Like in any relationship, listening is key
What does good listening look like? The doctor sitting at eye level with the patient, making eye contact, and at the right time, speaking loudly and clearly enough, with words that a patient truly understands.
—Susan Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation, Princeton, N.J.
Sitting down with the patient says, “I have time for you.” I believe that saying, “People don’t care how much you know until they know how much you care.”
—Jay Kaplan, M.D., past president, American College of Emergency Physicians, New Orleans
Often, a patient is embarrassed. What we’re talking about is really personal. So a patient will tread lightly and then wait to see whether the doctor can catch what they’re hinting at. If the doctor asks, “Are you sexually active?” and the patient responds, “Well, I’m married,” a great doctor won’t just write down “married” and move on. An engaged doctor will ask, “Wait — what does that mean?”
Active listeners leave some questions open-ended, so patients feel like they have the opportunity to explain what they’re experiencing, not just say “yes” or “no.”
Analyzing all outcomes
Some drugs make you dizzy, others make you go to the bathroom all the time. A patient should ask the doctor, “What will my life be like on this treatment? And is that going to be OK with me?” So many times, doctors skip this step. You want to feel like your doctor is walking beside you.
—Rebecca Sudore, M.D., palliative care physician and professor of medicine, University of California, San Francisco
Great doctors don’t make assumptions about people they’ve treated for a long time. Let’s say a patient visits often for headaches. It is easy to walk into that room and think, I’ll just tweak their meds and tune the patient out. But when you really listen, you may hear things like “I fell two weeks ago” or “I lost my job.”
—Earlexia Norwood, M.D., service chief of family medicine, Henry Ford Hospital, West Bloomfield, Mich.
Showing respect for patients and family
Address the concerns of any family members who are present, and provide a phone number in case there are questions. If the doctor can’t get to all of your issues, which happens often, they should politely say, “Let’s schedule another appointment to discuss that.” And if your appointment ends with a treatment plan, you want the doctor to ask you to repeat it back. That confirms that you have heard the plan and understood it.
With managed care, you’re seeing a patient every 20 minutes, and you’ve got a meeting to get to, and you’ve got stuff going on in your own life. Most people understand how busy doctors are, but they also want to know that, despite all that, the doctor’s still going to do what’s right by the patient.
—Barron H. Lerner, M.D., professor of medicine, New York University’s Langone Medical Center
Slowing down is really hard. And many docs are driven by habit. But if we slow down and pay closer attention, we would pick up on many more things.
—John Kugler, M.D., a clinical assistant professor, Stanford University’s School of Medicine
Building a solid reputation
Where you’re trained doesn’t always represent how good you are as a physician. When I look for a doctor, I also look to see whether they write journal articles in their field. I ask what their reputation is with their colleagues. There are measures out now of how well we do as a hospital system. You can look them up on the internet.
—Martha Gulati, M.D., chief of cardiology, University of Arizona
In an emergency, great doctors are the ones who ask plenty of questions. It’s all about teamwork, so he or she will ask for our assessment, any medical history we’ve been able to gather and what we’ve done so far. Not-so-great doctors? They don’t ask much of anything at all.
—D. Troy Tuke, assistant fire chief, EMS of Clark County, Nev.
It’s important that your doctor stays up with the literature. You don’t want someone who says, “I’ve always done it this way.” Medicine is always changing.
—Lorraine Withers, nurse practitioner, Novant, Charlotte, N.C.
Focus and perspective are essential
A good doctor wants you to understand as much as you can. They’ll help you learn. And don’t be shy about looking things up on the internet. You really don’t want anyone who says, “I’m the doctor, and I’ll do the thinking.”
—Dave deBronkart, patient advocacy pioneer better known as “e-patient Dave,” Nashua, N.H.
What I learned by interviewing doctors who had been through serious illnesses is that it really changes their perspective. One was a gastroenterologist who told me, “I have treated abdominal pain for years, and then I developed abdominal pain. It was so much worse than anything I could imagine.”
I’ve taken care of thousands of patients with miscarriages. But I never really understood just how painful it was until my wife and I had three. We now have three healthy children, thank God, but it really taught me something. Now when I’m treating a woman after a miscarriage, I say, “I’m sorry for your loss. I know it’s awful.” I give them a moment. I don’t just jump into their medical care. It’s like that old saying: “Cure sometimes, treat often, comfort always.” You can’t undo a death, but you can still comfort.
One surgeon told me that, the night before he underwent surgery, his doctor said he had a 5 percent chance of dying on the table. And the surgeon-turned-patient couldn’t sleep that night. He told me later, “I never realized the difference between a 5 percent chance that you might die and a 95 percent chance that you’ll survive. They’re statistically the same, but they have such different emotional meaning.”
Treating the whole person
A great doctor considers the whole person. If the patient is being treated for diabetes, the doctor must also be aware of the person’s home environment — do they have transportation to the grocery store for healthy food? Is there a safe place to walk in the neighborhood for exercise? Do they have money to buy their meds?
Fancy tests are great, but doctors run more tests than they need to. Where I work, we believe that patients expect a hands-on examination. It creates a patient-centered experience. Doctors miss diagnoses when patients are not examined.
When somebody says, “I have chest pain,” a good doctor listens to their whole story so that they can determine the right path to take. Otherwise, every patient gets every test in the book. And then it’s not medicine, because that’s not using your head. Most people with chest pain don’t need an angioplasty. Most of them need some Zantac and exercise.
Be a more empowered patient. You’ll be helping make your doctor a better doctor. If you have a troubling symptom that your doctor is dismissive of, say something like, “But this is interfering with the quality of my life.” The doctor will hear you more clearly and think, Oh, this is a real symptom. Or if you have questions, bring a list and ask them.