My grandmother’s and mother’s generation believed medical doctors were the gods of medicine. Physicians were always right—and not to be challenged on diagnoses or treatment. Medical school dogma of the past firmly seated doctors with their crown of knowledge on the throne and ignorant patients on the examination table.
When I worked as a dietetic technician at a hospital many moons ago, I remember one doctor in particular. In order to ask or request something for one of his patients, I learned quickly that I had to approach his favorite nurse. Then she would relay the message to him. Zipping my lips is difficult for me in those types of irrational and unequal power situations, but I acquiesced for the sake of getting the patients what they needed—and to avoid getting fired.
Is change in the air? The current generation has the Internet at their disposable and a plethora of information as well as a Human Resource Dept. with policies, procedures, and protocol. And they appear to be more assertive.
Consider the 2014 book, “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests” by Leana Wen and Joshua Kosowsky. Written by two physicians, the guide is for patients to read before appointments. The premise is that the doctor-patient relationship needs to be collaborative instead of one-sided. I recommend the worksheet in the book that is completed before the appointment. Answer the questions and take the form with you. The authors reveal how to deal with a doctor who seems too busy to listen to you; learning test risks, avoiding harmful tests, and evaluating whether they’re worth it; and how to get a working diagnosis.
In the appendixes, which include “21 Exercises Toward Better Diagnosis,” Wen and Kosowsky further elaborate on their recommendations. The following are 8 pillars to a better diagnosis:
1. Tell your whole story.
2. Assert yourself in the doctor’s thought process.
3. Participate in your physician exam.
4. Make the differential diagnosis together.
5. Partner for the decision process.
6. Apply tests rationally.
7. Use common sense to confirm a working diagnosis.
8. Integrate diagnosis into the healing process.
Listen to Dr. Wen’s Ted Talk at TEDMED 2014, “What Your Doctor Won’t Disclose.” (www.ted.com)
According to a 2014 article in USA Today, “It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes…Medical schools drill students in the art of taking a careful medical history, but studies have found doctors often fall short in the listening department. It turns out they have a bad habit of interrupting.” (www.usatoday.com)
I have the utmost respect and high regard for my general nurse practitioner and the one before her. They didn’t whirl in and out like a tornado. Eyes were not glued to the computer screen during the entire appointment. They listened, asked questions, and gave instant feedback. My favorite doctor of all was so unique that I mailed a yearly Christmas card to his office for several years after my life-changing surgery—then I stopped so as not to be perceived as a stalker—LOL.
Changes in Medicaid, Medicare, health insurance, managed care networks, and billing need to be taken into account as well. “Time is money,” surmised Ben Franklin. But, neither time nor money can bring a patient that dies from malpractice back to life or erase her/his earthly suffering.