Bad Medicine: The Two Types of Doctors

1372 Relax and Succeed - Every type of doctor

Dear Doctor,

It is my hope that you will receive this with an appreciation for my intent. In no way am I interested in attacking you. To the contrary, I would like to offer my assistance. I have no doubt that you are a good person at heart. I do however feel that you (and many other doctors), would benefit by asking yourself how your patients would define a ‘good’ doctor vs ‘bad’ one.

In caring for my parents, and in tending to my own health for more years than you have been alive, I have witnessed the approaches of a very large number of doctors. In addition, people talk in labs and waiting rooms, and the general consensus about doctors is extremely clear.

Over the last several years there has been a notable shift (as one group retires and another comes on), and there is an increasing number of these weaker doctors. I suspect this is entirely innocent and unconscious, and it may in fact be that modern training leads with better science, but it may have done so at the price of developing a healers approach.

As patients in your waiting rooms and hospitals, we know your receptionists and the nurses you work with are generally the ones who are often left managing the confused, worried or angry patients you leave in your wake. I don’t not see this as an issue with you, which is why I plan to post this publicly, so that all doctors who have this common lack of awareness can also learn from our unfortunate experience.

My hope is that by offering you a compassionate explanation, maybe all of you can be better at what you do as a result. I prefer that, because it seems more likely to generate a win-win scenario for doctor and patient alike. On a broad basis, this increased awareness could have a considerable impact on the quality and cost of care in medical institutions everywhere.

I will begin by stating that I fully support the scientific method and have enjoyed studying all of science’s major disciplines. Many of the tools and methods that have doubled life spans over the last 100 years came from the evidence-based medicine for which I am grateful. It is an extremely solid basis for us to lean on both as a doctor and as a patient.

As important as that scientific knowledge is, it’s still only half the job. Because it’s not a bio-bag of chemistry sitting on the exam table, that’s a human being who is thinking about how good you are at your job the entire time you are with them, and long afterwards as well.

My general suggestion is that many of you would benefit from at least attempting to be aware that you are not singular. You are quietly being compared to every other doctor we have ever seen. In fact, if you are open to improving, the patients themselves can become fantastic resources in what is hopefully a lifelong education in what it is to be a good doctor.

Today, the weaker doctors act as though people like Dr. Patch Adams aren’t real people, and that medicine didn’t change as a result of him, and people like him, offering a bold example of what it is to be a better and more complete kind of doctor. The film, The Doctor (based on Dr. Edward Rosenbaum’s 1988 book, ‘A Taste Of My Own Medicine’) also expresses this same point, though in a much different way.

Many doctors are just people who want high grades or a good salary or status, and the world would be better off if they went into business rather than medicine. Others are equally problematic, but they are simply lacking in awareness, rather than being in the wrong profession.

Those good-doctors-in-potential are more like Patch Adam’s roommate in that film, played by Philip Seymour Hoffman. He is extremely earnest in his desire to be the best doctor he can be, but I would hope that this missive might motivate you to do as his character did, and at least experiment with being this other kind of doctor. I feel confident in saying that it’s very likely to make practicing medicine much more rewarding for you as well as us.

Our problem came from not seeing my father when we came to you. You saw a chart, an old man, a concern about breathing, and a question as to whether his troubles breathing were due to pneumonia, or something relating to his heart. At his age, these things are profoundly meaningful and quite foreboding to those who love him.

In every case, the best doctors will stay aware of that reality, and they will respond to it by offering suitable comfort. This better connects the patient to the doctor and that increases the odds of open, honest communication, which can be incredibly useful to you.

1372 Relax and Succeed - The very best kinds of doctor

In most cases you enter the exam room and often keep your hand on the door handle, as though you’re just ducking in for a second but have to go. You speak extremely quickly, which is complicated by your thick accent. Our family is well-travelled and has always been fascinated by other places and cultures, so we’re fine with a foreign doctor and an accent. But whether it’s done with a thick accent or in perfect English, slowing down to ensure you are understood would profoundly help communication. You never even seem to note whether or not your words have sunk in.

