Sunday, June 23, 2019

Is My Doctor Any Good?

When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand.  Of course, if you come to see me with a stomach ache, at some point I will direct the dialogue toward your abdomen.  Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes.   Why does this happen?  First, I enjoy it; and secondly, it helps me to understand the patient better as a human being.  I won’t give this up, despite the many forces – Electronic Medical Records in particular – that conspire to dehumanize the medical experience. 

I am a trained typist and had several secretarial jobs in my younger days.   The tool of the trade then was a contraption unknown to the generation whom are now soldered to their smart phones.  It was called a typewriter.  For those curious, you might actually be able to palpate one of these dust covered devices in your grandmother’s attic.  My favorite was the IBM Selectric, which had a sphere covered with raised letters and characters which rotated with each key stroke before striking the paper.  Oh, the simple world devoid of Google, cut & paste, Instagram and Wikipedia.  Kids today would never give up their technology, and they have no clue what they have given up in exchange for 

The IBM Selectric Typeball

When a new patient arrives, I always ask how they came to see me in particular.  Sometimes, I am gratified to learn that a satisfied family member referred them.  On other occasions, they have selected me at random, a seemingly chancy method of selecting a physician.  These folks likely would do more due diligence in purchasing a washing machine. 

If they have a primary care physician (PCP), I always ask if they are satisfied with the care there.  These have been extremely valuable inquiries and are unique opportunities for me to learn of patients’ views on their PCPs.   Of course, their review may not be the full story.  And, I would not allow one bad review to change my impression of a doctor.  But over time, I accumulate more data on individual physicians.  For example, if nearly every patient cared for by a Dr. Kildare offers a glowing tribute, this will weigh heavily when I form an opinion.  Similarly, when we read reviews on line for various products and services, they carry more weight if there are a large number of reviews, rather than one or two, leaving aside for a moment the pitfalls of relying upon on-line product and service 'reviews'. 

The truth is that doctors have little clue about what actually goes on in our colleagues’ offices. Physicians and their offices may treat medical colleagues differently than they do their patients.  I’m amazed how often a patient’s experience differs from my impression of a physician who may be quite cordial with me in the elevator.  And, it goes both ways.  I’ve met doctors who seem to me to deficient in social skills and yet, patients love them.

If primary care physicians are smart and seasoned, they will ask their patients about us - the specialists.  Are we as nice to their patients as we are to them?

So, when you come to see me in the office to discuss your heartburn and your hemorrhoids, don't worry.  We''ll get around to it.  First, we may reminisce about milk bottles, fountain pens, paper road maps, Encyclopedia Britannica and my beloved IBM Selectric.


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  3. Interesting. One of my frustrations has been finding a PCP that I'm happy with (recently moved). I've found that specialists will NOT recommend a PCP. Not sure why but I'm sure there is either a $$ or etiquette situation that isn't clear to me.