What do patients want from their doctors?

in Patient | 22 responses

With doctors pressed for time, and patients increasingly dissatisfied with their care, how can physicians do it all?

According to a 2006 study, patients want their doctors to be “confident, empathetic, humane, personal, forthright, respectful and thorough.” But in the age of conveyor-belt medicine, and the standard 15-minute office visit, it’s becoming apparent that today’s physician will have trouble fitting that mold.

There are some tips a busy doctor can use, including, “greeting [patients] warmly by name, asking briefly about important events in their lives, maintaining eye contact, focusing on the patient without interruptions, and displaying empathy through words and body language.”

However, the pearl that I found most useful is prioritizing the list of patient issues. As Larry B. Mauksch, a specialist in doctor-patient communication, suggests “first ask about patients’ concerns and then focus on just one or two of their most pressing medical problems, saving others for later visits.”

Indeed, it’s better to focus on a few issues well, rather than superficially covering an entire list.

Comments

Barb
I would like my doctor to listen without a prescription pad in hand.
Billy
To pick 1 or 2 pressing issues requires addressing all in atleast some detail initially. Not doing so is a disservice that can result in malpractice. That is what takes time quite apart from the fact that the 15min office visit is predicated on medical practice from the 1940′s.
Finn
“confident, empathetic, humane, personal, forthright, respectful and thorough”
That’s my internist! Also my gynecologic oncologist and my cardiologist. I guess I’ve been lucky, but I’ve also been assertive enough to dump previous internists who didn’t listen, were impossible to reach, insisted on following their own agendas that had nothing to do with me, barely spoke then sailed out of the exam room before giving me a chance to ask questions, etc.
I also do what I can to make my office visits go well: I bring an updated list of medications, maintain a log of symptoms to help determine whether changes in treatment are working, bring a written list of issues ranked by priority so even if one of them take more time than expected, the issues we don’t get to are the least important, and take notes so I know what I’m supposed to do after I leave.
Jennifer
I am fortunate to have a very good physician. He has a great “bedside manner” and also is very knowledgeable.
I don’t know about other health consumers, but the way I see it, I want someone who will help me make the right choices for treatment or lifestyle choices.
Physicians are frequently very busy, have to deal with the HMO’s (another topic of its own!) and probably want to deal with someone who has an understanding of what they want and what the problem is they are experiencing.
My vote would be for someone who is a partner in my healthcare. I have a good understanding of my condition, though I am by no means a medical expert and the main reason I visit physicians is for their advice on treatments and lifestyle changes.
Helen
A good doctor/patient relationship has to involve some give-and-take. I think I’ve been lucky to have physicians who respect my intelligence and ability to understand my treatments and conditions. I also understand that they are busy people, that they have my best interests at heart, and that they do not always know the answers right away.
The best relationships are partnerships in which responsibility is divided between doctor and patient. It is up to my doctor to diagnose, treat, etc., and it is up to me to communicate clearly and effectively with my doctor, follow my plan of treatment and do my best to live healthily.
I’m going through what is turning out to be the very long process of being diagnosed with some congenital cardiac funny business. I find I truly appreciate the lengths that some of my doctors go to to help me understand exactly what is going on when I undergo an unfamiliar procedure or get new test results back.
When appropriate, a sense of humour doesn’t hurt either.
David
Concierge physicians likely offer all of this. It truly is, often, a matter of time available.
stargirl65
My patients want it addressed at the one visit so they don’t have to pay another $25 copay to return. I have tried to explain that I can only process so much information at one time and it seems they don’t listen. They want it all and they want it today. Even if they only called an hour ago for a sore throat and we worked them in, they then ask, “Can I get my pap smear and mammogram today too?” Oh and they need refills on all their medicines, even the ones that require complicated lab evaluations and then if they get them they do NOT come back for their previously scheduled appointment. Very frustrating.
family physician
I agree with stargirl65
Patients care more about their wallets than a strong doctor-patient relationship.
Why do so many of them call after hours even though they are clearly told to do so only if it is an emergency? The answer is … because they can. They get the doctor, and it costs them nothing.