This isn’t an issue with an accent; even if you were speaking English clearly, you go so fast, and seem so generally in a rush, that we honestly almost feel bad interrupting you for clarity about our concern. It does not help you as a doctor when we have a concern, but feel your scheduling needs are taking precedence over our health concerns.

In the case of my father, your response was to let go of the door handle, grab your stethoscope, and listen quickly to his lungs. The entire exam took under a three minutes and you didn’t ask a single question about changes in his diet, behaviour, or about any other useful information. And I wish that was more uncommon but in fact you are in a unfortunate majority today.

If a doctor’s going to use the Socratic Method to come to some sort of well-founded diagnosis, you need data. The better the data the better the analysis. Even from a science perspective bad communication is a loss of valuable data.

As an illustration of how it can be, and of who you’re being compared to and why patients universally prefer the other approach, I will use an example from my own life and my now-retired, but excellent and very popular doctor. I had been seeing him since I was 20.

Every visit started in his office, in comfortable chairs, in a non-medical environment. This helped patients relax. He would review my file carefully, and then he would always begin by asking about my life. How was I eating? How was work? Was I stressed about money or living in excess or using any substances? Data, data, data.

After that 5-10 minute conversation –wherein he relaxed patients so they would talk about scary or potentially embarrassing things– we would shift to the exam room where he would do his examination, ask more questions, and then tell you to come to his office once you were dressed. Once back in there, he was often in a book or on his computer, reading up on the latest relevant studies, or even boning up on some basic science.

The humility of slowing down and checking himself was worth a lot. He accepted that all humans are fallible, and that scientific knowledge doubles every seven months, and his humility bred a strong confidence in us as patients. Also, that kind of constant double checking was why he was concerned about, for instance, opioids, a decade before others even started talking about them. That is being an excellent doctor.

You may be wondering how all of this materially helps medicine, so allow me to provide an example.

I once went in with a very painful, bloated stomach that had become chronic over time. He greeted me warmly, then lead me into his office. He listened carefully, then took me into the exam room to check me over.

When I joined him he was reading, then he turned to me and sat quietly in his chair and stared at me, thoughtfully, with his fingers templed in front of his mouth and his brow furrowed in thought. He searched through mind’s data-banks of the previous conversations we had on previous visits, and here is what he said:

“You’re still dating the Italian girl?”

“Yup. She’s awesome.”

“Wasn’t her mother moving to Canada this summer?”

“Yeah, she got here a few months ago. She’s settling in pretty good.”

“Is she planning on working?”

“Yes, but she’s waiting for paperwork.”

“So, she’s home all day?”

“Pretty much, yeah.”

“So, is she doing any of the cooking?”

“Yeah it’s been great. She’s really good and she does almost every meal.”

“Your last name is Scottish. And your Mom is from Saskatchewan, isn’t she?”

“Yes and yes.”

“Grew up eating a lot of potatoes did you?”

“Tons. Love them.”

“Me too,” (involving himself helps maintain the connection between us). ”But now it’s mostly pasta?”

“Almost exclusively.”

“Since your symptoms line up with the diet change that’s our most likely candidate. Otherwise you’re extremely healthy. For a few people the issue can be gluten, so we can check for Celiac disease but, it runs in families, so if no one else has it that’s much lower odds.

“But when I just checked while you were getting dressed, a lot of gluten misdiagnoses are turning out to be allergies to other things in some kinds of wheat, like fructan. And I just checked, and they often use durum wheat for pasta. So let’s (note, he describes it as something ‘we’ are doing), try cutting out the pasta for two weeks. If nothing happens, we can do more testing, but if the stomach goes back to normal, then we’re probably dealing with an allergy. You can try introducing the pasta one meal a week until your body tells you to stop. The angry mother-in-law I can’t help you with.”

“You want me to go home and tell an Italian woman her cooking makes me sick?”

