Listen Up Doc!

Posted on: December 5, 2009
In: Uncategorized
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This week I ran across a posting by a Dr. Luks, a physician I follow on Twitter.  The information was originally written by another physician blogger.  Dr. Rob who writes Musings of a Distractible Mind posted this and it ran in the NY Time Health issue.  I was compelled to include this information here as well.

Rule 1: They don’t want to be at your office.

It may seem odd to patients, but most doctors forget that going to the doctor is generally unnerving. We work there, and being in a doctor’s office is normal to us. Not so with most patients. The spotlight is on them and their health. They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing….There is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table. The best thing to do in response to that is to show compassion.

Rule 2: They have a reason to be at your office.

They don’t come to the office to waste the doctor’s time. Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor. Why come in for a headache? Why come in for a cold?…It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in. Sometimes that reason is simple: they have terrible pain that needs to be treated. Other times, however, the reason is more subtle. When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer. If a person has chest pains, they are afraid it is their heart. On every visit I try to identify the real reason (or the real fear) that brings them to see me. I don’t end the visit until I have addressed that reason.

Rule 3: They feel what they feel.

Patients will often tell me their symptoms in a very apologetic tone. They seem to think that they have to come to me with the “right” set of symptoms, and not having those symptoms is their fault. Sometimes those symptoms make no sense to me at all, and I am tempted to dismiss or ignore them. But as a physician, you have to trust your patient….Yes, some may exaggerate what they feel out of anxiety or out of fear that you won’t hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint. I have heard from many patients that their doctor “did not believe” their complaints because they did not make sense. If you don’t trust them, why should they trust you?

Rule 4: They don’t want to look stupid.

People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….”

Rule 5: They pay for a plan.

What do people pay for when they come to the medical office? They pay for opinion, yes. They pay for knowledge as well. But what they really pay for is a plan of action….They want to know what is going to be done to help. I try and give a plan, either verbal or written, to each patient that walks out of the exam room. What medications are given and why? What medications are to be stopped? What tests are ordered and what will the results mean? When is the next appointment? What should they call for if they have problems? The better I can answer these questions, the more confidently the patient will walk out of the exam room. The days of paternalistic medicine are over – no handing a prescription and just saying “take it.” Patients should know why they are putting things in their body.

Rule 6: The visit is about them.

With all of the stresses in a doctor’s office, I get tempted to complain about things. Who better to complain to than someone who feels much the same way? But patients are paying for you to take care of their problems, not the reverse. I keep my personal gripes or frustrations to myself as much as possible.


As a Registered Nurse, and more specifically as a case manager, I feel that if physicians would take the time to study these six simple rules we would see a far greater satisfaction with our healthcare system.  So much of my job is filling in the blanks left by the physicians.  I realize there is not enough time to spend with our patients.  The current payment system for medical services does not allow the face-to-face time that our patients need and deserve.  My job largely came out of this need.

Every day I spend countless hours listening to patients, helping them to determine if their symptoms warrant urgent treatment, explaining medication usage and side effects, aleviating fears, sharing alternative treatment options, and just being there for them.  I love the patient advocacy part of my job, but not everyone has access to a nurse when needed.  The average patient goes to their primary care doctor for these very same things.  Even when I attend an appointment with my client, I find myself having to reiterate the entire visit because they did not have time to digest the information due to the very quick face-to-face interaction.

It is time our doctors realize what a huge difference they can make even in the ten minutes they spend with their patients.  Putting yourself in the place of the patient should help alleviate any attitude you might have.  Secondly providing time for questions.  Make sure when the patient leaves they have a written plan of action that they can review after they leave the office.  Provide an avenue for questions that arise only after they leave your office.  It would make my job a lot easier.  :)

Do you have any other suggestions in providing care for our patients?  As a nurse what interactions do you have with patients outside of the doctor’s office?  What recommendations would you make to extend the few minutes one has in front of the physician?

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2 Responses to “Listen Up Doc!”

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