Seeing is believing, but real benefits arise when the physician is the patient

September 1, 2012

For the first time in my life, I had the experience of being on the other side of the doctor-patient relationship. I would not recommend it to anyone, but I learned a lot of valuable lessons about medical care, some of which have direct relevance to the way we all should be practicing medicine.

Key Points

For the first time in my life, I had the experience of being on the other side of the doctor-patient relationship. I would not recommend it to anyone, but I learned a lot of valuable lessons about medical care, some of which have direct relevance to the way we all should be practicing medicine.

I suspect that physicians detect only a small fraction of the problems that arise in the hospital setting. Without the watchful eyes of the nursing staff and others, bad things happen. Although the physicians who cared for me were skilled, most of their visits with me during my brief hospitalization seemed almost pro forma. Nursing visits were never that way. The nurses would collect data on the important decisions that would invariably be made.

Case in point

I will cite a graphic example of how ancillary personnel can make a difference. The spouse of one of my employees had a routine colonoscopy. A few days later, he received a phone call from a medical assistant who informed him that he had colon cancer. Needless to say, this was extremely upsetting. A quick phone call to the gastroenterologist himself revealed that, in fact, the patient had carcinoma in situ rather than an invasive colon cancer.

On one hand, this was a relief to the patient and his family. However, no one should be forced to go through this kind of mental anguish for no good reason. I have little doubt that this physician is skilled, but his reputation in his patient's eyes is forever tarnished because of the few minutes of panic the patient experienced.

Don't sit on it

This brings us to the real point of this editorial. We physicians often order laboratory tests or perform skin biopsy examinations and then simply forget about it. Let me tell you from the personal experience of an anxious patient that the uncertainty associated with the test result is extremely troubling. We may get the answer and "sit on it" until we have the time or inclination to contact the patient. He or she often assumes that since a test was ordered, something must be wrong and a bad outcome is very possible.

How many routine biopsies of nevi are followed by an anguished telephone query from a harried patient praying that he does not have melanoma? I have biopsied thousands of pigmented lesions where my index of suspicion was almost zero for melanoma. Unfortunately, all of the assurances that I have given at the time of the biopsy procedure have not lessoned the stress of waiting for the result to be finalized.

Personal perspective

I had the experience of having "routine" blood tests ordered, obsessing about the results, and finally personally downloading the values from the lab website because I could not patiently wait for the result any longer. I know that these same test results were available to my physician, had he chosen to find the data. I like my doctor very much; he really knows what he is doing and I trust him completely. However, had I been like most patients and have waited for a phone call from him, the emotional toll could have been substantial.

As physicians, we must remember that patient perceptions are often very different than ours, and we must assume that their concerns about their health are magnitudes greater than ours. With that in mind, I have a few suggestions:

1. Communicate promptly with your patients after lab tests are available. With results in hand, never let a weekend pass before sharing the data with the patient. You will save him or her needless grief.

2. Communicate with the patient yourself, if humanly possible. It will show that you have the same concerns as she does about her health and well-being.

3. Do not mail a postcard days or weeks later if the result is normal. This sends the wrong message about your level of involvement in the patient's care.

As a physician, there is almost nothing more important to the patient than compassion. A dose of this will go a long way toward making your patients happy that you are their doctor.