“This way I get paid for an extra visit after she tries to do you in with a poison meatball.”

Bingo. That worked. I was fine and could eat pasta once or twice a week and I survived the ‘mother-in-law,’ (although that was a close one). Even if it turned out I had Celiac Disease, or any other permanent root cause, he had explained how to avoid it as an issue because there is no effective cure for either Celiac disease or a fructan allergy.

He essentially told me to listen carefully to what my body told me. That’s brilliant advice that I have used since that day. It amazes me how much people will eat things that hurt them and then blame the food rather than change their habit, as he prompted me to do by helping me to appreciate my own role in the maintenance of my own health.

Note, in that example, our trip to the exam room was just to check to see if I had any symptoms I couldn’t sense, but other than that there were no tests required, no expense to the system, none of the common suggestions about drugs or antacids. Just wisdom gleaned from data and a request to follow-up if the food experiment didn’t work.

It saved me time, the system money, and it made me recommend him to all of my closest friends, who were all excellent patients who managed their health responsibly. Plus the doctor and I got to like each other –I considered him a valued friend within a few years. It’s fantastically better than the drive-thru effect that currently exists in yours –and it seems now most– doctor’s offices. You lose as much through that as we do.

1372 Relax and Succeed - There is a reason it is called health care

Doctor, I can appreciate that everything in life is now very expensive and that running an office, and having such an excellent receptionist and all of your other administrative responsibilities, all add up to a lot of responsibility. I do respect that. Just as I want you to see my dad not as symptoms and a question, but as a human with needs, I have done the same in thinking about you.

Please know I am not questioning either your good heart, your education, or the challenges of practicing medicine today. Most patients will come in prepared to respect you, but we will lose that respect if we feel it is not being genuinely reciprocated.

Fortunately, despite the challenges that all doctors face, the fact remains that many doctors do find a way to be this other kind of doctor, so clearly that is possible while maintaining some level of financial viability. I doubt any patient, nurse or medical receptionist has found that the difference between these doctors is about money.

Good medicine is about attention. It’s about, are we distracted or focused? It’s about actual compassion brought on by real consideration of the complete human before us. You’re the leader in the exam room. The patient is often scared, confused, embarrassed or in pain. They’re often in their worst state of mind, so it’s a lot easier for the patient to open up and be honest with you if you’re the one that initiates the building of that rapport, through your demeanor.

To be honest with you doctor, I’m not sure I’ve made anything clear with this. I can see kindness in your eyes despite the rush, so I do hope this slows you down. In my experience, we all get better at any job through realizations of deeper layers of the job we hadn’t previously considered.

I know I have been made better by wise criticism in my own work, so I do hope this has that effect for you as well. The criticisms can sting at the time, but I’ve always liked those moments in the end because they always leave me feeling bigger and more capable, and my aim in taking the time to write this is entirely to be beneficial to you.

My father has always been like a wise Buddha, teaching smart lessons about a good life. And even with dementia, he often has a notably positive impact on all of us around him. He brings out the best in us, and when we lose patience it’s like he’s the monk putting us through our spiritual training.

It’s through his innocence that he does this. Because he is guileless he assumes all others are too. He takes people as they are. That’s why, despite your harried care, he thinks you’re fine the way you are. But it is my hope that with the guidance of your experiences with him, that you too might consider him a temporary guide. Because in the best of worlds, I’d like to think this unfortunate experience will lead you to more fully appreciate your patients as people, not as only the issues they present.

If you’ve managed to keep reading until here, thank you. I do appreciate your consideration and wish you the very best in both your personal and professional life. I do hope hope this communication can help you gain more joy from your work days, because I can only assume it would be a much nicer day spending time with human beings than with just their diseases, injuries and illnesses.

Finally, please don’t forget to thank and value your nurses and receptionists. There are many times when it is they who protect you from angry or painful reactions I’m sure you would rather not experience. I am confident they are often keenly aware of many ways that the doctors they work with could be better.

