How Do I Know If I Have a Good Doctor?

“I went to the doctor that everyone said was the best surgeon for knee problems. Holly cow, was he arrogant! He didn’t tell me anything except than I needed a total knee replacement … and he wouldn’t answer any of my questions … he made me feel so small just for asking.” Deserves a one-star review … bad doctoring here. My advice? Find another doctor.

In a situation like that, never respond, “You’re the doctor,” implying that the doctor knows best; because in today’s healthcare system, often that’s not the case. If you ask why you are having a test or procedure, you are entitled to get answers, period. By the way, arrogance is one of the worst qualities of a bad physician; if you see an arrogant doctor, always move on, or at the very least, get a second opinion.

U.S. Healthcare Industry Lacks Transparency and Accountability

We spend more than any other country in the world on healthcare ($4.3 trillion this year), and among Western nations, we rank last for quality of care … but a lot of corporations and people in healthcare have gotten very rich!

By the way, your increasing medical costs right now are due to increased premiums for insurance, increased co-pays, and sky-rocketing drug costs. (Not the topic of this blog: But the U.S. healthcare system is profoundly unscrupulous and corrupt; capitalism cannot fix the healthcare crisis — this “industry,” especially pharmaceuticals, needs government regulation.)

It cannot be over-emphasized that we healthcare “consumers” are generally naïve, gullible, and too-trusting in a for-profit, corporate healthcare world. Forget the saying there’s a sucker born every minute — in today’s “market,” we are all suckers and snake oil is everywhere.  So, you have a headache or a cough or post nasal-drip, or a thousand other symptoms and your doctor wants to get a CT scan or MRI. Here’s why should you educate yourself and learn to ask probing questions?

One of the ways the healthcare industry takes advantage of consumer ignorance is the over-utilization of expensive (high-priced) resources … so who needs a CT scan or MRI? Apparently, most of us. There are 80 million CT scans and 40 million MRIs done annually in the U.S. … that’s one for every 2.7 Americans … and that’s every year … and yes, more than any other country. And the price tag? The average cost of a CT in the U.S. is $3,275 and for an MRI, $1,325.

Hold on to your hat; here’s the math: We spend $315 billion per year on CT scans and MRIs; that’s almost $1,000 per capita per year.

So, when your doctor orders tests, puts you on a medication, recommends a treatment, procedure, referral, or surgery … you must ask questions. After all, the doctor is usually your entry point into a black-box industry that wants your money. The refrain is Caveat emptor … a fundamental principle in contractual relationships between a buyer and a seller … let the buyer beware.

In other words, in healthcare as in everything else (not quite so essential), don’t buy a pig in a poke!

The Good Doctor-Patient Relationship

“What Should I Do If My Doctor Won’t Answer My Questions?” Answer: Get another doctor.

Communication is the bedrock of the doctor-patient relationship. You should be asking questions, since we patients are often uninformed, intimidated, and frightened … just looking for answers. Words are important, and how those words are delivered matters — an empathic and positive demeanor with timely eye contact should be in the tool box of a good doctor. To be a good doctor is to be a good communicator.

I sent a patient with MS to a neurologist whose reputation was that he specialized in that. But, when I saw the patient back after her consultation, she threw up her hands and exclaimed, “I am NEVER going back to that doctor; he never … not even once … during the whole time I was there … looked at me.”

I have taught medical students, residents and fellows for the better part of fifty years, and I would like to share with you some doctoring (communication) principles that I think are important and you can use them, too.

An important one is eye contact. When a patient is telling me something that s/he thinks is important for me to hear, I look them in the eye, because that’s how the patient knows that I am hearing them. And when I have something important to say, and the patient is perhaps distracted, I ask them, “Please look me now so that I know that you are hearing me.” Eye contact is recognition, and it’s essential to good patient-doctor communication.

In taking a medical history, if I am steering the conversation … “Please tell me about your symptoms and no so much about the tests you’ve had, and the opinions of other doctors” … my last question is always, “Now, you can tell me anything else that you think might be important for me know … that we haven’t already covered.” Listening to the other person’s concerns is essential.

