May 3, 2013

Is Your Doctor Listening to You – Part 2

Part 2 of 2 Parts

In this part I will cover a blog from Dr. Rob Lamberts. I have followed his blog regularly for several years and enjoy his writing style. I also like his outlook on doctor-patient relationships. Occasionally he will cross into doctor-speak, but he generally says what needs to be said in patient terms for everyone to understand. He has a knack for bringing out the best in communications from the patient and from following him on Facebook I can understand why his patients want him as their doctor.

Doctor Lamberts tries to follow this list as a doctor when seeing patients: (Bold are his headings and comments are mine). Read his blog for his analysis.

  1. Listen – He finds a lot of keys by listening.
  2. Direct the dialog – Here he means not just asking the right questions, but keeping the patient on track. He will not accept a patient's self-diagnosis, but he wants to hear the patient's story and see if he comes to the same conclusion.
  3. Believe the patient – He does not want to be considered ignoring a patient. He realizes patients can be self-conscious about what they are saying. He wants the patient to tell him what the problem is and will help by asking questions.
  4. Examine – Dr. Lamberts uses the examination to get more pieces of the puzzle and develop a more complete picture of the problem.
  5. Get more data Family members can often provide other data and it is important to listen to them when an incomplete picture is present. Dr. Lamberts feels that this sometimes prevents additional visits for the same problem. Sometimes more visits are necessary to get more facts or until he asks the right question.
  6. Make a list – This is not just the list that the patient may have which can often provide keys, but Dr. Lamberts makes lists also. He wants to know what are the things he can rule out, and what other possibilities are still in play. This is used to aid in determining which test may or not be needed.
  7. Address the fear Many times this is what brought the patient to the doctor. This fear needs to determined and confirmed as this will help the patient understand what is happening and know that their concerns are being addressed. It is also important to know when the patient does not have fear and may only need an excuse for work or school.
  8. Order the right tests More tests if often not better and can confuse the issue. Dr. Lamberts is correct here and only orders the test to rule out important bad diagnoses or strengthen the case for others. I like his thoughts of tests are not meant to change what I know, but to change what I do.
  9. Look for patterns It is often the pattern that makes the diagnosis, not the symptom. Getting a good, factual narrative from the patient, often eliminates many of the symptoms and creates the pattern.
  10. When all else fails, do nothing – This is difficult for most doctors. The key here is ruling out serious problems. Communication is the next key so the patient understands to call back or get another appointment if the symptoms or a pattern develops. When the patient understands the plan and knows they will have follow-up, patients will cooperate with doctors that communicate.

Dr. Lamberts concludes his blog by giving advice to patients and is worth quoting.
Let me end with a bit of advice for patients:
  1. Tell your story first. If you have theories, tell them only after you’ve told the story, otherwise you may cause the doc to jump to conclusions.
  2. Don’t be ashamed if it sounds silly. You feel what you feel, and sometimes the strangest symptoms are the key to the diagnosis.
  3. Say why you came to be seen. What is the worst symptom and what do you fear the most?
  4. Don’t insist on tests or medications. More is often less. The best doctors, in my opinion, order less tests and give less medication than the worst ones.
  5. Get a plan. Understand what the plan of action is, and when you should call or come back in.
  6. Don’t ever assume. If you don’t get results, never ever ever ever assume “no news is good news.” Never. You got that? Never.
  7. Try not to be an interesting patient. It’s bad when you are a puzzle to your doctor. Words like, “man, that’s interesting,” or, “I’ve never seen anything like this before,” are usually bad signs. It’s even worse when you are presented in front of a group of doctors or are published in a journal. Don’t seek fame in this way. Stay boring.
P.S. That last one is tongue-in-cheek.” Emphasis in bold is mine.

Don't get me wrong, both doctors have good things to say, but I personally feel that Dr. Lamberts is a doctor I would enjoy seeing more than I would Dr. Wen. This is contrary to what I would normally think or do. Both blogs are worth the time reading on a regular basis.

I will mention another blog of mine using lessons doctors have learned by listening to patients.

No comments: