Day 18 – Advice for new doctors or nurses

I apologize if this post begins by tippy-toeing around, but as I make this pitch to you – a new doctor or nurse – I don’t want to imply that I’m giving you advice so much as suggestions. I know you have all this incredible knowledge. I know you’ve turned in many long, hard years of schooling, and you have a student loan the size of a mortgage to show for it. You’ve done your internships and your share of free clinic duty, and it’s time to start out in your own practice, demonstrate your knowledge and skills, and get the respect you deserve!

However, pause for a moment. You’re dealing with people in your practice, and people are messy! Patients have their own expectations and needs when they come to see you. Some patients may be a pain in the ass, but even those PITA patients are there for a genuine reason. They’re sick, even if the illness is stress-related from having to live with their mother-in-law. It’s going to be complicated as you unravel all the reasons why Mr. Smith complains so often about chest pains and his mother-in-law, and decide whether there’s a cardiac workup to be done, or instruction on how to relax and handle stress better. Both cases are important, and both require you to pay attention to the symptoms Mr. Smith is presenting with, as well as what he is saying.

I’ve been a long-time patient (not by choice) and I’ve seen many things that doctors do right and as many things they do wrong. I’m going to give you an overview of some of the behaviours and attitudes that make me praise you, and others that, ummm, make me not want to praise you. These are based on my own experiences and those of loved ones, and I welcome other patients to add their own suggestions in the comments.

After all, you’re trying to heal us, and we’re working hard to get better. Isn’t that what we’re here for?

Blessings,
Jane

Here are my suggestions for new doctors and nurses:

Always:

• Introduce yourself clearly, including how you prefer to be addressed. Otherwise we waste time wondering what your name really is; and do we call you Dr. Williams, or can we call you Karen? Don’t give a first name if you don’t want us to use it.

• Find out how we prefer to be addressed. It could be that Hilary Marjory Brown would like to be called Ms. Brown, Hilary, Marjory or something totally different. I spent a few years transitioning to using my second name, Jane. I used Jane everywhere, but my documents read Linda. Even after establishing that I was going by my second name, the doctor would address me as Linda. What’s worse, once corrected, they’d promise to make a note on my file and then at the next appointment, they’d call me Linda again. If you’re going to call us by name (which is better than ‘you’), please use the right name.

• If your appointments are running late, please have your receptionist give us an estimate of how much when we check in. Our time is important too, and we may have to check in with our job, family, childcare, or the person transporting us from the appointment to let them know. We understand things can run late, especially when you spend more time with us, but please don’t take it for granted.

• When we do meet, apologize sincerely for the delay. If you don’t do this or don’t even acknowledge the delay, you’re saying that your time is more valuable than ours. Don’t do that. Maybe you’re a brain surgeon, but maybe we’re using every ounce of our energy to be in your office. Maybe we’re really needed somewhere else: by our children, aged parents or a friend. Sometimes our time can be a matter of life and death too. You’ll find we’ll forgive most any delay if you apologize with sincerity.

• From the outset, invite us to ask questions during the appointment. We need this if we don’t understand what you’re saying. Leave time for questions at the end also, because we may need the entire appointment to absorb what you’ve said.

• Consider having a way for us to contact you when questions, unexpected symptoms or side effects arise outside of office hours. We don’t expect you to give your personal phone number or email address, but can you use a service to provide emergency help when your office is closed? If you don’t provide this kind of service, please make sure that we have access to an information line, support line, clinic or ER where we can get emergency help. This is doubly important when we are at risk of suicide.

• Talk to us at the level we’re at. Sometimes you need to keep the explanations simple. Sometimes, even patients who are very literate in their health conditions have a bad day and can’t absorb the information you’re sharing. Don’t be afraid to use appropriate language using the names of real parts of the body if we’re capable of understanding it. Some of us have degrees of our own, or have done extensive research over many years of illness. We may feel you don’t trust us with the information if you don’t talk to us honestly at a level we can understand.

• Allow us to have a chaperone to all appointments, and not just examinations. If we experience anxiety talking to health care providers, or suffer from symptoms such as brain fog, we need a companion to help us understand everything that arises at the appointment, and to help remind us what follow-up actions we are required to take.

• Listen actively. It’s important for us to know that you’ve heard us and want to help us.

• Trust us when we share our symptoms and experiences. It may be that our perceptions are skewed, but trust that we feel the symptom and the severity of that symptom as we describe it. It’s your job to figure out how and why the symptom is occurring, and if it’s referred from elsewhere in the body or is due to some other factor. If the symptom is normal, explain why it is in non-dismissive language. If we sense you don’t believe us, we won’t trust you. A therapeutic relationship is nothing without trust.

• Accept an integrated healthcare approach and encourage accepted alternative therapies if they fit in with your treatment plan. We like to be empowered participants in our health care, and that includes taking steps on our own to improve our well-being.

• Accept that sometimes we can be overwhelmed and have bad days when we don’t comply with the treatment plan. If we have difficulty complying, explore it with us and ask how the plan can be modified to be more successful.

• Recognize that what is normal for one person on a diagnostic test or scan may not be normal for someone else. If the patient reports symptoms that can’t be explained by the tests or scans, don’t dismiss the patient as a hypochondriac!

Please don’t:

• Please don’t give information or make diagnoses outside your area of expertise. We’ll have a lot more respect for you if you say, “I don’t know”, but know where to get more information or refer the case to a doctor with the right expertise.

• Please don’t focus exclusively on your speciality such that you don’t see the body and mind is a complete system and don’t consider other symptoms or side effects that might affect your treatment plan.

• Please don’t tell us that we have “low pain tolerance” or otherwise compare us to other patients with the same condition.

• Please don’t assume that we’re not trying to get better.

• Please don’t assume that we’re drug seeking if we say we’re in pain. Some of us try to use the minimum of drugs required to manage our condition. If we seek more pain killers, it could be that we’re in more pain!

• Please don’t assume a patient is obese because they are overeating, eating the wrong food or not getting enough exercise. Often prescription medications, especially psychiatric medications and birth control, can have a huge impact on our weight. Help us understand why we might have gained weight, and give us access to resources that help us to lose weight.

• Please don’t tell a patient with chronic fatigue symptoms that all they need to do to feel better is to exercise for at least an hour a day.

• Please don’t allow us to leave your office in upset if we have reacted poorly to a lack of diagnosis or lack of recognition of our symptoms. This is doubly important if self-harm is an issue.

• Please don’t tell us that you’ve had the same symptom and it wasn’t that bad!

• Please don’t overturn another doctor’s diagnosis without referring to any test results or the other doctor’s reports. We need to have faith that you’ve considered the other doctor’s opinion and can explain objectively why you are reconsidering the diagnosis.

• Please don’t interrupt us when we’re taking a reasonable amount of time to describe our symptoms or situation, unless to clarify understanding of what we’re saying.

• Please don’t get mad if we explore our diagnosis or symptoms on the internet. If you don’t want us to google random sites with possibly poor information, then refer us to websites or resources with credible information and answers to frequently asked questions about our illness. Encourage us to be involved in our care.

• Please don’t become hostile if we inquire about or pursue accepted alternative healing modalities such as naturopathy, massage or acupuncture.

• Please don’t refuse to give copies of your reports or our test results to us. It’s our health, and we have the right to be an equal partner in the process. If you’re afraid we won’t understand, then make sure we understand. Communicate to us.

• Please don’t add irrelevant subjective comments to your reports such as ‘patient doesn’t appear to be in pain’. You can’t possibly know what we’re feeling, and those comments just seem spiteful.