Who do you see when you are the patient?

[delco714]

For those commenting on the handshake issue - YES, I get the infection thing. But, my point is......
YES, it DOES affect the interaction with the provider. NOT acknowledging a patient's existence with even a common courtesy sets a poor tone for the encounter - I get more polite interaction with the kid at the local coffee hut than I got from this internist.
NEVER saw her before, know ZERO about her - the corp med did NOT put her bio online. She did nothing to set the tone for the interaction - no introduction - such as - "Nice to meet you. I know you were a patient of Dr X and she went to full time teaching. I would like to hear about your needs and concerns". Instead I was another sheep in the herd of her daily patients with no more concern for me than someone in line with her at the bank. She mumbled that her name was Dr Y and went into my med list as though I was nothing more than a statistic.
Common decency and politeness are professional necessities. I have worked with my share of colleagues who have borderline Tourettes or appear to be on the autism spectrum for social capacity but interpersonal skills are necessary to work with patients - Especially patients never seen before. Instill some confidence. Show some empathy. Be human.
Then we get to the point of having no respect for any knowledge I might have - whether I am a plumber or experienced provider. 
And, I do shake a lot of hands and wash them a lot and offer hand sanitizer to the patients as well.
And, yes, some patients hug me.
So, back to original post purpose - as a medical professional do you have a good relationship with your own PCP?

Asperger's?

And maybe that individual was burned out

What keeps me going when I should be burned is they are counting on me.. lives.. well being.. support.. I turn the burn into mindlessness and use it as fuel the best I can

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[jmj11]

1 hour ago, ventana said:

 

it is amazing that some doctors only function with in what they know 100%

I am almost 20 years out of school and a moderately smart guy (but thats it)

I am faced almost daily with things the I am not 100% on - I read and learn and partner with the patients to always be expanding my knowledge.  I just don't understand how you practice medicine with out always learning and challenging yourself....

In practice I never used the term, "I have no more ideas," or I never just said, "I don't know."  I would say, "I don't know but you deserve an answer" and I would either research it myself, it was remotely related to my area, or set up a referral to someone who would know. There is nothing worse than saying "I know you are struggling" then shugg your shoulders and add, "But have a good day," and walk out.

[Guest Paula]

I don't have a PCP  now but had a PA for years.  She was great and would still treat me like every other patient and we could talk PA stuff, etc.  She is the one who insisted I get tested (when I was minimizing) and voila, I had cancer.  (All good now, surgery cured it, no sequela).  Then I had to get a new PCP because my insurance no longer covered the practice my PA was in.  I got and NP and she was a colleague of mine and did a decent job.  Then I moved and now will probably establish with the one female physician at my new practice and she is new in practice for about 2 years.  I like her.  I don't want to see the retired physicians who work for us, mostly because they are specialists or pediatricians.    

I shake my patients hands when they stand up and offer me theirs (usually men do this, not women).  I usually grab the hand sanitizer when I enter too.  But I touch my patients when I do their heart/lung exams by gently touching their right shoulder, no one has ever complained about that, even in this world of stranger danger touch syndrome, ,etc....you get my point.

 

And of course I choke my patients with their thyroid exam....hahahaha...no one has turned me in for that either. 

[SedRate]

My old PCP was a PA and the reason I became a PA. They were personable, thorough, and pleasant. They moved, unfortunately. Nowadays, I see an APRN who was referred by a family member. She's great; similar to my previous PCP. We usually just end up talking shop. I tried seeing the MD in the same practice when my APRN was unavailable but they were a little stiff and more formal. 

[ICUPA]

My PCP is actually an NP at a women's health practice. I go once a year. No complaints, but I'm fairly young and haven't had any issues. I just go for general health maintenance. 

[surgblumm]

This has been an excellent thread due to the fact that we all have similar experiences and have made choices that best positioned us for care. I am a T2DM patient and early on in my disease I went to five endocrinologists. One quickly told be that I would be on insulin within five years and gave me no hope. I went to the next four and none of them told me to take off my socks . When the basics are not done I don't bother to stay with a physician as what will happen when the crap really hits the fan? Those people reminded me of a female seeing her Gyn and leaving without ever removing her panties. WTF? I finally went to an NP who was so good and diligent and attentive and respectful of my background, who investigated every aspect of my DM that I put her on a pedestal and became a NP advocate only to discover when using some other NPs for other services that they too were  a potpourri of all clinicians and mixed examples of the good, bad, and the ugly.

