What Makes a Good Physician
1. Sit with patients at their bedside. When
I was first hospitalized with acute pancreatitis during my freshman
year of college, I appreciated that my physician sat at my bedside,
because it showed he cared and had enough time to make me a priority. It
seems like a small gesture, but it makes a big difference. In contrast,
I roomed with this sweet elderly woman named Wilma, and her doctor
would stand at the foot of her bed. This made him seem distant and
disengaged, and the contrast between our physicians was noticeable and
left an impression on me.
2. Recognize that medical decisions can be really difficult for patients, and give them time and space to make these tough choices. Even
though you might have a strong opinion about what to do for a patient,
realize that some decisions have big implications. And some decisions
do not have clear answers. The patient is the one who will ultimately
have to live with the decision. My surgery was the hardest decision of
my life, because there were so many factors to consider and the data is
limited. The stakes were high with waiting until my pancreas got more
damaged or doing the surgery immediately. Both decisions carried a risk
for chronic pain and diabetes. I got conflicting opinions from
pancreatic experts which made the decision even harder.
I
had a physician friend suggest that I ask my surgeon, “If I was your
daughter, what would you do?” I was hesitant to ask this, because I
feel like we have been taught to let patients be autonomous and make
their own decisions. I decided to ask my surgeon anyway. He took some
time to think about it and ended up saying that he would recommend the
surgery sooner rather than later while I still had functioning islets
and was going into this relatively healthy. I really appreciated that my
surgeon did not say, “I can’t answer that. You have to make the
decision for yourself.” I knew I was the one who was responsible for my
own decision, but I needed help in making such a major judgment call. My
surgeon was the one who had witnessed the outcomes of 100+ patients
post-surgery and knew what individual factors contributed to their
complications and recovery. All I knew was the limited amount of data
that had been published and the conflicting opinions I was hearing. I
trusted my surgeon though, and I wanted to factor his honest judgment
into my decision. After answering my question, my surgeon acknowledged
how difficult the decision was for me and told me to take as much time
as I needed. He also told me that it is important to have comfort and
peace about a big medical decision before committing to it.
3. Celebrate the little successes with patients.
If they able to void for the first time without a catheter, celebrate!
If they get out of bed and walk to the chair, celebrate! These little
things are actually a big deal.
4. Encourage optimism.
I think there is a way to be honest with patients while still providing
hope. My surgeon would call the few complications I had during recovery
“speed bumps” instead of setbacks. This implied that I was still moving
forward in my recovery, but these speed bumps forced me to slow down
every once and awhile. My physician’s optimism was contagious, and my
family and I remained optimistic that I would have a successful
recovery. Honestly, I believe attitude plays a huge role in how patients
heal and recover.
5. Collaborate with the nurses. My
nurses were my advocates on the floor, because they spent so much time
with me and really became familiar with the ups and downs in my
recovery. They are so valuable and should never be taken for granted!
6. Ask patients if they have questions. I really appreciated
this from my doctors. They also acted like all my questions were valid,
although in hindsight, I probably asked some stupid ones. (On my first
hospital admission with pancreatitis in college, I asked the ED doctor
what lipase does.) I also think it is important to give patients time to
think if they have questions or encourage them to write questions down.
7. Provide some comedic relief (or at least try). It helps lighten the mood, so the patient forgets about their own situation for a minute!
8. Build a relationship.
Especially if you see a patient for an extended period of time, become
their friend and ally. I had the best chief resident here in the
hospital, and I actually looked forward to getting woken up on rounds
each morning, because this resident was so friendly and caring. She let
me into her life as well, and I learned about her life as a surgical
resident, her upcoming wedding plans, and her new dog. My friendship
with her made me realize the importance of a strong doctor-patient
relationship. And yes, this goes for surgeons too!
A Physician That Needs Extra Coaching…
1. Does not listen. This
has happened multiple times along my journey with pancreatitis, but one
particular incident stands out. When I was in the emergency department
for my 4th hospitalization of acute pancreatitis, the physician insisted
that I get a CT scan. I tried to explain to him that I just had a CT
scan a month before in Minnesota (now I was at a different hospital in
Missouri), and those results were normal. I was not interested in
getting unnecessary radiation and wanted to discuss this further with
the gastroenterologist on the ward since I would be admitted anyway. The
physician walked out of the room and instead of offering any sort of
explanation, he sent the nurse in to give me oral contrast for the CT
scan. I ended up getting the scan, and later the gastroenterologist said
that it probably was not necessary. I really wish I would have been
more vocal in that situation or just had the physician listen to me in
the first place.
2. Assumes the patient knows more than they do.
This may have been because I was a medical student, but I had several
people assume I knew how to count carbohydrates, give myself insulin
injections, etc. I had one physician start talking about hypokalemic
metabolic alkalosis in detail which went completely over my head. That
stuff is confusing for anyone, let alone someone who is sedated from
narcotics.
3. Does not greet or explain their role to the patient. I
had a large care team at the University of Minnesota which was great,
but there were so many people who came in and out of my room that it got
confusing after a while. Some people assumed I remembered them after
our first encounter, but it was hard to keep everyone straight
especially because I have no recollection of my first few days in the
hospital. I think it is helpful to introduce yourself to a patient for
the first few encounters to make sure they understand who you are and
why you are there.
4. Jokes about when a patient will be discharged from the hospital. Please
never say to a patient, “you might be able to go home in a day… or
three,” and then start laughing. Patients get quite sensitive about
getting discharged from the hospital.
5. Acts disinterested in the patient or acts like they are an inconvenience.
I was readmitted into the hospital for dehydration and had a medical
student process my readmission. I am sure he had an incredibly long day
of surgery, and it was obvious that he did not want to be there. I did
not want to be there either but at least tried to be friendly!
6. Stereotypes patients based on their medical condition.
I know we learn the most common presentations of diseases, and our
cases highlight that. But please remember that patients rarely present
that clearly and are a complete whole person that needs to be
considered. Please try not to stereotype patients based on what (may or
may not have) caused their health problem or what medications they are
taking.
