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A little exam fun for me... - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
A little exam fun for me...
All right, everyone:
I posted a request on staircase_wit's journal not so long ago, asking for his autistic spectrum friends to tell me what I, as a doctor, should be doing to make an autistic patient feel as comfortable as possible. I believe, firmly, that communication is the absolute key to healing, and that without it my purpose as a doctor is empty. And comfort is the gateway to trust, which is key to communication.
I'm going to expand it now: I'm asking you, O Best Beloved, and any of your friends who might happen to want to tag along for the ride:

Imagine, for a moment, that it is four years from now and I am practising medicine with my unrestricted license. You are my patient. What should I, as a doctor, be doing to make you want to come back both when you are not feeling well and to maintain your health?

You may look at this situation in several ways. I'm looking for the experiences you've had - the bad and the good - the things that doctors have done to you that you could not stand or absolutely loved. I'm looking for the things you wish doctors would do and the things you hope you will never see. I'm looking for anecdotes, stories, things that are possible in this age of HMO's and managed care and things that you don't think are possible. Spread it out - ask your friends.
How else am I going to learn what people really think?

And now I go to study neurology.

[Edit: I don't care if you all say the same thing, I want to hear what everyone has to say :) ]

now feeling:: curious curious

21 whispers echo . o O ( ... ) O o . whisper a word
daimones From: daimones Date: April 22nd, 2004 05:45 pm (UTC) (etched in stone)
Explain my options! Listen to my questions! Answer them, try to help me think of things I haven't thought of...but don't just treat me like I'm a moron. :) I haven't done much with doctors over my life, sooooo.
squigglz From: squigglz Date: April 22nd, 2004 05:49 pm (UTC) (etched in stone)
...I am scared spitless of doctors. I had horrible experiences as a child-I was sickly, and spent a lot of time in the hospital. Even today, I balk at going to the doctor.

The only decent doctor I ever had was a woman at my family practice. She spoke softly and reassuringly to me. She let me know exactly what she was doing and why. She was aware of my fear of doctors, and did everything she could to help alleviate it.

On the flipside, her colleauge is an asshole. Older man. Aware of my fears, but just didn't care. Very rough and brusque, rude even when I would ask a question.

In the first instance, I came to the office shaking in fear and left reassured.

In the second, I came in shaking and left shaking AND in tears.

The big thing to remember is that the patient doesn't have the training that you do, so it's all very scary when, say, they have a seizure out of nowhere and have to go to the doctor. Talking to them on their level, as a human being and not as some omnipotent pill-pusher is a huge help ^_^

Good luck on your schooling ^_^
mydestination From: mydestination Date: April 22nd, 2004 06:07 pm (UTC) (etched in stone)
I don't think I've had bad experiences with doctors.
I guess one of the main things is to talk to the patient calmy, and let them know what you're doing, because it might scare them and think it's something worse than it really is.

Last time I went to the hospital because my mom got sick, I didn't really like the doctor because he didn't seem to.. care much, I guess. He was only doing his job, which I know that's what he's supposed to do, but I would have liked it if he had been more sensitive, and friendly. The nurse that was helping was really nice, always trying to help and talking to us, making my mom comfortable, etc. So, being friendly and letting the patient know that you're their friend is always good.

Also, try to answer every question, even though it might seem really stupid and obvious, it might not be for the patient, since you know more about that stuff than they do.

I don't know what else. But those are the main things, I think.
mydestination From: mydestination Date: April 22nd, 2004 06:09 pm (UTC) (etched in stone)
Oops, I just realized that I'm just repeating what everyone else said.

