Are you disengaged with the ill?
HEALTH From the physician’s perspective (s)he is doing a great job. Despite running a tad behind schedule, patients are being referred for lab work, receiving prescriptions and getting referrals to other medical specialists in a timely manner. Before entering each exam room, the doctor puts on a great smile, greats the patient with brief pleasantries and begins tapping away on a computer that holds the answers to all treatments. However, in the eyes of the patient, this doctor is smug and disconnected.
When the nurse (LPN) previously took the vitals to update the chart, she asked, “What is the purpose for your visit?” Not wanting to perform a self-diagnosis the patient quipped, “I am here because I don’t feel well.” Not sensing the patient’s feeling intrusive lack of privacy, the nurse rephrased the question. Unable to obtain specificity, the LPN enters a vague description on the patient chart.
The examination room visit now takes on the air of a poker game. The patient is there because the illness has gone on for too long. Prior research on the Internet uncovered some potentially troubling diagnoses. Revealing such research to the doctor in the past elicited a condescending response. So not wanting to show his hand, the patient throws off a few “cards” in hopes of receiving better ones in return. Unfortunately, the physician is not reading the cues and is dismissive of the symptoms mentioned by the patient. “You are looking pretty well. I am going to recommend some routine lab work and will share the results when they arrive. I look forward to seeing you next year.” The doctor just “folded.”
The patient’s heart sinks in disbelief that he will leave with questions unanswered. How did the doctor ignore the symptoms? Should he risk sounding like an Internet-crazed paranoid madman and blurt out a list of possible diagnoses or retain the poker face? By now the physician is standing, fingertips on the doorknob. With anxiety building, the patient selects the most troubling illness suspected and shows his “hand.” “Should I be worried about illness x?” The doctor responds, “It’s unlikely” and shines that ‘Julia Roberts-George Hamilton’ smile. In a comforting tone (s)he adds, “Don’t worry. You’ll be all right. Please see the nurse on your way out.” With that, (s)he exits the room.
Later at home, family and friends ask, how the doctor visit went. A frustrated patient responds, “Not well.” A few weeks later, symptoms are continuing. The patient ponders scheduling another visit. Would it be another colossal waste of time and money? Should a referral be sought?
At that moment the phone rings with someone asking to make an appointment for a referral from the primary physician. Excitement turns to bewilderment after discovering this is not the specialist that can shed light the illness in question. It turns out to be a weight management consultation. This is a conversation that did not even come up during the visit. “Does my doctor think I’m fat? Perhaps I am overweight because I have been too ill to exercise. But is obesity the source of my illness? Or is better nutrition something that should be addressed after curing my primary problem?”
Marcus Welby, M.D.
In the eyes of the physician, (s)he is figuratively killing it (or literally not killing him) by efficiently handling so many patients. Obviously there is a doctor-patient disconnect. The patient needs to feel comfortable expressing any concerns. Can the doctor probe further when a patient offers insufficient symptom information?
In a bygone era, physicians were viewed as the ultimate source of medical information. Dr. Welby was the specialist—in everything—and had all the necessary tools for a diagnosis in his medical bag. Trips to his office or hospital were rare and patients loved him. House calls may not be returning anytime soon for anyone but the rich and famous but communication can be improved. Health care must find a better way to take into account the vast amount of publically accessible information.
I once visited a doctor with a long list of possible causes for a troubling condition. I had seen several physicians; gathering small bits of clues but no one seemed able to crack the case. The doctor then said, “Go ahead; read your list.” Like a lively tennis rally, Rapid responses were heard after each ailment mentioned: “No. No. No. No. No!” He was correct. None of the illnesses researched were valid. The problem was that the doctor did not offer any alternatives. More tests were done and I was sent home without a diagnosis, as if he was finished. My quest for answers continued through additional medical professionals.
One year I began researching something on the Internet for a peculiarity in one of the lab results. This is what led to the eventual diagnosis. It turned out to be a simple allergy that produced an uncommon reaction. Removing the allergen finally eliminated years of suffering.
Somehow we need to come to an understanding that ruling out one illness is not synonymous with a successful visit. Doctors often seem most concerned with ruling out common illnesses and treating symptoms. Patients share concern for ruling out major health problems but are comforted most by an actual diagnosis. Personal physicians that present themselves as more knowledgeable than Dr. Google (even if not as warm as Dr. Welby) can improve exam-room visits.