Tuesday, November 27, 2012
1. Acknowledge the potential awkwardness of the situation during the initial visit: Doctors are used to being in charge and calling the shots (no pun intended). When a doctor becomes the patient, however, the roll is reversed. Now it is the doctor sitting in the waiting room, patient chair, filling out office and insurance forms, etc. When first meeting the doctor-patient, it is helpful to say something like, “Well, I understand that this may feel a little bit awkward, but I’ll do what I can to make the situation as comfortable as possible.” Doctors usually appreciate this and you may be surprised how many will quickly say something like, “I am here as a patient. You are my doctor. And that is how I would like it to be.” This is the best possible situation but in other cases, there may be more resistance. See the next few points for handling this.
2. Allow for some creature comforts: I usually ask doctors how they preferred to be referred to in the clinical note (e.g., Dr. Smith or Mr. Smith) which gives me a good sense of the degree of formalities that will be involved in the case. Some doctors will insist on being called “Dr.” in the note and during personal interactions. While some evaluators may balk at this under the assumption that it blurs the doctor-patient boundary, the next point will show that this does not need to be the case. In my experience, this is typically not an issue worth having an argument about and is a good creature comfort to provide to help establish rapport. Another creature comfort that doctor-patients enjoy is conveying their status in a more passive way during the evaluation, such as wearing their professional name badge and/or hospital garb during the appointment (some of which may say Dr. Smith on it). It is best to understand that this allows that doctor-patient to feel more comfortable rather than feeling offended or threatened by it.
3. Make sure that boundary levels are still maintained: While allowing for some creature comforts is ok, one has to be on guard against imbalances in the doctor to doctor-patient relationship. For example, while on may refer to the doctor-patient as Dr. Smith, the doctor-patient should not simultaneously be referring to the treating doctor by his/her first name only.
4. Maintain control over the evaluation: This is related to point 3 and one of the most challenging aspects of the evaluation. Doctors are intelligent, fluent in medical jargon, and know how to discuss research findings. In fact, the doctor-patient is very likely to be more of an expert in some type of health care area than you are. This can be freely acknowledged in conversation in a way that makes the doctor-patient feel respected. However, always remember that the doctor-patient is coming to you for an evaluation because a) you have expertise in an area that he/she does not have or b) he/she cannot treat him/herself in an area of shared specialty (e.g., a neurologist treating another neurologist in the same sub-speciality area). Be on guard for the doctor-patient requesting that you to do things (e.g., ordering certain tests, prescribing certain medications) that you do not feel is clinically appropriate given the facts of the case. While patient input should certainly be listened to and incorporated when possible, it needs to be established from early on that the ultimate person responsible for making diagnostic and treatment decisions is the treating doctor. In cases where a conflict emerges about how to manage the case, the treating doctor will need to clearly convey his/her position with supportive evidence and proceed accordingly (see next point).
5. Present scientific data when possible: Doctors are trained in the scientific method and are more likely to agree with diagnostic formulations and treatment recommendations when presented with reference to supportive empirical data. This can include reference to laboratory test values, diagnostic imaging results, published diagnostic criteria, empirically supported treatment recommendations, reference to specific research studies, etc.
Suggested reading: A Taste of My Own Medicine: When the Doctor Is the Patient
Posted by MedFriendly at 12:09 AM