Sorry :\
ayradyss From: ayradyss Date: April 22nd, 2004 06:29 pm (UTC) (etched in stone)
No, please, repeat away! It's all right.
tyomniye From: tyomniye Date: April 22nd, 2004 06:26 pm (UTC) (etched in stone)

doctors coming out my ears

Caring is at the top of the list. That and the courage to say that you don't know something but will do your best to find out. Not that I think this will be a problem for you at all but I've had several doctors who come across as being extremely patronizing. They give you the feeling that you're either two years old & therefore don't have the experience to know what you're dealing with, or that you're simply not that intelligent. The neurologist who told me I didn't actually have hydrocephalus was like that. I didn't believe him and went for a second opinion b/c he never bothered to explain why he thought that & all the time he looked at me like I was some sort of lesser life-form. The next neurologist showed me on my MRIs why I didn't have hydrocephalus & explained what I did have.
One other thing that my family dr. from Goshen does that I have issues with: he has a set prescription for anyone who comes in with a cold. He doesn't even bother to examine before he gives you the medication, so if you were developing a sinus infection or strep he'd probably miss it. Complacency and apathy have no place in a doctor's office.
notamos From: notamos Date: April 22nd, 2004 06:30 pm (UTC) (etched in stone)
Everyone seems to be saying 'listen' and that's important, but also believe. I have a very simple acid test for doctors, it has guided me through the rocky shoals of HMOs for years now, and so far has yet to lead me wrong--when I see a new doctor and I tell them something I know to be true about my health and my body, do they believe me? When I tell a doctor that I have a very high pain tolerance and would prefer to stick to over the counter pain medicines, do they nod and recommend a few, then offer to write a prescription for a handful of stronger meds just in case? Or do they give me a blank stare and scratch out the exact same Vicodin prescription they were planning to write anyway? That is, for me, the single most important thing that separates a good doctor from a mediocre one.
feathered From: feathered Date: April 22nd, 2004 06:35 pm (UTC) (etched in stone)
Sorry Nykki, I'm sure you'll be an excellent one, but I still hate doctors, and probably always will. I don't like to be touched. Doctors *have* to touch, usually. So I don't like doctors. Also, I do not like to be looked at very closely. Another problem. I am always horribly uncomfortable around my doctors because they are *always* looking, even when they're not just checking me over to see what's wrong. They watch me constantly when they talk to me. They probably tell you "blah blah blah EYE CONTACT" in school, but I hate it. Give me a doctor who doesn't touch me and looks at the floor while they talk to me, and I'll probably be happy...

When it comes down to it, it's impossible to please everyone. There's no one way that would work to make everyone comfortable. You'll probably be working with children unless you've changed your mind since we last talked, so I don't know if this would work, but it might be a good idea to ask patients what they are comfortable with. With kids, you might just have to hone your people sense and try to find what will make the child feel more at ease. Some kids might feel comforted by touch, others, like me, will be panicked by it. I guess it's just a matter of reading signals and if the patient is old enough to respond verbally, asking what's okay and what's not.
amasashi From: amasashi Date: April 22nd, 2004 08:01 pm (UTC) (etched in stone)
For me, a doctor who cares for my emotional needs will always have me coming back. He may not be the smartest or the brightest, but as long as he understands my feelings and cares, I'll put my trust in him.

He also has to respect my little idiosyncracies and find a way for us to mutually work past them. In other words, he doesn't just invalidate my feelings or dismiss them as being stupid and try to force his routine methods on me.

These are most important to me :-)
clipdude From: clipdude Date: April 22nd, 2004 08:22 pm (UTC) (etched in stone)
Based on what I've read here, I think you'll be a great doctor, if that means anything. On of the biggest things I want when I go into the doctor is to be treated like an individual, not just another patient. I know it is very difficult for doctors to do this; they see a lot of people and don't really have time to personalize their treatment. On the other hand, it feels much nicer when I feel like the specifics of my situation have been taken into account.
unrequitedangst From: unrequitedangst Date: April 22nd, 2004 08:37 pm (UTC) (etched in stone)
I loathed doctors when I was a child. To this day, I'm still not terribly fond of them, and I can't stand audiologists or speech therapists. I find most of them rather condescending, truth be told, and I could probably write at least two or three pages on doctor problems when dealing with the hearing impaired/deaf/disabled, but ... I don't want to spam you. So yeah. ^^;

If you're working with a deaf or hard of hearing patient, make sure your face is illuminated by the light; don't stand with your back to windows/light sources. It's next to impossible to lipread under those circumstances, and many high functioning hard of hearing people need to use lipreading when talking to a person whose voice they're unfamiliar with.