I have had a PCP internist for 25 years who was considered a "Doctors, Doctor." He was through and had the longest finger ever for my annual physical but became argumentative when I questioned him. I ultimately found other problems and confronted him, such as a lower GFR, and he never suggested seeing a nephrologist. When confronting him he reluctantly referred me to one  but then developed an attitude. I only see him once a year and see his PA for my regular simple medical conditions. She is bright and we have a good rapport as she has seen me speak at multiple meetings and realizes this is one of the pioneers and  should take advantage of what I had to say or what trinkets I gave her.

My best experiences over the past 8-10 years have been with the VA who I go to for all my specialty evaluations except cardiology. I seem to get good caring Doc's who take the time to do a real exam, answer all my questions and respect my 46 years as a PA. I am fortunate to have a good VA hospital although if I needed surgery I would stay with people with whom I have operated with in the private sector. On only one occasion did I have a PCP who was out on maternity leave , be replaces by a NP who was also a medication con-firmer and a five second pulmonary exam , cardiac exam and she looked in my ears. She was worthless after two visits and now i have a PCP again who happen to be excellent. It's one hell of a journey and make me feel sorry for our patients who do not know how to navigate their care and be demanding as most of us are. Sorry for the epistle.

[ventana]

16 hours ago, delco714 said:

Homie I see 30 plus in urology

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sorry can't resist....

hope you are only shaking hands, and maybe you should think about wearing gloves :-))))

 

I can see 30 in a specialty if you are proficient, and keep it to the system you specialize in.  You should not have regular 45-60 min visits but instead 15-30

 

I also have to talk to a fair number of patients seen by specialist who complain they did not feel they were listened to and that is was just an assembly line.  I always fall back to the "they are the specialist and incredibly smart in their field, you need their brain and knowledge so bedside manor is less important"

 

Human touch and eye to eye communication is paramount if you are doing fast visits.  I had the pleasure of sharing patients with a house call psychiatrist a few years back, was always amazed as how she could get in the patients house, introduce herself, touch the patient, do a good MH exam and talk with the patient, and family, put everyone at ease, and be out of the room in about 10 minutes.  Patients loved her, family loved her, I trusted her - and she could see loads of patients.   I learned from her a few things.  1) fully enter the room, know the patients name and use it, shake hands or touch the patient and say "Hi how are you doing" then tactfully steer the conversation to what you need.  

 

 

 

[delco714]

sorry can't resist....
hope you are only shaking hands, and maybe you should think about wearing gloves :-))))
 
I can see 30 in a specialty if you are proficient, and keep it to the system you specialize in.  You should not have regular 45-60 min visits but instead 15-30
 
I also have to talk to a fair number of patients seen by specialist who complain they did not feel they were listened to and that is was just an assembly line.  I always fall back to the "they are the specialist and incredibly smart in their field, you need their brain and knowledge so bedside manor is less important"
 
Human touch and eye to eye communication is paramount if you are doing fast visits.  I had the pleasure of sharing patients with a house call psychiatrist a few years back, was always amazed as how she could get in the patients house, introduce herself, touch the patient, do a good MH exam and talk with the patient, and family, put everyone at ease, and be out of the room in about 10 minutes.  Patients loved her, family loved her, I trusted her - and she could see loads of patients.   I learned from her a few things.  1) fully enter the room, know the patients name and use it, shake hands or touch the patient and say "Hi how are you doing" then tactfully steer the conversation to what you need.  
 
 
 

Urology is mixed. Generally I'm very proficient, but I'm naturally highly caring and supportive.
The only way that volume works is the balance of easy check up from difficult consult or follow up (cancer talks etc). Days where the balance is askew, like yesterday, all but absolutely destroy me.

I don't like to rush visits, and I hate the computer. I do like taking care of people. For as crappy as press ganey is, I have very high scores of patient satisfaction. Sometimes I feel like a sociopath bc of how smooth I can make visits and patients feel warm and at ease, especially new to me patients.

My clinic days are 8-11:45 (last pt) + 1-4 (last pt). I would personally prefer a cap of 25.
I had 36 scheduled with 6 no shows yesterday. If I didn't have those I wouldn't have made it out alive. That's a different story/problem

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[Reality Check 2]

I will likely stir up my millennial counterparts but - oh well, here goes.....

Overall, I think we have lost some human touch and politeness as a society and think of things in Text Mode or online - no emotions detectable in many cases or taken out of context in others.

We have forgotten common human decencies and social skills.

We rely on technology too much and think everything fits into a neat little box of Evidence Based Best Practice.

