Friday, January 14, 2011

Doctor Doctor

The question on my mind today was what exactly makes a good doctor?  I happen to think I have a wonderful doctor and I was thinking about exactly what it is I like about her and what sorts of things a doctor could do that would make me unhappy.  The biggest factor to me is her willingness to not do anything, which is funny because I suspect many or most people would find bad rather than good.  I am confident that modern medicine can do wondrous things but that a significant chunk of what goes on is very expensive placebos or even procedures that do more harm than good.  Certainly some of that is on the shoulders of the patients who demand treatment even for things where treatment is not particularly advised but clearly some physicians are much more willing to just treat overzealously than others.  I like that when my doctor finds something about myself or Elli she outlines what the proposed treatment will do but also what it will not do and what the chances are that it will do nothing.  Knowing that if she really recommends something that it is certainly going to help more than harm is critical to me so I can pursue my usual strategy of getting only the medical help I absolutely must have and no more.

Somehow my doctor is generally available.  I know this is a huge boon because I recall a time before I had a family doctor when I got a really nasty chest cold that led to terrible wheezing and clogged up lungs.  I knew I needed treatment so I went and sat in a walk in clinic for 2.5 hours in utter misery until I could get in to see a doctor.  Having someone who deliberately leaves openings in their schedule to fit in last minute semi emergencies is a sign (to my eyes, anyhow) of a doctor who really wants to be sure patients can get in quickly when that is needed.  Obviously there is a gap between something that is serious enough for an appointment in two weeks and a emergency room visit and I have that available to me most of the time.  As I understand it most family doctors around Toronto just don't have anything like that and if you want to get in quickly you are generally out of luck or you head to the hospital.  Clearly people who aren't sick in the emergency sense need to be seen soon and shouldn't be clogging up emergency services so this availability seems superb for not taxing the rest of the system.

The last thing I very much appreciate is the precise level of familiarity my doctor has with us.  She is friendly and gentle but doesn't try to bother with idle chitchat or other small talk - straight to the point, get it done and get to the next patient.  I suspect many people really do want a personal relationship with their physician and want somebody chatty and eager to get to know them but I really do not; my ideal is someone who deals with the problems I have quickly, answers questions when I have them and then boots me out the door.  A lot of the time in my life I really find small talk uninteresting and unnecessary, particularly in professional relationships, and the fact that my doctor happens to match me in this way is fantastic.  Most likely of these 3 things everybody appreciates the second one as availability is hard to say no to.  I do wonder how many people really want the opposite of what I want in terms of level of medication and 'chattiness' for lack of a better term.  Those are really less about good and bad and more about style.


  1. in my experience a VERY small portion of the patients I see are like you. People who want the quick/to the point version of their information, want to be educated in a succinct way and then want to leave are the the people who make my life easy/rewarding. The people who want more relationship/closeness than is appropriate, who wont tell you want's really wrong, who present only with vague symptoms that they haven't thought about enough to delineate for you in any way are much more common, and time consuming to care for. I believe this would be Rob's opinion as well ... so it's not just the view from this one set of eyes. Interesting topic!

  2. I tend to go to the doctor having thought out what I want to say and what is going on thoroughly ahead of time. For me it isn't at all about being reassured but about getting expert information. I tend to list off every symptom I have thought of right away and give every piece of information available to me up front. I imagine that makes things much easier for the doctor. I figure if it is worth going to the doctor it is worth doing some thinking about ahead of time.

  3. how about this:
    Person: "I'm sick. So sick I had to come to the ER"
    Me: Tell me more. How are you sick?
    Them: I'm just sick. I can't get out of bed
    Me: do you have pain?
    Them: no
    Me: Do you have nausea/vomiting/shortness of breath/diarrhea/dizziness?
    Them: no
    Me: I'll give you a minute to think about what makes you think you're sick so you can explain it to me
    Me: did you come up with anything
    Them: I'm just so sick. I've been sick for 6 months.
    Me: Can you name even one symptoms you've had to help me understand.
    Them: no. I"m just sick.
    Me: sigh

    So real ... not one patient encounter, just a collage of many. It's very hard, and your thinking ahead of time probably helps your doctor be the way that she is. I'll bet she has times in the day when she's not like that ... because she's not getting anything back. Thanks for being one of the people that make my life (and my colleagues lives) rewarding!!

  4. Sky, do you remember when you worked for HRDC and had to program tailored software for them and they wouldn't tell you all of the things you needed to know. They didn't get the right results because they didn't give you the information you needed. Going to see the doc falls into that same category. It should be a team effort and be subject to thoughtful,open and honest discussion by both parties.