Thank you.

peace. s

The Star Trek Problem

1266 Relax and Succeed - Star Trek Star Trek was an attemptAlex was just trying to watch Star Trek but he had trouble focusing because he was very upset about what was happening at work. The owner of the company had set up a test to see who should get a promotion. Alex and a co-worker had both worked hard at that test and not only did the co-worker stab him in the back at the last moment, but later he learned that his competition had a secret deal with the boss! It was infuriating. It had been bothering Alex for weeks and tonight he was particularly upset.

“You know, sometimes you don’t act like you care when I’m telling you this stuff.”

“Oh, sorry. I didn’t mean to give you that impression. I just don’t want to engage in conversation about it because every time it comes up you end up really upset, and I care about you so I figured you’d rather watch Star Trek and get your mind off it than to be upset. I didn’t mean for you to feel unsupported.”

“Well I’d like a little more empathy over here. Going through all of that really hurt.”

“I’m sorry Alex. I know you’re hurt. It’s why I came over even though I had plans tonight. When we have an expectation of how things are going to go, it’s a very painful thing when we find out we’ve been working under false pretenses. I know you’re hurt, it’s why I didn’t go to the game tonight and came over instead. But if I care about you I have to do it the way I do it because I don’t know any other way.”

“Well it’s not helpful and I’d prefer if you’d at least consider doing it my way. And how can this crap not upset you? You believe things should be fair, right?”

“Okay, first off, we’re watching Star Trek, so this feels a little Borg-y.”

“Borgy?”

“Sorry. Aren’t they they race that needs you to assimilate to their perspective because they can’t tolerate individuality?”

1266 Relax and Succeed - Star Trek Picard“I’m not asking you to give up your individuality I just want some support for this crap that happened at work! I am not Borging you dude.”

“Okay, I’m sorry. I care about you, and it sucks that you got hurt. I don’t like any part of that. But I don’t look at the world the way you do so it’s hard for me to do what you want.”

“What’s so hard about giving me support?”

“But that’s not what it feels like to me. To me it feels like I’m engaging in co-dependency.”

“Co-dependency? I’m not addicted to getting screwed over at work dude.”

“Are you sure you’re not maybe a little addicted?”

“How do you figure I’m addicted to pain because I got ripped off and lied to at work–all so some idiots could rip me off based on a bunch of lies?”

“I don’t mean you’re some crazy addict, but look; here’s how I see this stuff: You’re upset because you thought for sure you had the inside track on the project that was going to win over your boss . Then you found out that the goof you work with had lied to you about what the boss wanted. So you were mislead and it hurts. That part I totally get because that is super crappy. But you love Star Trek. To me, what the guy did at work isn’t so much a problem; it’s just a Kardashian being a Kardashian.”

“They’re Carda–ss–ians, not celebrities with big butts. And what, you mean he’s just a greedy scummy liar who’s trying to get power for himself?”

“Pretty much, yeah. And you’re half-Klingon, so now you’re all revenge-y because to you, your word means something.”

“How’s that help me?”

1266 Relax and Succeed - Star Trek Cardassian“But if he’s one of the girls with the big butts, isn’t scummy part of the deal? Isn’t that the difference between the crew and the captains on these shows? The crew gets caught up wanting the character to be who they want them to be, and the captains always take them as they are and they manage that instead? So I was just saying, be like a captain. Don’t take what he did personally. He would have done it to whoever he was up against. He’s a… Carda-ssss-ian.”

That did make Alex feel a little better. The guy at work had always been pretty consistent, so it was helpful seeing him as a Cardassian and not as the jerk he was personally. “Yeah, but that still doesn’t explain my boss being a prick.”

“Doesn’t it? To me that makes sense too. Your boss just does what greed does. He’s 100% greedy Ferengi. The Cardassian offered not to ever go after the Ferengi’s job if he got the promotion. He’s lying and you know it, but the Ferengi would happily support the Cardassian being promoted if he felt like it would keep him in charge of the rest of you.”