But I don’t blame them completely; their health insurance is so expensive that they want to “get their money’s worth.”
WarmSocks
“Indeed, it’s better to focus on a few issues well, rather than superficially covering an entire list.”
And even better to make sure all the patients concerns are addressed thoroughly.
If I make an appointment specifically to ask questions, hire a babysitter so there can’t possibly be any interruptions, and drive an hour to see my doctor, I don’t want to be rushed out the door in ten minutes. Doctors should have a pretty good idea what concerns a person with a specific diagnosis will have, so some basic education and tips on where to find reliable information could cut down on a lot of future questions.
K
“Patients care more about their wallets than a strong doctor-patient relationship.”
I could say that doctors are more concerned with their wallets that a strong doctor-patient relationship. Overbooked drive-by appointments. I once had a doctor walk out the door while I was crying, saying my appointment was over.
If I called my PCP right now for an appointment, my options would be urgent care with a PA or wait 6 weeks for an appointment. I have to take time off from work (I don’t have sick leave) or find child care for my children. I get my 15 minutes, we never get to those things on the end of the list. I could make another appointment for 6 weeks later…
I have several complex medical issues that overlap and dealing with one symptom at a time is not helpful. I rely on google to answer my questions about my chronic conditions and use alternative medicine when possible. Most of my interactions with my PCP involves refills for medication and preventative tests. No laundry list for me…I would guess doctors like the short appointments.
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WarmSocks
@K – sounds like you need to find a different PCP. When I call my doctor’s office, I tell the receptionist why I want an appointment; if it’s urgent I’ll be seen the same day. If it’s not urgent, I might need to wait 3-6 days for an appointment with the doctor; I’ve always been able to see the ARNP on the same day I phone. If you always have to wait six weeks to see your doctor and he doesn’t answer your questions when you finally get in, it might be time to find a new doc.
@Family Physician & Stargirl65: I’d prefer to double-book appointments and pay a second co-pay than have to make the drive a second time.
I have a typed list of issues I want to address, which I give to the nurse when I arrive. My doctor always covers everything on my list, even though I have repeatedly said that I can make another appointment if we run out of time. Usually we stay within the time scheduled, but one time it took half an hour, and one time it took over an hour. I would gladly have paid extra for the extra time spent, but apparently insurance doesn’t allow that.
David
I think patients need to realize that most physicians WANT to offer the best of care to everyone and make everyone happy – appointments lasting 30 minute to an hour – or whatever it takes. We want to be compassionate and sensitive and competent and thorough. But to run a business in the current climate (or to be an employee physician with others running the business) requires a high ‘throughput’ – the industry name for rate of product or service provision. Keep in mind, this is simply, in many cases, to keep the doors of their practices open.
Concierge physicians offer all of the time patients want – but at a premium price. Some physicians simply don’t accept insurances – which is their way of escaping the system. They provide a better service, but patients pay more and may have to file their own reimbursement request with the health insurer.
As a neurologist I often am asked to provide my patients with medications (blood pressure meds, antidepressants) which I did not originally prescribe or I am asked about basic medical problems which I am less qualified to answer. They are asking me because I listen to them more, am more attentive, and they can book appointments with me more easily. But fundamentally they are asking me because I am paid more by the insurers – thus giving me the TIME to address their concerns. Their primary care physicians are harried, have a difficult time keeping up with their schedules, and are booked out for a considerable amount of time. Primary care physicians are reimbursed less and undervalued by insurers. The result is the poor service that patients get, unless they are willing to pay more.
K
“I’ve always been able to see the ARNP on the same day I phone.”
Seeing the ARNP or the PA does nothing for the doctor-patient relationship. Most of the time I have to repeat everything again with the doctor wasting valuable time.
The last urgent issue I had I was shuffled off to the PA. When I had complications with my condition, my PCP was not up to speed and was unable to direct my care (and unavailable for an appointment.) Some relationship.