Similarly, don't speak slowly, because it doesn't help your speech and it's just condescending. A little louder is fine, but don't over-emphasize your speech, because that can actually make it harder for us to understand.

I don't know if this is true for other people, but in my particular case, when I lie down, my hearing drops rather dramatically. This usually makes it next to impossible for me to hear anything during a pelvic exam, for instance, or while my stomach is being palpated (sp?), and lipreading is out of the question, since the doctor's face is shaded while they look down, so I would suggest explaining what you're going to do before the exam starts.

And. This isn't really an answer to what you said, but always, always, always test infant hearing, because no matter what nurses say about children's hearing, about half of them don't know what they're talking about when it comes to hearing loss diagnosis. My parents followed every rule in the book, and I still wasn't diagnosed until I was two and a half; it still sends chills down my spine, because I only spoke seven words at the time.

Like I said earlier, I could probably babble a lot more, but I'll be quiet now. ^^;
iliana_sedai From: iliana_sedai Date: April 23rd, 2004 02:43 am (UTC) (etched in stone)
I never wanted to be the person people call "my" doctor... but these are some useful tips I will remember. Thank you for posting them. ^_^
attickah From: attickah Date: April 22nd, 2004 08:39 pm (UTC) (etched in stone)
I agree with what was already said before--I've got a brain. In fact, I've actually got a miniscule amount of knowledge about my body and how it's supposed to work. Talking to me like I'm 3 isn't exactly the high point of my treatment.

Listening to what I have to say, explaining what you're doing to treat my problems, and above all not digging around in my arm when you miss with an IV on the first shot...those are the most important things involved in making me a repeat customer of a health care professional.
surgeonufo From: surgeonufo Date: April 22nd, 2004 11:25 pm (UTC) (etched in stone)
I want to know I'm at the forefront of your thought process for the time I'm in your office.

I want to feel like everything I have to say is being seriously considered, weighed and possibly used.

I want to know I'm not being treated a fool and am hearing truthfully what my ailments are.

I want to know I'm being taken seriously.

I want to know my privacy is secure

I want to be remembered. (More second time, but...)

I want to be a person, not a chart with notes.

If I think of more, I'll add. Hope this helps :)
coanteen From: coanteen Date: April 23rd, 2004 09:25 am (UTC) (etched in stone)
the most horrific doctor i ever had was my first ob/gyn. the woman over-booked patients to get as much money from OHIP as possible (canadian system, fee-per-service. more pts = more $).
i once came in with some questions written out and refused to leave until they were answered, and she said i was disrespectful to my betters. then she got into a shouting match with me...in her waiting room.

so, that's the horror anecdote taken care of.
i think it's hard to be everything to all people. for example, take obs/gyn. most of my female friends want their doc to be sensitive, caring, talk to them, explain what s/he's doing. with most other docs i want that too, but in that particular case i want someone fast and competent, who'll do the job with a minimum of chat.

i think the best thing is to take the cue from the patient. some patients are very involved and knowledgeable, want all options explained and the decisions left up to them. some prefer the doc to make the decisions, and that is their right too.
adapting to the patients' level of need, knowledge, etc is probably the hardest and one of the more important things to do concerning communication.
turnberryknkn From: turnberryknkn Date: April 23rd, 2004 07:46 pm (UTC) (etched in stone)
(reading and scribbling notes furiously)

