal cues as well as verbal cues.  (“Uh huh, ah…”)
  7. Explore their beliefs about the illness.  (Yes it’s hard to keep your mouth shut when a patient insists that smoking isn’t bad “because, Doc, I know you’ve heard it before, but I don’t inhale.”  Just heard this from a diabetic as he went on his way to the cardiac cath lab…  But try!)
  8. Acknowledge the patients feelings/values.  (“Yes, quitting smoking is really hard, even our President Elect thinks so.”)
  9. Share information in terms that patients understand.  (Save the free radical talk, two gene promotor theory of cancer for some one who cares.)
  10. Encourage questions: “what questions or concerns do you have?”
  11. Reach agreement on the treatment plan, actively encouraging patients to participate in the plan. 
  12.  IMPORTANT: TRY TO GAUGE THE PATIENTS WILLINGNESS  AND ABILITY ENGAGE IN THE TREATMENT PLAN!  The best plan in the world is worthless if the patient can’t/won’t follow it!
  13. Provide resources (hand outs, referrals etc.)
  14. Realize you can NOT cover every item at every visit. 
  15. Close the encounter by summarizing the treatment plan and setting up the follow up plan.

The patient encounter needs to be a balance between “patient centered skills” and “agenda setting skills.”  Interestingly, when a patient is dissatisfied, they underestimate by 8% how much time the physician spent with them, while if they are satisfied, they overestimate the time the physician spent with them by 20%!

Please see link from Society of General Internal Medicine below.   First author is Matthew F. Hollon, M.D., M.P.H., from the University of Washington. 

http://sgim.org/userfiles/file/AMHandouts/AM08/WC01%20Matthew%20Hollon.pdf

How To Listen So Patients Will Talk

I wish that in medical school and residency we had spent more time learning how to communicate.  We finish training stuffed with knowledge (think a brat on a grill!) but are horrible at distilling that knowledge to help people.  As a hospitalist I have tried to hone my interviewing skills, but feel that I could use some improvement.   Here’s my own two cents on how to interview a patient  (of course, I’m a doctor, I’ve got an opinion!):

1) Read the chart before you go in.  I have gone back and forth on this, wanting the patient to tell me what was wrong in their own words, but finally have settled on, “Hello, Mr. Hurting, I understand you have had chest pain (or warts, or whatever) for the past two days (weeks, months, decades…).  Could you tell me more about it?”  I have started doing it this way, because, when I used to say, “Hello, Mr. Hurting, what brings you to the ED today?”  inevitably I would get a wisecrack like, “My wife.”  or “The ambulance.”  I’m hoping my chart reading before hand makes me look smarter!  (I have a personal theory that if I had a British accent, I would appear smarter, but that’s a whole different blog.)

2) Please slow down, and don’t interrupt the patient.  Let them get their spiel out, before you jump in with the questions.   Try not to turn the interview into an interrogation.

3) Review the medication list (the med rec, which I think is your best friend!) every time, using trade and generic names.  Many patients will know one or the other, but not both.  Hopefully you will not encounter the dreaded, “I take the little peach pill” scenario.

4) Try to answer the following questions:
–what is my diagnosis –(why am I sick?)

–what will happen next?  (What tests, treatments, other specialists?)

–when will I be informed of the test results?

–will it hurt?

–when will I get out of here (the hospital)?

–and of course, when can I eat?

5) For pity’s sake, introduce yourself and shake hands!  (I know, this post is slanted towards hospitalists today.)  Give the patient and family a card.  I occasionally give my pager number to so called “needy” families.  I find that they take comfort knowing they can get hold of me, and seldom abuse this.  I must note that some of my colleagues frown on this.  (“We don’t do that,” one of them said frostily.)

6) Always ask, “Do you have any other questions or concerns you want to share with me?” before concluding the interview.  I also tell patients and families how they can get hold of me.  (“Ask your nurse to page me.  We have someone here 24/7.”)

Please feel free to share your suggestions.  My communication skills are a work in progress, and I bet yours are too!