Tuesday, February 25, 2014

An Open Letter to Doctors

Dear Doctor,

I can’t begin to convey the frustration I experience as a patient waiting to see you. If it’s not the overbooking that tests my patience, or the rudeness from your overworked office staff, it’s the brisk ten minutes of time I have with you to discuss my symptoms that ends up being misused because you don’t listen.
Let me write this again. You. Don’t. Listen.

Maybe it’s because you’re pressed for time. The health care system is in crisis, and well, you need to see more patients per hour in your clinical practice to offset your financial costs. Perhaps you're having a bad day - or worse, lost your passion and curiosity as a healer and just reach medical conclusions in a perfunctory manner.  

Whatever the reason, being a patient nowadays sucks. Why? Because the time needed for patients to accurately convey physical complaints and seek the underlying reasons for their illness isn’t there.  For many, the importance of doctors listening from a patient’s perspective is no longer part of the doctor visit.
Research tells us that it takes only 20 seconds before a doctor interrupts a patient and directs the diagnostic consult. This is one of the main reasons why 25% of patients are misdiagnosed.  And in half of these cases, studies show that misdiagnosis results in serious injury or sometimes death.

Misdiagnosed patients overcrowd the health care system by seeking further doctor visits and receiving additional medical tests to evaluate their symptoms. So, there's a higher financial cost from not listening to patients. And there's a socio-emotional cost too, with misdiagnosed patients feeling helpless and hopeless, slowly giving up on the medical system.

So, in the ten minutes that’s allotted for me to see you at the appointment, please give me a solid 5 minutes. Allow me time to convey my physical and emotional experiences to you in a way where I know I’m being heard - and that you process the information from my perspective. 

Your Patient


kenju said...

Excellent. Our docs (university system) allow us 15 minutes per appointment and if it looks as if it will go over that, they get an antsy look on their faces. It doesn't give one a feeling of confidence in the relationships.

Dr. Deb said...

Dear Kenju,
I think it's very hard to be a physician these days. The problem I see is that patients don't always know how to assert their needs in detailed but succinct terms. This post was written on behalf of many of my own patients who tell me they feel rushed, overlooked, and diminished. Add the stigma of mental illness, and that makes for even more helplessness on their part. I've also been on the receiving end as a patient in doctor offices that don't manage their practice well - and have had some bad experiences with doctors too.

For the most part, I think once you assert your needs to the physician, the broken system gets interrupted. Suddenly everyone is back on the same page as healers.

Sad that managed care has taken over so much in our lives!

Say said...

I've found that this varies some from region to region. When I lived in a city in Ohio, I had to hunt to find medical providers who valued time with patients, though I eventually did. (Medical tests at the hospital were another thing, though - in, out, they may not even remember your name and they certainly would explain to you what is going on.)

Now that I have moved back to a rural state in Norther New England, my experience with medical providers is SO different. All of the providers I'm seeing up here - and I have health issues that mean I have a few regular providers - seem to spend at least 20 minutes with me. Even my NP (who's my PCP) who works in a fairly large county-wide health system. Some of the providers - like my obgyn - have bios that state that they intentionally keep a small practice so that they can have adequate time with patients. But others just value that and know it's necessary for good care. I've also noticed that providers here take a MUCH more egalitarian and collaborative approach to care; I have yet to see one provider here who wears the white coat of authority, for example, but they ALL did in Ohio.

I wonder how much the surrounding culture and the medical culture of various institutions impact this.

Dr. Deb said...

I am so pleased to hear that you have good experiences. I do think it varies from region to region as you say. The most important thing you did was to find a professional who valued time with patients!


Dawn said...

Agreed! So well said! I had a Dr.'s apt last night, and I left there feeling more frustrated than when I got there. I typically have to book my appts 2 months in advance, then he was 40+ min late taking me in after my scheduled apt time, rush me through the "what's wrong with you" thing and I ended leaving there with only 1 out of 3 issues dealt with!?!? 1 of the issues, I never really did get an answer to because I was rushed onto issue #3 before #2 was dealt with. Oh and the icing: the nurse forgot about me. She said she'd be right back and 20 min later she returned and said "OMG I forgot you were here... ok lets do your breathing lung function test now!" as if it were nothing that she completely forgot about me. I ended up being there for almost 2 hours last night! grrrrr :(

Dr. Deb said...

Oh no! I wish we could slow things down and have the time we need with the doctor - and the doctor needs to have with us.

BTW, I've been forgotten in a consultation room too. I had to get redressed to out and ask if they forgot about me, lol!

Anonymous said...

I have been having a very hard time finding a psychiatrist that will listen and even a good therapist who will listen. I just went to a consult with a Psychologist. She would ask me a question and then shoot down every answer without even knowing my background in detail or really my mental state at for the time I was sitting there. My formal diagnosis is major depressive disorder. She started off with basic questions. Job etc.. I told her I lost my job...her answer "victim mentality"; I told her I am having a hard time leaving the house, again, her answer was "victim mentality." When I told her I was just hospitalized for suicide, yep, she said it...'victim mentality." This went on for the entire hour. I don't even know why I just did not stand up and leave. How can someone with a PHD in Psychology actually be like this. I felt beaten up and still do. Being in hospitals, seeing many psychiatrists and therapists, the system is very, very broken.

S'onnie said...

Unfortunately NZ is not much better. There was an article here that said Doctors interrupted patients after just 17 seconds! Of course that is assuming you can see a dr - you need to be registered with a surgery to be able to see a Dr ... where I live in Upper Hutt... there are no drs taking on new patients. so If i want to see a dr I have to go to the one I am still registered at - in another city which a) is almost impossible when sick to do and b) I can't go back there after I lodged a formal complaint about one of the nurses who rang me at work the day after my best friend had passed away and demanded to talk even though I said it wasn't a good time (not only because of my friends death but because my phone line at work is recorded so anyone could have listened to the call) she went on to berate me so loudly that several of my team could hear her and when I said look I can call you in a couple of days she told me she would call me at work and at home each day until I made the appointment for my cevical smear test. I haven't gone back and have of course now moved cities and can't get a dr

Dr. Deb said...

Reading your post saddened me. What a terrible experience for you. Please continue to look for another therapist - one who will be supportive, interested and professional.

17 seconds! Terrible. I'm not sure why professionals don't listen anymore. I hope you can find a new doctor in your new city. Getting good care shouldn't be as hard as it is!

S'onnie said...

Thought i would just add, courtesy of a doctor who diagnosed (incorrectly) after asking just one question I am not sitting in pain with 90% of my skin covered in infection because I was treating the incorrect condition and what I was doing made it 1000 times worse. Finally went to another doctor spent almost 5 minutes asking me questions and looking at everything before diagnosing and giving me medication that will/has actually helped!

Dr. Deb said...

Ugh. I'm so sorry that happened to you.

Jay said...

I have seen the frustrations described in this letter as issues that have severe

Jay said...

I have seen the issues you describe in your letter as prominent- and in the rare disease community, extraordinarily prominent and of concern to the mental health of patients and families. The road to diagnosis is usually long and difficult- taking years and specialists at numerous university hospitals. One individual I worked with achieved a diagnosis of Late-Onset Tay-Sachs Disease after years of misdiagnosis of everything from Multiple Sclerosis to Somatoform Disorder. By the time diagnosis was achieved, palliative treatments had less of an effect than if diagnosis was not so delayed. The psychosocial, psychological and physical remnants were not something I would wish on upon my worst enemy. The Rare Disease Impact Report has managed to establish the existence of this issue quite well: http://www.shire.com/shireplc/dlibrary/documents/RareDiseaseImpactReportforWeb.pdf