I also believe in “matching and pacing”… body language. Did you ever watch two people locked in a conversation, maybe over a cup of coffee or perhaps discussing a problem at work? Their body language seems to mirror, that is, they have similar postures and maybe even similar gestures and expressions. Matching and pacing is something that good communicators do naturally. But you can teach it to medical students; I do.

Here’s an example of a matching-pacing maneuver that comes up all the time. If I begin talking to a patient and s/he has her arms tightly crossed, which probably means that s/he is not ready to communicate or even that s/he is “defending” against me, what do I do? I cross my arms and try to mirror the posture of the patient. Often, the patient will take one look at me and uncross her arms.

When I first cross my arms, I wait until the patient notices, and then uncross them. If the patient does the same, all is well to start. But if she keeps her arms crossed, I continue to mimic, and as the conversation gets going, I begin “pacing” … I look to move in ways that the patient may begin to mirror, for example, even with arms still-crossed; I may extend a hand to make a point. I am trying to soften the patient’s pose, because getting the patient’s arms uncrossed is to breakdown a potential communication barrier.

Think about body language when you are with your doctor. If your arms are crossed or you are leaning way back, you are sending a negative message. So, sit up, smile, and engage with the assumption that you are your doctor’s equal when it comes to any and all conversations about your health.

Since I am writing about good doctor-patient communication here, I should tell you that I also use a lot of metaphors and teaching tales. For the patient with reflux who continues to down daily diet Cokes: “Say, you wouldn’t fight fire with water in one hose and gasoline in the other, would you?” These work really well and they are less threatening than stern admonitions like, “You have to quit that, or else.”

What Can I ask My Doctor?  Almost Anything … You Have a Right to Answers to Medical Questions that Concern You

So from my side, good doctor-patient communication involves listening, appropriate eye contact, matching and pacing, and the use of non-threatening metaphors. And patients can do the same techniques, especially when asking questions that might make the doctor uncomfortable … you are within your rights:

Why is this test necessary? Will the results change what you do or recommend? How so?

I know that you asked me to sign a consent form for this procedure, but in reality what are the risks that happen more than once in a blue moon? How risky is the anesthesia?

If I were your sister, what would you tell her? How many of these procedures have you done?

Do I face potential unexpected out-of-pocket expenses here? If so, how much, or how can I find this out?

If I don’t have this procedure (or surgery), what will happen? Are there maybe less invasive options?

What are your feelings about second opinions? Could you recommend a doctor for a second opinion?

What are the most common side effects of this medicine? How long will I be on it? What will it cost?

You have a right to ask almost anything to your doctor, especially if you are confused, uncertain, or simply don’t understand a test or treatment… and remember, after you see a doctor or any other healthcare provider, ask yourself:

Did s/he listen patiently and hear my concerns, issues, and fears? Were they addressed?

Did s/he adequately explain tests, treatments, etc. that were, ordered, prescribed or scheduled?

Was s/he a good communicator and did s/he make eye contact with me when we were talking?

Was s/he empathetic, patient, personable and professional? And by the way, was the office and support staff also courteous and professional?

Finally, the doctor doesn’t always know best, because many physicians have conflicts of interest. And you have a right to know even though these questions can rattle the doctor … as perhaps they should do.

Do you get any kind of kick-back, if you prescribe this drug … or use this medical device?

Who owns this surgicenter? Is it you or your family? Is this surgery really necessary now?

A final thought on surgeons and surgery: Surgeons like to do surgery as they may get paid ten-times more per hour in the OR than when they are in the office. When I went into practice, I recognized that this dollar discrepancy posed a potential ethical problem; so my solution was to think of every patient as a family member … would I recommend that procedure for my sister or son or mother? That’s what always kept me honest on that score.

Meanwhile, here are a few procedures in my field (ENT) that are done too often, meaning that they are sometimes unnecessary, including nasal septal surgery, turbinate reductions, sinus surgery, endoscopy, jaw surgery for TMJ, and UPPP for big uvula and snoring. You need to ask questions and maybe do some homework if your doctor suggests that you need one of those procedures.

Caveat emptor … let the buyer beware … your best defense is a doctor who you trust because you communicate well.