10 Signs & Symptoms of a Good Doctor, Part 1

by Melodie on March 20, 2010

© Adrian Clark

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When you learned you had cancer, it was most likely a doctor who broke the shocking news. And from that point on, a stream of them entered your world – testing, advising, consulting and treating. So how do you know that these professionals are competent to guide you toward healing from cancer?

There are some clear signs, according to Jerome Groopman, M.D., an oncologist who wrote “How Doctors Think.” I’ve synthesized some of his points into a list of qualities to look for in a doctor and added some ways you can help your physician give you the best care possible.

1. A good doctor doesn’t let his personal feelings about you bias his care.

When you sit down with a new care giver, you usually pick up on a vibe from that person pretty quickly. A warm relationship often develops. Yet caring emotions can cause a doctor unconsciously to avoid doing a procedure or exam that’s necessary but will cause pain.

Dr. Groopman describes a young man named Brad, whose immune function deteriorated after several rounds of chemotherapy. He developed a fever. The doctor normally followed a strict protocol to examine his patients who were at risk for serious infection, and began his day’s exam by checking Brad’s eyes, ears, nose, throat and lungs. But his favorite patient was so weak that Dr. Groopman decided not to have him turn over to do the rest of his exam. “Enough for today,” Groopman had said. That decision nearly cost Brad his life. Had Dr. Groopman followed his usual routine–despite the fact that it caused Brad pain–he would have found an abscess on his patient’s buttocks and treated it before it led to a raging blood infection. His affection for his patient had blinded him.

You can help your doctor guard against this error by saying periodically, “I understand that sometimes you may need to do something that causes me pain. I want you to do it anyway so that I get the best care for my condition.”

Unfortunately, medical care is also affected when a doctor dislikes a patient. Research has shown that most patients sense a doctor’s negative emotion, but tend to fault themselves as being too complaining or demanding. They are not likely to address the situation or change caregivers, not realizing how their care may be compromised. Physicians who dislike their patients often interrupt them during visits and come to convenient, but potentially inaccurate, diagnoses.

I chose at one point to stay with a doctor whose dislike (or disapproval) I sensed because she offered a treatment that I believed she best could offer. I worked at improving our communication and didn’t take her negative vibes personally. The outcome was gratifying for both of us. On the other hand, I have not hesitated to find a different doctor when I knew that I could have a good relationship and good care with someone else; the combination is unbeatable.

If you find yourself in this situation, take action. Either communicate your discomfort to your doctor and improve the situation, or find a care giver with whom you can develop a mutually respectful relationship.

2. A good doctor lets you fully explain your story or concerns.

The recounting of your story is one of the most important tools your doctor uses in determining what is wrong and how to address it. Yet on average, physicians interrupt their patients within 18 seconds of starting their account. A good doctor asks open-ended questions and responds to your emotions in a way that draws you out. As you feel free to respond, important clues, cues and new information may be revealed that will guide your care.

It’s pretty common to go into a physician’s office feeling anxious or fearful, especially when the issue is cancer. A good doctor will try to understand your emotional state; this not only provides a sense of relief but will lead to a more complete recounting of the story and, ultimately, better care.

As a patient, you can help your physician by organizing your thoughts before coming to the appointment. Write down the chronology of your illness, a list of your symptoms, treatments, medications and anything else you can think of that might be relevant. Doing so can ensure that you convey complete information to your doctor without unnecessary rambling. And if you find yourself wrestling with guilt over “taking too much of my doctor’s time,” just remember that this dialogue is a critical part of your healing.

3. A good doctor manages time wisely so her focus can be on you.

There’s only so much you can do while waiting in a doctor’s exam room after you’ve flipped through the crumpled magazines. And still the doctor isn’t there to see you. That’s not necessarily a bad thing; it can mean she’s spending needed time with each of her patients and will spend an adequate time with you.

A 20-minute visit may be all that is needed when your symptoms are straightforward and an answer is clear to your care giver. But a discerning doctor will recognize when more time is needed – and will take that time to ask questions and explain her recommendations. Haste leads to errors.

Doctors are busy people, and that’s not going to change. But if your doctor is taking phone calls, being interrupted by a nurse with questions, checking her watch or leaving the room to deal with something unrelated to your case, you can be sure that the steady flow of her thinking is being fractured. And that lack of focus can lead to missteps in decision making. You are paying your doctor to be fully present with you while in her exam room or office.

If you observe this happening, you might ask, “Would it be better if we rescheduled this appointment? I’d like to talk with you without interruptions.”

It’s often the nurses, interns and office staff who allow a physician to work efficiently and effectively. As a patient, you can make them part of your team too – conveying concerns, information and questions that will help them jointly contribute to your good care.

4. A good doctor communicates clearly and sensitively.

I frequently hear people say, “My doctor said to call if I had a little bleeding” or “He said to expect some pain.” But those are vague measures that can mean different things to different people. A good doctor will be more specific: “I want you to call me if you have more than ½ cup of bright red blood from this site within a 30-minute period.” This prevents misunderstandings that could have serious consequences.

Dr. Groopman tells of a woman named Gloria Manning who suffered multiple, complex illnesses. She’d been prescribed many medications but continued to suffer from high blood pressure, shortness of breath, weight gain and chest pain. Doctors had labeled her “non-compliant,” and lectured her for ignoring her prescribed diet and medications. Finally, an astute physician put things into context; Gloria was an elderly African-American woman from the Deep South. She had never learned to read or write, and therefore could not read the labels on her medicine bottles.

A good doctor will explain, clarify and make sure you understand his instructions. One of my physicians recorded an appointment at which she explained critical information, and gave me the recording. She found that patients often needed to listen again to her instructions and teaching in order to absorb the information accurately. Other doctors type or write out their instructions for me to take when I leave an appointment.

You can help your physician by asking specific questions. If you’re talking about pain, ask “How should I expect the discomfort to compare to having a tooth pulled?” Or if he prescribes a medication, you can repeat back what the drug is for, how often it’s to be taken, whether there are any special instructions, and what specific side effects to expect.

Oncologists often describe the probability of a treatment’s effectiveness in percentages. But the way this is phrased can have a powerful impact on a patient’s choice. If a recommendation is stated in the positive, patients are more likely to choose it. For example, “We have a 30% chance of improvement with this treatment” creates a different reaction than “There is a 70% chance of failure and death.”

 If you’re talking about probabilities of a treatment being effective, you can ask, “Would you describe that percentage in a different way so I can understand it better?”

5. A good doctor is clinically competent.

You can find out whether a physician is competent in his field by talking with other doctors or nurses. Check for educational background, licensure, training, areas of research, and any legal action or professional disciplinary action taken against him. A good place to start a search into a physician’s professional background is with his institution’s website which often has a page summarizing much of this material. His state’s department of professional regulation or medical board can also provide information.

One would think education at an elite medical school and long years of experience at a prestigious hospital would create the best doctors. Surprisingly, that’s not the most important indicator. It’s not the education or experience that’s most important; it’s how the physician thinks about a case.

One study of 100 incorrect diagnoses found that inadequate medical knowledge was the reason for error in only four cases. Another study of situations where serious harm came to patients showed that in 80%, a series of errors in thinking led to the poor outcome.

Oncology–in fact, all of medicine–is a mix of science and soul, says Dr. Groopman. Good doctors and their patients embrace both to create life-changing results.

In Part 2, we’ll look at five more “signs and symptoms” of a good doctor, including how to spot some of the common errors in thinking that can compromise your care.

Are there any of these five areas in which you can make a change to strengthen your relationship with your physician? How will you do this?

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