Alex did have to concede that his boss was pretty Ferengi. “So, what…? You’re saying rather than being personally pissed off about this I should just see it as my Klingon honour being offended by a Cardassian political move that was supported by a greedy Ferengi?”

“Pretty much, yeah.”

Strangely, Alex had to admit; that made it all seem more sensible, and he liked the idea that he got to assume the role of Captain in the deal. “So this is how you deal with stuff like this?”

“I’m half Vulcan half human. I use logic for stuff like your work thing, but I’m still human enough to care that my buddy got hurt.”

“Why did you say I was only half-Klingon?”

“This stuff all happened a few weeks ago. I got that it offended the Klingon part of you, but the fact that you’re still thinking about it now makes me think that maybe your Klingon Dad slept with a Trill, because I think you’re holding onto this memory for longer than it’s worth.”

Alex gave that a think and conceded that it was reasonable. “At least Trills are hot.”

“You do still have that going for you.”

peace. s

Scott McPherson is an Edmonton-based writer, public speaker, and mindfulness facilitator who works with individuals, companies and non-profit organizations locally and around the world.

To Know Oneself

1249 Relax and Succeed - To know oneselfBruce Lee (and I’m sure many others) said that we should study ourselves in action with others in order to better-know ourselves. Many people will hear this and do a cursory glance at their lives, literally looking for examples of them being polite or generous and that will be it. They’ll have self-passed themselves when really what they did was forgo an opportunity for valuable self-reflection.

To study ourselves in action, it is the action within our consciousness that counts. It’s possible to be extremely polite to someone while intentionally manipulating them into something they wouldn’t do had they not been intentionally mislead. What counts is in our internal intentions. When we listen to people, do we truly listen without expectation, or are we in a constant dialogue with ourselves, criticising them at every phrase?

How casual have we all become about our subtle mental criticisms of others? We live within our consciousness. Whether we’re constantly bitching about them, or wanting to be someone other than ourselves, both have us in equally unpleasant landscapes of thought. It’s like going on vacation to a place we’re sure to despise.

1249 Relax and Succeed - The money does not see his own backsideWe have to learn to not accept these mental headspaces. We have to learn to pay attention to that suffering more. Yes, I’m suggesting that we focus on when we’re taking a crap between our own ears. Because that’s what we’re doing when we think uncharitable thoughts about ourselves or others. Other people don’t feel our brain chemistry, we do. Seriously: if we know these thoughts are painful, then voluntarily thinking them is like choosing to open spoiled food so we can smell it better.

We all need to pay more attention to what our brain is doing because, if you’re like most of us, half the time our mind is on autopilot, flying whatever routes our childhood caregivers taught us to fly even if that makes no sense for our own destinations in life. Then when we do become conscious, our unconscious life will feel strangely robotic, as we come to realise that we have no idea why we personally are doing what we’re doing.

Whatever it is–your drinking, your job, your temper, your sadness, your lack of trust–these are all things that were taught to you. They are not the natural you, they are the squashed by your packaging version of you. It is you, but you’re distorted and out of shape. And you can see that shape in how you internally react to others.

1249 Relax and Succeed - You cannot have a positive lifeIf you watch yourself closely, you’ll soon realise that you’re likely to do the same thing one of your parents did (or in rarer cases, the exact opposite). That’s your ego following programming. To be free you have to make that programming conscious. It’s usually painful, so that helps you spot it when it shows up so that you can change direction and end that suffering.

Today, every time you catch yourself criticising either you or someone else, take a moment of meditation and prayer and follow your criticism with a compliment. If you make the latter in person and out loud, you’d be amazed at how fast you can start remembering not to think ill of others.

It’s a good saying, really; “Think ill of others.” To do so is the act of poisoning ourselves with negative thoughts. Clearly that is something we should avoid doing. Let’s take steps in that direction today. By the way, I think you’re awesome.

peace. s

Scott McPherson is an Edmonton-based writer, public speaker, and mindfulness facilitator who works with individuals, companies and non-profit organizations locally and around the world.