In my office, every new patient encounter starts the same way. I walk in and say, “Hello. Let me put down my computer (which I take from room to room), wash my hands” (which I purposely point out that I do before I touch anyone or anything else), and then I turn to the family and greet the child first. Depending on the age, I might be squatting and gently touching the little one who is obviously frightened to shaking hands with an older teen who is unhappy about being here. Then I ask who everyone else is because in this day and age you cannot assume relationships, which have to be recorded in the chart and precisely known for medical legal issues of consent to treat.
All that happens before I even find out why the patient came to see me. (Our medical assistant takes a brief history, but I always take my own.) Every physician has a different style or opening. I usually ask,”What brings you to see me?” Most of the time a coherent story will emerge with a little redirecting and further questioning.
But sometimes (and more often lately) I am confronted with a variety of truly amazing responses:
“I don’t know, my doctor sent us here.”
“Didn’t my doctor send you the records?”
“That’s what you are supposed to figure out.”
Before the visit, every patient of ours receives a package in the mail asking them to fill in the medical information, including medications, past surgeries and an inventory of some recent complaints. We send an easy to read checklist about what to bring.
So, yes, this makes me frustrated when a patient and the family comes unprepared. Our encounter should be a two way street. Time and resources are wasted when the patient doesn’t prepare for the visit. If any of you are interested in the patient forms that we send, you can check out our website. We are pretty thorough.
Then after the history is taken, I preform a physical examination. Many parents are great about preparing their child and preparing me for the unexpected–a child who might not really like to or want to be examined. For those who understand or care, I tell them what I am going to do. Most are okay, but I have to be aware of the ones who hate the tongue depressors–usually they tense up and start to cry when you ask them to open their mouths.
If we are really lucky, the family will have brought in old records, x-rays that were taken (I read my own scans for certain tests), and a list of questions/concerns.
But the really tough part comes when we talk about what my opinion is about what is going on and what the options are. Most people are really grateful that a problem is identified and a solution may be at hand, even if it takes a few diagnostic tests, some change in diet or lifestyle, medications or even surgery. When this happens and we make a plan which is followed through, all is good and everyone seems to be happy.
But that is not what always happens. You explain, questions are asked (or often not), and there is little to no follow through (although I always dictate my findings and recommendations in the presence of the family, and ask 3 times if everything made sense, and if there are any questions). Almost everything we talk about has written material supplementing our discussions. Sometimes I ask the family to repeat back to me what they want to do so I can be sure we are on the same plane.
This is where I become frustrated. At what point have I done everything I can do? I try to educate, but there has to come a point where the family (and appropriate age patient) needs to take some responsibility. With the internet and all the educational materials we provide, the layers of helpers that are available in our office to speak with patients, including myself, I think that communication is sufficient. But it has to be a partnership, a two way street. And I hope for those of you who are planning a trip to the doctor in the near future, think about this patient encounter I have described and decide how you can help your doctor better help you.