TIme With Patients by Stella Fitzgibbons MD
One of the many reasons I left outpatient medicine, except for a volunteer clinic where I get to spend as much time with each patient as he or she needs:
Patient comes to the ER of Big Teaching Hospital because he’s getting worse and nobody can figure out why, in spite of his going to a string of doctors. One put him on propranolol for his tremor, another told him his psychomotor slowing was due to depression and gave him something for that, another handed him a script because he had balance problems that affected his walking, and a fourth gave him arthritis meds for his stiffness. NONE of these docs ever listened to more than one complaint at a time, probably because they were locked into a 15-minutes (or less) appointment schedule. Only when somebody sat down and listened to the whole story could his Parkinson’s be diagnosed. But because it’s easier to write a script than to listen, this gent went undiagnosed for months.
In my humble opinion the Nobel Prize in medicine should go to anybody who can figure out a way to motivate doctors to do a good job instead of seeing as many patients as possible every day.
It isn’t the doctors’ fault. It is impossible to practice good medicine today. The Dr is no longer in charge and has to answer to too many masters, none of whom can diagnose or treat anything and none of whom share their priorities (commercials and mottos notwithstanding)! We really don’t have time to do our job and take care of our patients because of too many demands and too much interruption from third parties – insurance companies saving money, pharmaceutical companies making money, lawyers advertising to make patients money, the government mandating one unsuccessful change after another designed to improve quality and reduce costs but always failing to do anything but steal more and more time from physicians. At the end of the day we are in charge of nothing and responsible for everything. It takes a long time to relate, diagnose, and treat people properly, and we simply don’t have it!
How to “motivate doctors to do a good job instead of seeing as many patients as possible?” That’s no great challenge: just pay according to the time and effort spent to listen and make the diagnosis, which right now NOBODY does.
Sadly, it is not at all hard to diagnose even the most subtle and exquisite problems. It just takes training and practice. Learning how to shut up is a critical part of good doctoring. Learning how to listen is, as well.
Perhaps half the time, when listened to, the patient will give away the diagnosis – “Doctor, do you think this is Parkinson’s?” or even, “Doctor, I think this is a nerve poisoning all over my body.” That’s close enough for a layman’s eye.
It is common for the experience to go about diagnosis with a frog’s mind – “Buzz! a bug. zap.” A tremor. Or dyskinesia. Or depression. It only takes a second or two to diagnose this symptom or another – but it takes a long time to diagnose it correctly.
We practice “Rain-Man Medicine” – something with exquisite attention to detail, but no insight into the greater picture. In fact, we tend, in our society, to live our lives this way. That is the root of the problem, and the quick-fix is not at all apparent to me.