The Inspectionby Stesha Doku on Oct 15, 2012 • 9:08 am
A friend sent me an email 2 weeks ago about his experience in establishing care. A young male in his early 20s, he is healthy and was looking only for a physical. He had a less than stellar experience with the physician who saw him. “Is it just me or does it feel like mechanics gather more data on an initial inspection than doctors do during physicals?” he wrote, “I’m pretty sure that humans are more complex than most internal combustion engines.”
He had a point. His concern is a common one: feeling like a physician’s quick glance at vitals and listening through the stethescope were not quite thorough enough. If there was something to be found, would this physician have found it? Our ensuing conversation and his experience was about expectations. We want our doctors to spend a sufficient amount of time on us to gather real data but we’ve come to expect our doctors to be in a hurry. A physician who takes his time is heralded as being above the curve. Those who don’t are never considered to be considerate of our time only sloppy with theirs.
In order for healthcare delivery to be effective a physician should know the expectations that must be met for each patient and meet those that are reasonable and in line with good practice. The patient, simultaneously should be transparent about their expectations for improved communication. The questions I posed back to my friend were the same I’ve started to incorporate in discussion with my own patients: “What exactly did you want your doctor to do that he didn’t (How can I help you today)? Did you have any complaints he ignored (Was there anything I missed that you wanted to discuss today)? and did you feel like you could ask for him to do more if you wanted more than what he offered (What are your expectations for this visit)?”. The answers to those direct questions to a patient can provide some surprising answers — that if taken into account will save everyone time and frustration.
By the same token, my friend consulted an analogy that has both helped physicians and hurt us. If we consider the body to be a machine of sorts we can approach understanding and therefore fixing it. But the analogy is limited: unlike the machine, a healthy 20-something male can tell me he doesn’t have symptoms (the foundational approach to modern medicine), has time and emotions that should be respected and shouldn’t be subjected to more than is necessary. Very unlike a machine a physician can gather information about a patient’s health the moment that they walk through the door. Sometimes that itself is the most valuable information to be gathered despite a patients expectation that we must do something to them to gather information.
Photo credit: Nice working on a car by derobert