Imagine having a friendly conversation with young medical and nursing students in a coffee shop. Out of the blue, one of them asks, “What advice would you give us as future doctors and nurses? What can we learn from you to help our own patients in the future? I’ll discuss the question here, then it will be your turn to respond in the comments. What would you tell medical trainees?
Competence and Attitude
The two most important things for a good doctor to have are competence and a good attitude. You, as a patient, want providers to be good at what they do, and be willing to look up something they don’t know. You want them to treat you with respect and care, as if you were a fellow human being.
You’d think that last one goes without saying, but I can assure you it does not. In the olden days, it used to be called a bedside manner. When I was little, my parents used a doctor that they admired because he called a spade a spade, or some other such ridiculous euphemism for being an absolute jerk. The guy would only talk to men. Women and children ranked somewhere below the barn cat’s third litter of kittens in importance. He smoked like a chimney and so did my dad; both of them died young. Dad used to laugh about the doctor NOT telling him not to smoke, because, “how could he, he smokes more than I do!” I’ll always wonder if a better doctor might have let my dad live to see his grandchildren grow up.
Competence means learn all you can in school and learn where to find information when you’re out of school. Continuing education and research/internet skills are important.
Attitude and respect for patients seems like it would be simple, but clearly is not. A young doctor at my first visit cheerfully informed me that the insurance actuarial charts for my demographic meant I would live to be (N) number of years old. I told him that was my age right now. The deer in headlights look on his face was priceless. The backpedaling began, and the more he talked, the deeper he dug the hole. He finally stopped talking and looked at me and waited. I said nothing. It wasn’t my job to bail him out of a screw-up, and I didn’t. He deserved to squirm for saying shit like that. He wasn’t there very long and I never saw him again. I would like to think he won’t say that again to another patient, but I’ll never know.
“Most people ...”
Don’t respond to something I tell you by saying, “Most people don’t have this problem.” Example: I have some severe (anaphylactic/crash cart) reactions to certain drugs.
When you say, “Most people don’t have reactions to xyz,” you are telling me that you don’t care if I code. Because that’s exactly what I hear.
Maybe you don’t know that people can die from reactions to medications. Maybe your attitude is “win a few, lose a few, mehhh.” These thoughts do not inspire confidence in you as a provider. The relative frequency of the occurrence has nothing to do with it. If a patient presents with crisis level vital signs, minor wounds on a lower extremity, and history of encountering a brown patterned snake in the Rocky Mountains. Would you say, “Most people don’t get bitten by rattlesnakes, so I don’t believe you were?” See how silly that sounds?
What is a better way to phrase that? Tell me that in the medical literature, reactions to xyz are less than one in 10,000. Tell me that in your 10 years of treating patients, you have only seen it happen twice. You will be giving me the same message, based on observed facts, and it won’t come across as condescending and passive-aggressive.
I have walked out of procedures when a nurse insisted that I have a certain IV. I said, “No, I’ve done anaphylaxis on this stuff, and I don’t want to do that again. IT IS IN MY RECORDS IN GIANT RED TYPE, DIDN’T YOU SEE THAT?” (Total silence in response.) Then they proceed to argue about how most people have no trouble with this drug, and they HAVE to use it because reasons.
They are not listening and do not comprehend the problem. I’m outta there. Pull that sucker and slap a bandaid on my arm. I’m getting dressed and getting my copay back on my way out the door. I’ve done this more than once, and I’ll do it again if I need to. It works, see; I’m still alive today, writing snark on the internet.
Once was a glorious fight with a doctor at the rural clinic where I went for an infected animal bite. Doctor said I needed penicillin and I said, nope, I have bad reactions to that. Doctor said that most people have no trouble with penicillin, it was the only thing that would be effective for the festering bite, fever and angry red streak up my arm. I just had to “get over the idea of being allergic.” I said “NO,” again and that doctor started yelling and screaming at me for pretending to have allergies. I couldn’t get out that door fast enough and never went back. It meant driving 40 miles each way to a bigger town with doctors who know that drug allergies are real. Guess what? They were able to treat it with antibiotics that were NOT penicillin. What would have been a better thing for that doctor to say?
“What kind of reaction did you have?” is a question that tells me you heard what I said and that you are actively seeking information about the problem. This has been the response of medical providers a lot more often in recent years, and that is definitely a change for the better. This opens the door for a discussion of risks versus benefits of using the treatment in question.
There is a tired old TV trope about “the brilliant doctor with poor social skills,” aka “the asshole doctor with a heart of gold.”
That’s hogwash.
If it walks like a duck and quacks like a duck … that’s most likely what it is.
Don’t Gaslight Me
Do not tell a patient something you could not possibly know WITHOUT PROVIDING A SOURCE OF INFORMATION. “We learned in medical school ...”, “I have seen in practice ...”, or “Research in the medical journals say ...” are all good ways to approach this.
Otherwise, say you are a male doctor, I am a pregnant patient who already has other kids, and you are telling me that childbirth is not really painful. I may be polite to you on the outside, but inside, I’m like, “HAHAHAHAHAHA. YOU CAN’T POSSIBLY know this; you are a DUDE!” I won’t tell you, but you’ve lost all credibility. Tell me where your information came from. I may or may not tell you that your source is wrong. Getting wrong information from a mistaken source is a forgivable offense. Intentionally gaslighting me is not. People know when you are doing that. They really do.
This is especially true in any situation when the demographic of doctor and patient are in mutually exclusive Venn diagrams. Different genders, different ages, different cultural backgrounds, really, this is true any time people are experiencing problems the doctor has not personally experienced. Doctors in their younger and athletic decades of life who talk about the challenges of arthritis and other geriatric concerns are sometimes prone to minimizing things. Please don’t; the pain is real. We want help, not platitudes.
Little kids are especially sensitive to being teased, mocked and lied to. (ie - see the chain-smoking doctor discussed above who always teased me.) My brother once bit a dentist hard enough to draw blood. “He lied to me! He said it wasn’t going to hurt at all. IT DID HURT. HE LIED. So I BIT him.” Adults understand that ‘white lies’ are a tool in the toolbox. Kids don’t.
Patients want to believe their doctors are all-knowing and never mistaken. We might not tell you, but when you say something that we know is wrong, it is a BFD, (a very big deal).
Update: hat tip to old 60s radical for linking a Johns Hopkins study regarding the frequency of death related to medical errors.
Okay, now it’s your turn. What advice would you give medical students to improve care for their future patients? Go.