Do you mind if I post a link to this entry to my own diary, such that my LJ friends can answer the same question on this page (and thus allow us both, and everyone of the rest of us to whom this info would be useful to have it all in the same place?)
ayradyss From: ayradyss Date: April 24th, 2004 12:00 pm (UTC) (etched in stone)
Nope, link away. Spread the word!
cheyinka From: cheyinka Date: April 23rd, 2004 08:50 pm (UTC) (etched in stone)
Some of these are probably related to the fact that I'm an Aspie, so take that into consideration.
Explain to me what you're doing, as many times as I ask for it to be explained, unless (obviously!) there's a reason to do it immediately.
If I need to do something that looks awkward (curling my legs up to my chest, holding my wrist in a white-knuckled deathgrip), try not to comment on it. If it's not possible to do something with me in a certain position, tell me what you need access to and wait for me to figure out how I can coil myself up.
If you don't understand me, ask me to clarify instead of guessing. I won't be offended.
Don't tell me that something won't hurt at all. You don't know what I'm sensitive to. I would rather brace myself for something excruciating and find out that it only hurt a little than brace myself for something hurting a little and end up screaming.
Don't tell me I need to calm down, unless I'm potentially causing harm to myself. I've probably been trying not to panic from the moment I checked in with the receptionist - let me pretend that my attempts to look calm are working.
chemta From: chemta Date: April 27th, 2004 12:17 pm (UTC) (etched in stone)

a doctor....

I believe that a doctor should speak softly, assuringly, and confidently. I may have a headache or a fever, so I don't want a loud voice. However, I want to know that you're confident (give me a solid handshake while you're at it).

Please don't ask me what I want done about it right off the bat. That's tactless... something a nurse practitioner at a university health center does. Give me thought-out options and the benefits and potential problems of each.

Ask questions to get to know me and help me relax while you're doing routine things like shuffling papers or testing my reflexes.

Get me involved. Ask me to keep a chart of my progress if I'm doing a new therapy or taking a new drug (it helps me remember!). Let me know the chemistry behind a drug I'm taking or why you want me to drink warm milk before bedtime. Educate me about my body and the way it interacts with the world.

Wondering who I am? Remember an evening telling stories in a laundry room? Remember a prom that involved light sabers?
ayradyss From: ayradyss Date: May 2nd, 2004 02:36 pm (UTC) (etched in stone)

Re: a doctor....

I remember...and I have you narrowed down in my mind to one of a few people, but memory is hazy, now.
From: sepuki Date: May 2nd, 2004 11:32 am (UTC) (etched in stone)
My husband and I had some horrid doctor experiences a little while ago. One month after the wedding, he fell at work and hurt his back. They told us little, and did a lot of outpatient spinal injections. They were agomizing for him. I remember almost crying in frustration at more than one appointment, because his anestesiologist (-sp?) wouldn't tell us anything. Communicate, clearly and at length if need be. There's little scarier than having your husband's spine tampered with and not knowing what is being done, or what it will do.

I wouldn't ask a doctor to form any kind of emotional bond with a patient, because I'm sure that happens enough of its own accord. I do ask that doctors don't don an apathetic attitude. It's only unnerving. I think...confidant detacted frendliness, maybe?

Also, please, be careful when drawing blood. I know it's a very standard thing, but if it gets messed up it's scary and painful. I had one nurse use the needle to dig tor a vein. ;_;. I had a bruise that extended easily six inches both ways from the puncture. Another nurse did something weird with the bandage afterwards, and it soaked through with blood. I asked him for help (or at least a fresh bandage) when he passed by, but he told me I was fine and moved on. My husband flagged down another nurse who came in and did it right. By then, though, I had blood dripping all over me. I know it's minor, but it was very scary for my husband who's afraid of blood. ^_^''

I don't know if you'll ever actually take blood, since you're going to be a doctor and not a nurse, but it can be really traumatic if it's not done right.
21 whispers echo . o O ( ... ) O o . whisper a word