The doctors I love

I was musing about how I screen doctors, to whom I refer and with whom I enjoy working.  What makes me pick up the phone and call Dr. A and not Dr. F?  There are basic reasons; do not call a dermatologist to do brain surgery, make sure the doc speaks the patient’s language, it helps to be skilled in that particular disease and, of course, they actually call me back.

However, thinking about how I choose a doctor, it occurs to me that the attributes of skill, communication and results, are the entry qualifications, but they are not enough. They make a Dr. B, not a doctor A.  A primary reason I refer patients to specific physicians is “Carpe Diem.”  Seize the Day.  Or perhaps the cumbersome, “Comprehenderent Patiente,” Seize the Patient.

Its my day off, 7:05am, I am in the kitchen, in my underwear, drinking a cup of coffee, trying to ignore the dog who is excited about the prospect of a walk, when my cell phone rings.  It is Dr. RS.  It is his day off too and he is standing in his kitchen, drinking a cup of coffee and ignoring his dog.  I suppress the underwear image.  He wants to discuss a mutual case that is bugging him, a young man with cancer to whom we have both given care for years.  We go over the problem, come to a solution and at the end of the conversation, and this is key, he says, “Do you want me to handle it? I will call him.”

Even in the early pre-coffee fog, Dr. RS. is taking responsibility, taking control, and seizing care of the patient.  None of the “I will mail a prescription to the patient so he can set up the test, “ or  “have him call my office for an appointment,” let alone, “Why don’t you call him?”  Dr. RS. is taking the patient under his wing to make certain medical care is done soon and done right.

This is key to the best doctors; they see every patient as their personal responsibility.  Patients perceive this kind of care, as “how would you treat your mother?”  It is much more.  It is guaranteeing that every connection is made, every question answered and that whatever happens, whether the medical problem is in that doctor’s specialty or not, the doc confirms that treatment is given without the patient having to stumble, confused, from office to office, hoping to find the right care.  Such “close-the-loop” doctors use their medical expertise and understanding of the healthcare system, to “walk” the patient through until medical issues are addressed and a plan is actualized.

One of the most astonishing office calls we receive is from new patients who have been told to “find an oncologist.”  The patient has a mass or a pain or a bizarre blood test and some “physician” says, “well, you might have cancer” (or even “you do have cancer”), so “go find a cancer doc.” You have to be kidding!  This seems to me like if your house was burning, you call 911 and they send you a list of firemen.

This contrasts with one of the most professional calls we receive, every day, when a primary doctor or surgeon calls our office, insists on talking to one of us directly and says, “I am here in the office with Ms. Smith.  When can you see her?”

This is not an easy thing for patients to measure, but I think patients can get a sense early, if they are aware of its importance.  Does the doc or office get back to you?  Do they help set up tests?  Do you worry for weeks after a critical test is performed, because they have not told you the result? Do they listen and communicate?  Do they seem to connect and care? Do you feel lost, adrift, or does the doctor captain your journey?

The key to the great physicians is not just compassion, caring about their fellow man. The key is passion, investment in their patients, going not the extra mile, but the basic step of making sure each patient gets complete and connected care.  It is what patients should desire, each patient expect and each patient needs.

