I’m a medical student and I just got back a bad review from a practice patient that has left me feeling a little blue. I really do want to be a good doctor and liked by my patients, so I would love to know what makes you like your doc and want to go back to them.
I purposely chose not to make this a poll because I don’t want to limit/bias people’s ideas, but I can throw out suggestions if people like.
Thanks you guys!
Listens to me. Everything else is secondary. I’ve had some very bad experiences with primary care physicians, and I can make a few recommendations: Show up for appointments, don’t try to sell me anything 
, if I call with an issue, return my call (or at least have someone return it for you) within 24 hours.
But by far the most important thing is to listen. You may know exactly what’s wrong with me, and know that it has nothing to do with whatever issue I want to tell you about, but that doesn’t mean you can just cut me off, or speak to me as if my opinion is worthless. I know that doctors are stretched and don’t have a lot of time with patients, but just listening makes a world of difference in how the patient feels about you and your advice.
Where I live, in Ontario, a pulse is all that’s required.
Could you elaborate on why you think that’s the case, and what you would like to see in a primary care doc (besides a pulse :))?
[ul]
[li]Sobriety[/li][li]Easy access when I’m sick. I.e.–allows walk-ins.[/li][li]Makes getting non-pain-killer presecription refills simple.[/li][li]Listens.[/li][li]On my Insurance.[/li][/ul]
It’s just that there’s such a profound shortage of doctors here that anyone will do. People wait years before finding a family doctor.
I have a doctor, but only because she was my wife’s doctor before we married, and so I was accepted in as family. To be honest though, the last time I saw the doctor was maybe 8 or 9 years ago. Anyone with competence would be fine by me. I don’t really care about bedside manners or gender or anything. If I need to see a doctor, I want competence: that’s about it.
Listen to my history and take account that I have some experience with my chronic condition – and don’t pretend you know more than you do about what causes it. We both know no one knows what causes it, so how about you don’t look like a stupid liar by lying to me that you do.
ex: I have dishydrotic eczema. It doesn’t itch, and it’s not apparently allergenic. It is triggered by stress. Yes, I am aware that eczema normally itches furiously. Mine only itches when I have an infection. When I tell you I have an infected patch of eczema don’t pat me on the head and say “eczema itches.” Mine doesn’t. When come back, bring staph culture and do not bring condescending attitude.
In advising a course of treament, please explain why you are advising this thing, and briefly explain some of the other options and why you’re not advising them. Try not to live in the magic world where cost is not a concern to people. Its odd but vets will generally offer several options at different price points/chances of success, but doctors rarely do that.
Be Physically gentle - I get very anxious around doctors and I’m already pretty much a wuss when it comes to pain. Do not grab, yank, toss, mutilate, spindle, or burn my body, thx~. If you’re about to touch me, please tell me what you’re going to do so I can try not to freak out. (also: my white coat hypertension is extreme. Please take my blood pressure at the end of an appointment).
Be honest - If something is going to hurt, just tell me so. I have ways of dealing with it, such as by looking away, focusing on my breathing, and consciously relaxing. I can’t do those things if you surprise me. If you lie to me about this, I will likely never return to your office.
I would want a doctor who is willing to spend plenty of time with me, who is pretty thorough in the exam. I also think having a doctor who is a good listener is really important. I also really, really dislike doctors who talk down to me, or who don’t give me enough information to make a good decision. For example, if a condition is new to me, don’t just say, “Take X and come see me in three weeks.” Tell me what is physically going wrong, what the treatment hopes to accomplish and how, and what the chances of success are.
My favorite medical practice was the midwifery group I went to when I was pregnant. When I checked in, I was given my file and sent to the bathroom, where I got a urine sample, tested for nitrates or proteins or whatever (it’s been awhile), recorded the results in the chart, visited the nurses station for blood pressure/blood draw, then spent quality time with the midwife. The actual meetings with the midwives varied from 15 to 45 minutes, depending on how complicated the visit was. We had long conversations about why exactly it was important to get more protein and iron in my diet. We also had lengthy talks about how to handle various side effects of pregnancy, and what types of things I might expect during labor and delivery. I always felt that the relationship with the midwives was a real partnership.
Also, don’t introduce yourself as Dr. Lastname if you plan to call me Firstname.
Communication is key. I want you to listen carefully,a nd let me know what you think that means, what the possibilities are that youa re going to address, and what treatment options you have decided upon/rejected and why.
No, I don’t expect a medical education, just pay attention and understand that I have an excelent mind and am the primary stakeholder int his outcome.
Technical competence and efficiency. Unlike most of the other posters, I really don’t care if you’re patient, have a decent bedside manner, or whatever. It’s nothing personal, but I don’t want to see you - and if I’m in your office, I want to leave as quickly as possible. By all means, listen as thoroughly as required to produce an acceptable medical history and diagnose my condition - but if I walk in with, say, whooping cough, you’ll probably know that as soon as you hear me. Just tell me what I have, write me a scrip, and let me know under what circumstances I should come back to see you again.