I have two clinics to chose from…they both operate under the same model of care.
Monica
While I certainly understand the frustration on both sides, I gotta say, I’m tired of the whining of physicians. Yes, your work is hard, boo hoo. We’re all overworked, overstressed and undervalued, and guess what most of us aren’t lucky enough to be doctors. So suck it up, MD. If you don’t like it, you can go do something else. At least that’s what people tell me when I complain about the stresses of my job as a waitress.
David
Monica said “…I gotta say, I’m tired of the whining of physicians.” That’s funny, I didn’t really hear much whining in the comments above.
She also states: “If you don’t like it, you can go do something else.” This is true, and clearly many physicians are doing just that – or retiring early – or finding alternative career paths. But why would you want to state the obvious? Perhaps you feel there is no value in analyzing our health care system, including the many players (hospital administrators, taxpayers, physicians, nurses, patients , etc.) and their concerns. Well then, perhaps you should go read something else. For anyone who is trying to find solutions, though, it should be interesting to hear from providers of health care to see their concerns.
amar
Mainly what I want from my doctor is respect. A show of respect by my doctor puts me at ease and allows me to better communicate with her. The other important quality I look for in a doctor is communication. My doctor is open and explains what her course of action will be and helps me to understand the tests and the treatment plans. She always follows up and will send me a letter if she cannot reach me by phone.
http://hcrenewal.blogspot.com Roy M. Poses MD
It is very hard to do adequate medical care when it is broken up into visits of 15 minutes or less, especially when a patient has problems that are even slightly complex. There are some tricks that make it easier to do barely adequate care under these circumstances, but the tyranny of the 15 minute visit is bad for patients, and for doctors.
What I don’t understand is why so many of us physicians act like the 15 minute visit resulted from an act of God, and must be accepted as inevitable.
In fact, the 15 minute visit is a product of the current system for paying physicians. And this system has largely been driven by how Medicare pays physicians, which in turn has been controlled by the opaque RBRVS Update Committee (RUC).
On Health Care Renewal, we most recently summarized the pernicious role of the RUC here:
http://hcrenewal.blogspot.com/2009/6/letter-from-RUC-and-my-reply.html
Hospitalist
Monica -
Many doctors are doing just what you suggest – packing it up and leaving medicine. It is easier to get a breast augmentation than to get an appointment for health care maintenance. That is the American way. But when we all pack up and leave medicine, who will help you when you scald yourself with coffee (I did it as a waitress) or slip on the floor and break your wrist? Doctors are frustrated because they are having a hard time HELPING THEIR PATIENTS get better care while in the constraints of the system. Not only are there constraints of the system, but this mentality of “fix me after I destroy myself” is incredibly pervasive and has penetrated awfully deep into our society. So far, 6/6 patients today are in the hospital due to alcohol related illnesses and smoking. I still have 9 more to go, all of whom want an hour of my time, right now. I have been a waitress, you have not been a doctor. With all due respect, please do not try to tell me how to do my job unless you have walked in my shoes. That seems to be a favorite pasttime of Americans.
Anon
” Doctors are frustrated because they are having a hard time HELPING THEIR PATIENTS get better care while in the constraints of the system. ”
Doctors helped create the system. They sign up with these third party payment contracts, which to be honest have paid them exceedingly well over the last few decades. If they feel squeezed now then they only have themselves to blame. If you don’t want to be paid in 15 minute increments, then don’t sign the contracts that pays you like that. The choice is yours.
And Monica is right – stop whining. A lot of people who don’t make near as much as you work just as hard. And they don’t have the lobbying power you do.
http://www.headache-treatment-options.com David
I’m going to keep on whining! Whining is the first step in identifying a problem. You then search for solutions, which can be at the macro level (fix ‘the system’) or at a micro-level (quit your job, modify your job, don’t accept insurances). Again, such ‘whining’ does serve a purpose and should help people to understand why physicians are making the choices they are making.
Doctors can decide not to accept insurances, although this is not exactly easy, and depends on the overall wealth of the region in which you live. I wonder if the same people who tell physicians not to whine would then whine themselves about doctors who choose the concierge or no insurance model.
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