Informing patients and families about the things they need to know is a challenging and sometimes time-consuming part of medicine.

One must consider how people learn, and the difficulties of learning under stress. If an illness wasn’t bad enough, many people come into the hospital or doctor’s office with a high level of anxiety because of a previous encounter that may have been very emotionally charged (severe illness in a family member, for example).

The “mistake” that I see some doctors make is to think that they can have a meeting with a patient or family, “have it all out”, explain “everything” and be done with it. But we know that under stress especially there are limits to how much people can hear, understand, and remember. Many are lost in their own thoughts even though they appear to be listening. If a lot needs to be communicated, there should be a plan to have more than one session, and encouraging people to write questions down in betweeen, so they don’t forget and can also organize their thoughts better.

Note-taking, tape recording, etc are OK, BUT one can get focused on the process (writing or operating the equipment) and not really listen to what is being said.

At some point there does have to be some respect for the physician’s time. One of my “pet peeves” is when I have spent a long time with one family member or the patient, and then another comes up and wants the same long session — it’s the patient who truly has the right to a one-on-one session, not every single member of the family individually.

To be a physician, you must get better at this in a never-ending way. Those who don’t have the patience or the willingness should hire an assistant to help them out — it’s not an optional job.

Why stay somewhere you hate, taking ‘care’ of people you fear and dislike? It’s an honest question, and I wish some of you snarling dogs out there would get a grip and admit that it might not be so bad if you have to send out your next set of Xmas cards saying “This year Jim decided to retire from medicine and is now entering a new career as X.” You can do it! It’s a free country!

Maybe you love science, but not medicine: medicine has those pesky humans attached to it. People like me…and I have to tell you, I go out of my way to be grovelingly grateful to my doctors and nurses and admissions clerks and lab techs. It’s a very hard job they all have, and I appreciate their efforts when sincerely given. I moved cities some years ago and had to start all over assembling a team of doctors who pay attention and don’t find me just another annoying sick person. We sick people aren’t the problem, fellas, we’re the reason you went to medical school, but for those of you for whom that’s not enough to get you through the day, all I can say is: CAREER COUNSELING IS YOUR FRIEND!

And for those of you who really do love medicine and its pesky humans, maybe try some minor market research and ask patients to fill out and drop in a suggestion box anonymous comments about your office and your bedside manner. I bet you’ll learn something and be the better for it. It’s not peer review, but hey.

“…you’ve got a condescending edge to you that is a tad scary.”

“…but there’s an attitudinal thing there…”

“…is not only condescending and rude but appears, from his writing, to demonstrate a pathological narcissism that I fear might endanger his patients.”

“…not much to do with compassion and interest in other humans and the human condition.”

“but I’m beginning to think taking care of people is not the motivator for some of you — instead it’s to make money and wield your intellect.”

“I suspect you probably do the same thing off-blog too”

I was not being condescending when explaining that I am a reasonably well educated person, because that is relevant to whether I’m able to follow instructions, take notes and understand what is going on. If I can’t keep up with what the doc is saying and take notes and ask questions at the same time, what about the folks who don’t practice those skills in their everyday jobs like I do? That was the point.

I don’t pathetically clutch my little tape recorder, but I tell you I am quite alarmed and even frightened by the attitudes I see in too many of you posting who are apparently MDs. The anger, disdain and hostility can only get in the way of the service you provide. Service?? Did I say ‘service’? Golly, I did. Because that’s what it is, and I don’t know why that ticks so many of you off. You’re not manufacturing widgets, you’re dispensing advice, and that’s a service. A hostile attitude and lack of respect for your patients will only get in the way of your ability to do what you ostensibly went to medical school for: to take care of people who need you…but I’m beginning to think taking care of people is not the motivator for some of you — instead it’s to make money and wield your intellect.

Part of the problem is perhaps that the selection criteria for medical school have lots more to do with board scores and not much to do with compassion and interest in other humans and the human condition. It’s sad that the highly technical nature of medicine has skewed the med school admissions process to technicians and away from the humanists. It’s changed the interaction with doctors even in my lifetime, making it so much less an art and so much more a science.

Rich thanks for not taking offense at my comment… here’s a quote from you in this thread: “I feel sorry for you that you are more concerned about your affect on the physicians earning potential (or the cost to him/her of substandard care) than you are about receieving high quality care for yourself.” Your comment is certainly one way to interpret what was said, but edges on snide, when it wasn’t the purpose (to my reading) of the person who made the comment. It’s not a productive response from you and to me shows more of a ‘So there!!’ response than one of respect.

And another example: “The article and the piece above are both about hospitalization, not the doctor’s office – I guess written words don’t stick much with you either.” Yes, you’re right, I didn’t follow DIRECTLY on topic to the in patient comment made before, but so what? It made me think of the issue, because I’ve had the same experience as both in patient and out patient [and PS, the canned sheets the nurse hands you when you leave the hospital about eg 'wound care' is not exactly what I need when trying to understand the larger medical issues and effects and expectations about prognosis and recovery.] What’s the point of your comment that ‘written words don’t stick much with you either’? That again is kinda snotty and utterly unproductive. It might give you the feeling that you’ve played the trump card in the conversation, but you haven’t, and in fact have chilled the conversation. That’s what I mean about your attitude, and I suspect you probably do the same thing off-blog too. Reminds me of a snotty wine steward talking down to the poor slob who comes to a restaurant looking for a nice dinner and instead of being treated pleasantly is put in his place. The diner is out the cost of his meal if he goes home feeling stupid; the patient may not open up with critical information in the future if he’s just going to get put down. Just cause you’re smarter IQ-wise doesn’t mean you’re better human-wise. That’s my point. Thanks for listening.

A commenter (1.30 PM)asks if there is any research on the degree to which doctors falsify or spin medical records.

rich, md at first vehemently resists the possibility that doctors routinely spin their records (9.57 am)and claims that there is plenty of research on the issue. However, when pressed, he simply refers to medical pubs search engige and snidely disputes the commenters (correct) assertion that HIPAA would increase the cost of such research.

Obviously, rich, md has no idea about whether reseach exists to support his point. I spent some time researching the topic and while there is plenty on the accuracy of medical records, I found nothing on his point: on whether doctors employ anti-litigation “spin” or falsification in medical records. If anyone has any insight or cites, I’d appreciate it.

The relevant point here, however, is rich md’s presumption of knowledge where he had none. He knew of no research concerning the degree of falsification/spin of medical errors, yet gave the impression he did in order (of all absurd things) to try to win an internet debate. Does he do that when he gives diagnoses and prescribes medications?

Those who resist seeing doctors as wealth maximizers . . . well what can you say? Capitalist society assumes we are all so, and has done pretty well. Other societies (like the USSR) that believed differently well, have done less well.

Finally, the goal of health policy is to institute economic incentives that maximize consumer welfare. Taperecorders or videocams may do that by eliciting superior performance from medical care providers. They’ve worked in improving the performance in other jobs, like retail clothes services–so let’s give it a try!