Oh, that’s a huge pet peeve of mine. I hate it when doctors do that. I shattered my kneecap in a car accident when I was 20, and the first time I saw my orthopedist after the surgery (ie when I wasn’t high as a kite on painmeds) he used my first name. So I used his. He got very offended and started lecturing me about how he didn’t give me permission to use his first name, that it was Dr ____, and so one. The med student looked terrified and his nurse looked like she was bitting her tounge really hard to stop herself from laughing. He was one of the best orthos in the area and in his late 50s. For the rest of my visits he made a point of addresing me as Mr Lastname with a huge emphasis on the Mr.
The doctor has to take the time to hear my story. Then I want to hear his in terms of my options and guesses as to results. I want the doctor to feel comfortable that I’m not going to sue him and I’m willing to take certain risks that the next patient might not. I have occasionally declined medical treatment and I want to know truthfully what I can get away with. I want a doctor that is flexible enough to deliver a lesser care option if that’s what I desire.
I didn’t realize that was true in Ontario; it is certainly true in Quebec, especially in the Montreal area. There are several reasons for this. New doctors who choose to set up in Montreal are paid only 70% of what they get elsewhere in the province. So the areas around the island are insanely well served, but we on the island get shafted. This policy was put in place by the separatist Parti Quebecois since they never get any seats on the island (I exaggerate slightly) and neither party has any incentive to change it since all the contested seats are elsewhere. At the time it was instituted, there were severe shortages in the sticks (what else is new?) but that is long gone and the severe of GPs is on the Island.
Then there are hundreds, if not thousands, of foreign trained doctors whose immigration was based on that training and who are not permitted to practice because of opposition from the College of Physicians and Surgeons. They are required to undergo residency in a local hospital, not an entirely unreasonable requirement, but then they limit (I think to 20 a year) the number of residencies open to foreign doctors. Then many graduates of our medical schools opt for greener pastures where their choice of where to practice is not so limited and pay tends to be somewhat (if in Canada) or a lot (if in the US) higher.
I live in dread of the day my GP retires. It is impossible to find one these days who will take new patients. About 15 years ago (when he was only about 45) I saw a grown man prostate himself (quite literally) on the floor of the GP’s office begging him to take him and his family as patients. To no avail. Although he is only 60, he is not in the best health, has reduced his hours to only 3 1/2 days a week, takes frequent vacations and is clearly getting ready to retire.
To get back to the OP, listening is a good start. Another thing: don’t try to be omnipotent. Many’s the time I’ve seen my GP pull down a medical tome if something came up he wasn’t overly familiar with. I respect him for that.
Things that probably don’t apply to you yet, but will when you have your own practice:
Scheduling. If I can’t get in for a month with an acute illness, you have too many patients. This is what’s making me fire my doctor this week. My daughter had a wheeze and cough (with a history of prematurity and bronchial dysplasia and a hospital stay for pneumonia in January) and I was told the first available was in 5 weeks. Not acceptable.
Don’t make me see you when I don’t need to. Again, current doctor. There’s no reason for me to make an appointment with the doc for my child to get a flu shot or her third Hep B. Just tell your nurse to let me come see her directly, since she’s the one administering it anyhow. This reeks of bill padding and it’s a horrible inconvenience (especially with the 5 week delay.) And yes, I know you can do that because when I fuss enough, you do it. Just do it without the fuss, okay?
Things you can start (or stop) doing right away:
Don’t write while your patient is talking. That makes me think you’re not listening closely. Yes, I know you have to do your charting, but take the 2 minutes to listen first, then write.
Do read your charting to me and make sure what you heard and wrote is what I said or experienced. I like to know that what you’re going to refer to next time is what I believe happened this time. A GI doc told me several months ago that my daughter “didn’t look like” she had a gluten intolerance, because kids with a gluten intolerance “are usually weaker looking than her.” Last visit, he told me she was “looking better” and that “last time her hair was thin and lanky and she looked weak”. Bwuh? I know he couldn’t have remembered what she looked like from 9 months ago, and he must have been going off his notes, but that description didn’t sound anything like her, or like what he told me he was seeing last time.
Do explain my treatment options. Go ahead and tell me, “this would be my first choice”, but please do give me at least one other option, along with why that wouldn’t be your first choice, as well. I may have different rationales for my choices, and if we talk about them together, we can probably figure out the best treatment option together.
Do tell me the side effects, *especially *the ones I should call you about if they happen. I know docs don’t want to mention side effects, for fear of psyching people into them, but I can handle it. I fired a CNM from Planned Parenthood who had the poor judgment to tell me, a woman with a classical c-section scar, that Cytotec has “absolutely no side effects or risks” when used for cervical dilation. :eek: I didn’t argue with her, I simply left and didn’t come back (and didn’t fill the scrip!)
Don’t tell me that herbs are dangerous unless you have some actual information about the specific herbs I’m taking. Doctors who presume that because it’s not taught in med school, it must be dangerous, just piss me right off. You get a pass if you’ve actually studied herbs, but I know only about 4 MDs who have. Go ahead and ask me what I’m on and why, and I’m happy to give you a list and a list of resources, and I won’t be at all offended if you want to look them up for your own edification and to discuss them with me at my next visit, just don’t assume they’re harmful until you have some evidence that they are.