9 Comments

  • Thank you for taking time and thought to spell out here what I was blessed with in L.A. county, starting with my family doctor of 20 years, and what I am hoping to find in my new state. The Doctors I Love sounds like a bill of rights for patients. I will be referring to it in my blog.
  • 1940's style custom tailored boxers....:)...thank you doctor...having a primary care doctor that has the office CMA or LPN ..licensed? call and say everything is fine..when your leg is swollen to double it's size..at the radiology group..not OK. Or, the same person seeing your post surgical breast..no man allowed..and being contempt full??? "she wears that scar like a medal".. real stupid behavior...I hate that all men all women stuff. Thank you again for an insight full post!
  • Shellie
    You have described my GP! I've followed him from practice to practice for 18 years, and he now is in practice for himself. He's the doc, there are 4 staff members and that's it. When I was diagnosed with cancer he did just what you thought he should: called the oncologist and got an appointment for the very next day, all while I was still in the office. Same thing for setting up the CT scan at the radiology center. Since then, I have had to switch oncologists, in order to find the same compassionate and complete care that my GP has always rendered. It was worth the search, as I did find an oncologist who is a doctor I can love. The glitch from the patient perspective is that we patients sometimes don't even know that the type of care you describe should be expected. The unfortunate reality is that such doctors/medical staff are few and far between. Patients accept the mediocre level of care that is out there, believing that that is all there is.
  • Mary
    I sent an Email to the oncology chaplain-titled-I'm lost--- I spent 3 months being sick a few days-well a few days from strep. Sometimes it was my throat, sometimes my kidneys, etc. My PCP said it was a cancer problem in my throat. My oncology radiologist said that it couldn't be from radiation, because my mouth didn't dry out- and he looked at my throat and checked the glands. He suggested a virus. The post rad CAT showed the cancer tumors dead. I mostly ached and slept for over 12 hours a day. I finally found an old doctor about 80 years old at an Urgent Care that ran a strep test. It was hot-and atypical strep was the diagnosis, no sign of inflammation and no fever.I got bit by my dog-Let me put it this way-my hospital health system never charged me for the ER visit and the punctures were filled with pus. I just didn't know whom to contact because I didn't have a specific complaint. I wrote my PCP on my EHR, asking for a CBC or anything to see if I had an infection. He told me to get over it and live with chronic pain. I'd change doctors but there's a waiting list of a year to change doctors, and I had one worse than him. I REALLY THOUGHT THAT I'D GONE CRAZY.
    • meyati
      I immediately went to the ER, when I was bitten, and then 48 hours later was hospitalized for all of the pus coming out of the punctures.That was in May.
  • Liz
    Of course you also need good office staff since they can also be a weak link in an other wise good practice. Boy have I suffered at the hands of that one!! - I finally fired an oncologist over that when the office staff problems continued to compromise my care. Too bad as I really liked the oncologist and despite me saying something repeatedly nothing changed - Example: they were notified 2 hours after the test that I had a white count of 0.5 and no neutrophils. I found out as I picked up a copy of the results myself some 24+ hours later since that office never calls anyway and I know how to read blood work. I called them, no one called back, called the next day, was told I could have an apt in 8 days, I insisted and was finally seen at the end of the day only because I said I'd camp out there and waylay the oncologist. Oncologist said he never got the blood results... Variations on the same theme repeated enough times I fired the practice. Reluctantly. Both of my most recent cancers (breast and non-Hodgkin's lymphoma) I have been a victim of the go find a surgeon, oncologist... response. So I then ask who would you suggest. Sometimes you get an answer and sometimes not. On the other hand I am getting good at this (now that I am 5 cancers into this) and even if I had someone recommended to me I'd still check up on what the other choices were, what others said about that doctor... (not to mention getting a second opinion and then see who they would recommend - if I got so lucky they'd do that that is LOL). The trouble is that I do think some doctors really don't know who the best specialist is locally and some do have interpersonal issues with some doctors and so won't recommend them even if they are the last doctors on earth... information overload hits not just patients but doctors too. Interpersonal issues (and friendships) are not confined to just someone's personal life and can cloud judgements as well...
    • meyati
      i personally think that 2 things are going on-practicing covering the rear-end and being in various stages of dementia. Then my first oncologist had a combination of both problems. My problem wasn't with the desk clerk, it is with the administrators and counselors. It took me about 6 weeks to get a new oncologist. I don't have a nurse navigator. The tumor board was rigged, hand picked oncologists were called in early, while the radiologists showed up the next day for when the appointment was scheduled. What's sad is the oncologists that attended. the tumor board asked if they could see me or help out in any way. Meanwhile, I was calling, Emailing, going up in person, cursing, screaming, kicking the walls. I was calling the head office in Texas everyday. Finally I screamed lawyer. In my first visit with my new oncologist, he looked up and said, "You are a delightful person, and I understand your logic. I'm so sorry that this happened to you." Then he told me about his take on the tumor board-and he commented that the radiologists never showed up, I told him they did show up, but it was the following day. Somehow the radiologists and I connected. The radiology worked for me, but I bet we were breaking every rule. I feel so betrayed by most of the nurses anymore. I don't respect them. They complain that they are treated poorly by the patients-maybe it's a vicious cycle-but the staff are the gatekeepers, and you judge a doctor by his staff.
      • First time I ever heard/read this being expressed by someone other than myself. Very well said.
        • meyati
          Thank you, but great minds think alike---LOL

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