How to be an Authentic Doctor #17: Be Prepared

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I received a nice compliment the other day. A patient reminded me how I remembered the other issues she had going on from previous visits and asked her about them when I walked into the room. To her it showed trust and credibility and she really liked me because of that. It was very nice and affirming. My ego ate it up. Now, did I actually remember her backstory? I may have but the odds are that I probably didn’t. What I do, however, is try to preview someone’s chart before I walk into the room. This is a tough habit to create but it is totally worth it. Those minutes reading what you did with the patient on the last visit or two can mean the world to them as evidenced by my patient story above.  It also can prevent you from looking like an idiot and confabulating. How many times has a patient asked you, “Remember last time when I (blank)?” and you answered, “Of course” and then proceeded to:

  1. Rack your brain for an answer
  2. Bullshit your way through the whole conversation just praying that something will tickle your memory
  3. Feel uncomfortable the whole visit praying they don’t call you out on your charade

I have been there and done this so many times over the past twenty years that I can’t even count them anymore.   It still happens, but rarely, when I get rushed and I fall into the same trap. It’s embarrassing and it’s bad medicine. But I try and I recommend you do the same. Take the two minutes OUT OF THE ROOM and prepare yourself be previewing the chart. You may even get a compliment out of it someday.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “How to be an Authentic Doctor #17: Be Prepared

  1. Kathy Wire
    May 29, 2014 at 1:20 pm

    Love the article and the comments. And you never know when that jog to your memory will help you recall some important thing that needs follow up.

  2. Kurt
    May 28, 2014 at 9:08 pm

    Ahhhhh, that’s how I survived for 22 years. Just flip/read a few pages back in the chart and look at the problem list. The Plan just about says it all. (Well all of my records were dictated and readable.)

    Now, so much garbage is in the EHR record, much harder to do. Scroll, click, resize this, roll back to that
    all takes time.

    Might have something to do with the fact I just scored third in a patient survey out of 22 in a multispecialty group. Sure wasn’t the dirty jokes or the ESD advice I give to patients. Kurt

  3. Kristin
    May 28, 2014 at 4:09 pm

    Keen observation, I accompany my friend to office visits because they often forget what they were told or forget to mention things. Could be a case of “white coat” where they forget doctors are people too.

    His previous doctor (he goes to a clinic because of MediCal coverage) they would call him from the waiting room, weigh him then lead us of to a waiting room, there the nurse would take his vitals, make notes of any complaints and we would wait…and wait. The chart was outside on the door. The doctor would knock and come in, stand as far away as possible and with a straight face ask what he was there for. His nurse practitioner would then write out any scripts or lab orders as he scurried out the door.

    A week after his last visit he had an appointment with a clinical psychologist who became alarmed at his breathing and vitals and ordered him off to the ER, from there he was transferred to a cardiac unit where he ended up in ICU for a week.

    Now the new doctor takes the time to read the chart, schedules lab tests, calls with the results and can actually remember his name when the walk in the exam room.

  4. Jay Cooperman
    May 26, 2014 at 10:35 pm

    Excellent advice.

  5. May 23, 2014 at 10:30 am

    Look at something to jog your memory – never, never, never walk in a room “naked.” Patients would forgive you for no pants – they won’t forgive you for no brains.
    And after the MANDATORY CHART REVIEW, if they bamboozle you , #2 and #3 is out. Do #1 and if you hit a blank, just say honestly – “Sir/ma’am, I’ve just hit a blank, because I’ve seen a few people today. Please jog my memory.”
    The Worst Thing for me and some other doctors is PEOPLE’S NAMES. I’ve tried all sorts of tricks – but it’s just not in my recording studio. I’ve had patients ask me – “don’t you remember my name?” and absolutely draw a blank. Tell the truth. Then tell them something you recall about them – that’s much easier. “Didn’t you ask me last visit about whether to take melatonin for sleep?” or “Didn’t you tear your ACL in 1967 when you got arrested for streaking in Dodger Stadium?” (Don’t say the last one unless you’re pretty darn certain.) That way, the patient knows you’ve got your recorder on, but you’re just as human as them.
    I’ve never been bawled out by a patient for showing human characteristics. And “I’m sorry.” rarely constitutes prima facie evidence in litigation. Use it as needed.

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