Don’t try to be my father. That authoritarian physician bullshit went out with the horse and buggy. I am in charge of my body. You are a wonderful, learned human being, but you are also my employee. I hire you to learn the stuff I don’t have time to, just like I hire a plumber so I don’t have to learn to plumb and a mechanic so I don’t have to learn how to work on my car. But, just like my plumber and my mechanic, I expect you to give me information and let me decide what the course of action will be, and I will fire your ass if I’m not happy with your work. 
Oh, yes, please! Time span, if nothing else. Another reason my kid’s doctor is getting fired. I didn’t even realize she was due for her last Hep B until I got a note from her school, because the doctor never told me when to make another appointment for her.
If you have a nurse/tech/assistant take my history down in the chart before you show up, do me a favor and look over the chart before you walk in and essentially make me repeat all that stuff again. It’s polite of you to not come in blind. I know from experience, working in healthcare and having taken many a history myself, that it seems like the presence of a doctor will trigger the patient’s memory near-magically, but use the history and notes to press for more info, where needed.
Listen to me.
Explain to me how you came to whatever conclusion you have come to about what is wrong with me.
Explain to me if there are multiple reasonable options for treatment what they are and what the advantages and disadvantages are, and at least make some pretense of letting me decide which course to take.
If you send me for a test, tell me how the results could change my treatment. If they wouldn’t, give me a good reason why you would want to know them anyway.
If you prescribe medication, tell me what it is, how long to take it, and when I might expect to start seeing some effect from it.
Practice evidence-based medicine, and that includes not recommending some fad diet that your mother-in-law lost 30 pounds on.
Be willing to admit that you don’t know everything. I knew my doctor was a keeper when I asked him about whether I could take a medication while breastfeeding and his response was to pull a book out of a drawer and look it up, instead of blithely reassuring me.
Have an actual way for me to contact you if I have a simple question. If I just need to ask “This prescription you wrote me says take on an empty stomach, but it’s making me nauseated. Can I eat some crackers?,” I should be able to e-mail that somewhere or have a number to call that isn’t the number for making appointments or for billing.
If I tell you I’m nervous about a test for which I’m waiting for results, don’t tell me to go home and get drunk.
Yes, that happened.
Be confident. If you are going to be checking someone’s prostrate, you want to eliminate as many awkward moments as possible. No one want’s to see a physician question himself during an embarrassing physical exam.
Listen. This has been covered already, but people want to know that their concerns are being heard. No one likes the feeling of leaving the doctor’s office thinking that the doctor might have made the wrong diagnosis because he didn’t understand their medical history.
Focus on what the patient wants. Don’t focus all your attention on making the patient super healthy. If the patient’s cholesterol is a little high, then explain that pills are available and what would happen if he doesn’t take them. Don’t just prescribe him the pills as if he no other choice but to take them.
Focus on quality of life. Sometimes an illness can create difficulties besides the medical symptoms. If you can recognize those and deal with them, then people will like you even more.
Do not be judgmental. If I can’t trust you, I will walk out and never be back. You can tell me I’m overweight without harping about it for 10 minutes. You can advise that I stop smoking marijuana. But don’t fucking harp about it unless I’m there specifically to lose weight or stop smoking. Help solve my problem if you want my business.
I had a gyno flat out LIE to me, saying that birth control is patently ineffective in overweight females, therefore he wouldn’t prescribe THE SAME PILL I HAD ALREADY BEEN TAKING FOR A YEAR. Sure, it’s a few percentage points less effective for me than Suzy Skinny. But it’s still far greater than zero, you paternalistic ass. Because of you, I had to waste $80 on a trip to planned parenthood to get a 12 month refill on my existing rx. I can’t believe my medical network INCLUDES assholes like this!
And don’t make the mistake of assuming that all your patients are at the same (low) level of intellect merely because they’re below yours. There’s as large a gap between me and you and there is between me and the high school dropout who just left your office. Speak to your patient’s level. If I tell you “I’m amenorrheic”, as opposed to the last chick who “ain’t got her monthly bidness in a yur!”, please adjust your vocabulary and attitude accordingly.
I hate doctors in general. It doesn’t take much assholery for me to reach my tolerance limit. Mostly it’s the paternalism I can’t stand.
Be aware of the most high pri cultural differences that might come up in your area.
For example, some cultures are predisposed to consider the doctor no less than God and don’t ask ANY questions. Be aware that some people may do this and try to make sure to leave room for questions.
Another personal example: An annoying reflex of mine is that I’ll automatically say no first, then feel silly when the doctor takes that at face value. This happens because I internalized the Chinese way of saying no several times to be polite before saying yes at a very young age. And it still crops up especially when talking to authority figures, even when I’m aware of it. :smack: I’m not saying that you should push stuff on people, but be aware that there might be similarly conditioned reflexes in the people you see.