The practice of medicine has changed dramatically over the last couple of decades, with many of the changes unfortunately not so good for patients. It's a well-known feeling among health care professionals, that among all the new elements of bureaucracy and information technology requirements and mandates, the one person who is often completely forgotten about is the patient.
As someone who has worked up and down the east coast in every type of hospital over the last several years, I am witness to that unfortunate truth. We always tend to forget the patient. With that in mind, I have gotten a real sense of what patients value and desire from their physician. Here is what I suspect those “dream doctor” traits would be, and what a letter from a patient would look like:
Dear Healthcare Organizations & All Physicians,
Based on my interactions with doctors, here is a list of the things I'd really like mine to be like. I find that most doctors are technically excellent and very competent, and the major issues simply relate to communication. If you are serious about raising the quality of care and improving the health care experience, you may want to take some of these points on board:
• Speak to me respectfully and take time to listen to me. Empathy and compassion go a long way, and sometimes just a caring ear can count for an awful lot. Sit down and explain everything clearly to me (and my family if they are also present). Give me a chance to ask questions too.
• Following on from the above, please make sure you are on the same page as any other doctors I'm seeing. It really gives me great heart to know you are all talking to each other!
• When you are with me, please maintain eye contact. I am really bothered if you keep turning around to your screen to type furiously on your keyboard and click boxes. I am a real person with a story to tell.
• Familiarize yourself with my chart and past history before you see me for the first time. Again, this is very heartening and reassuring to me.
• Be accessible. If I have a question or concern, it's great to know that I can get in touch with you. I know you are super busy, but even if it's your office staff or a colleague, it should be relatively straightforward for me to relay a concern.
• Please make sure that when I leave your care, whether in a hospital or in your office, that my followup instructions are clear and unambiguous. I don't understand technical medical terms. Last time I left the hospital I got a printout of computer gabble that looked similar to the paper I got after my car was serviced—that meant nothing to me and I couldn't understand.
• Keep in mind that you are seeing me at one of the lowest points in my life. Those few minutes you spend with me are really important and I'm hanging on every word you say.
• Smile more and remember that each patient you see is a real person and not just another name on your list! I have a life and just want to feel well again so that I can back to it.
Many Thanks for the great work you do every day,
Based on the above, here is how a “dream doctor” would communicate (in a hospital):
• You walk into the room and greet me with a handshake and warm smile
• You pull up a chair, sit down and get talking, asking openended questions
• You already know a lot about me (assuming we are meeting for the first time)
• You speak slowly and clearly, avoiding excessive medical jargon
• You maintain eye contact and don't keep turning around to start clicking and typing
• You give me and my family a chance to ask questions
• You summarize everything to me
• You say goodbye and tell me when you will next be seeing me or how I can follow-up
These requests could come from anywhere in America, or indeed the world. The question however, from the physicians' side, is how do we get to a health care environment where these (relatively simple) demands can be met? If physicians simply don't have the time to do these things because for every 5-minute patient encounter there's 20-25 minutes of bureaucracy and IT click boxes, we clearly can't fulfill our patients' wishes and needs.
That's why we need to get back to the drawing board. The doctor-patient interaction is sacred and those precious few minutes transcend everything else and should be every doctor's “zone”. That is something that no mandate, administrator or information technology can ever touch. They are what the patients and families will remember and judge you on. Patients simply cannot just be an afterthought in a real health care system.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.