Maybe we are training new providers to be less human, less interactive and more "diagnostic" or scrutinizing.

I don't think it is a good thing by any means. 

Somehow we managed to establish with patients, diagnose and care for folks without UpToDate, without a computer and without Google for a very long time and without telemedicine, stereo stethoscopes, etc.

I fear we are losing our humanity and interpersonal skills. The internist I just saw could be a MENSA scholar, valedictorian and booksmart out the yang but she wasn't a warm or engaging person and she didn't want to actually listen to me or hear who I am or where I come from.

I have to remember that with each of my patients. Some are highly educated, some are type A, some depressed and some not mentally capable of making self care choices. We can't lose our humanity or capacity to care for people as people - not statistics.

Ok, done with soap box............................

[Cideous]

2 minutes ago, Reality Check 2 said:

I will likely stir up my millennial counterparts but - oh well, here goes.....

Overall, I think we have lost some human touch and politeness as a society and think of things in Text Mode or online - no emotions detectable in many cases or taken out of context in others.

We have forgotten common human decencies and social skills.

We rely on technology too much and think everything fits into a neat little box of Evidence Based Best Practice.

Maybe we are training new providers to be less human, less interactive and more "diagnostic" or scrutinizing.

I don't think it is a good thing by any means. 

Somehow we managed to establish with patients, diagnose and care for folks without UpToDate, without a computer and without Google for a very long time and without telemedicine, stereo stethoscopes, etc.

I fear we are losing our humanity and interpersonal skills. The internist I just saw could be a MENSA scholar, valedictorian and booksmart out the yang but she wasn't a warm or engaging person and she didn't want to actually listen to me or hear who I am or where I come from.

I have to remember that with each of my patients. Some are highly educated, some are type A, some depressed and some not mentally capable of making self care choices. We can't lose our humanity or capacity to care for people as people - not statistics.

Ok, done with soap box............................

That's not going to be fixed with a handshake and the subsequent inevitable case pink eye.    

[delco714]

I will likely stir up my millennial counterparts but - oh well, here goes.....
Overall, I think we have lost some human touch and politeness as a society and think of things in Text Mode or online - no emotions detectable in many cases or taken out of context in others.
We have forgotten common human decencies and social skills.
We rely on technology too much and think everything fits into a neat little box of Evidence Based Best Practice.
Maybe we are training new providers to be less human, less interactive and more "diagnostic" or scrutinizing.
I don't think it is a good thing by any means. 
Somehow we managed to establish with patients, diagnose and care for folks without UpToDate, without a computer and without Google for a very long time and without telemedicine, stereo stethoscopes, etc.
I fear we are losing our humanity and interpersonal skills. The internist I just saw could be a MENSA scholar, valedictorian and booksmart out the yang but she wasn't a warm or engaging person and she didn't want to actually listen to me or hear who I am or where I come from.
I have to remember that with each of my patients. Some are highly educated, some are type A, some depressed and some not mentally capable of making self care choices. We can't lose our humanity or capacity to care for people as people - not statistics.
Ok, done with soap box............................

And some of us are Mensa and emotionally intelligent ... And millennials ;)

I'm more inclined to say the older providers are lacking personality, anecdotally of course

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[ventana]

On 11/7/2019 at 2:33 PM, Cideous said:

That's not going to be fixed with a handshake and the subsequent inevitable case pink eye.    

you will NOT get pink eye if YOU JUST WASH YOU HANDS

 

GEEZ IT IS NOT THAT HARD TO COMPREHEND THAT WE DO NOT HAVE TO BE GERMAPHOBIC

 

SORRY CAPS GOT STUCK ON, NOT YELLING 

[rev ronin]

I will often shake hands on my way into the room and then immediately wash my hands (which were clean enough to begin with), commenting while I do that both human touch and hygiene are important.

[Reality Check 2]

Met my next new PCP today and had a great visit.

Respectful interaction and he appreciated that I typed out my medical hx for him.

Spent time talking about things affect me and what could/should/ needs to be addressed. 

My BP was great - I wasn’t stressed about talking to him.

So - good match and mutual respect - deep relieving sigh.....

[EMEDPA]

I saw a local PA who owns his own clinic for years until my insurance no longer covered his practice. Now I see a local doc walking distance from my house. happy with both. 

[BirdDogPA]

Used to see an NP when I was in school as he was affiliated with the University. Great guy and actually precepted for the PA school. Now see a family med MD. 
 

Would love to see a PA but very few in the area.