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Old May 4, 2004, 07:25 PM   #1
wdlove
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How Do You Make a Better Doctor?

For the first time in 20 years, Harvard is reforming the way it molds medical students into doctors. The biggest change is getting them more time with patients in clinics and labs and maybe even house calls.

By Rich Barlow *|* May 2, 2004

"Do you have pets?" medical student Angel Foster asks the mother of a 10-year-old patient, probing for what landed the girl in Cambridge Hospital with an asthma attack. No, the mother answers, except for all the mice in the house.

Through the telescope of their conversation, Foster glimpses a world where circumstance conspired with biology to constrict a little girl's airways. It turns out that besides vermin, her young patient has had to endure an older brother's smoking in the four rooms of public housing closeting their family of nine.

http://www.boston.com/news/globe/mag...better_doctor/
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Old May 4, 2004, 07:35 PM   #2
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Well they did say the surgeons could reduce the chances of medical error if they just sat down and talked to the patient about the medical procedure -- "No doc my other left."

Imagine actually slowing down the doctors enough to actually get them talk to the patient.
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Old May 5, 2004, 02:28 AM   #3
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Yeah the bedside manner of many doctors is poor, its not really their fault tho because they have such a heavy patient load spending equal amounts of time for each paitent gets harder and harder.
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Old May 5, 2004, 02:48 AM   #4
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My doctor and his associates are probably the most popular doctors in my town. They seem to be great doctors, they seem to really care for their patients, and they actually attempt to get to know you. When I was a child, it was just one doctor. As more people started seeing him, he hired/partnered with another doctor, then another. I think there are now four general practitioners and a pediatrician in his office now. They actually had to leave his old office and rent out an entire floor of the office wing of the local hospital. But, due to everyone liking them, people are now starting to dislike them. He tryed rushing through each patient's visit, but he didn't lke doing that, nor did most patients. So, now, he is still in and out pretty quickly, but he does not talk fast or make you feel rushed. He still asks you about your personal life, "how's the wife and kids", "did you get the yard fenced yet so you can put that dog out so little Johnny's asthma doesn't act up so much?" But, now, I have listened to patients yell at the receptionists like dogs, curse and complain and threaten to take their business elsewhere because of the wait. I'm usually called back to the examination room in 30 minutes or less, but on rare occasions I've had to wait an hour or more. If some of these people would move to a larger city, or an underdeveloped country, they might realize how great they have it here with their 30 minute wait. These same people would never rush through building their deck or fixing their car because they want it done right. Our docs are trying to do the best job they can while effeciently getting patients in and out. Some people need to just chill out so the doctor can feel more comfortable spending the nessecary time with the patient. I like it that despite seeing over a hundred patients on some days, when I see my doctor out in town he knows me and asks about my insomnia, my son's allergies, my other son's asthma, and my wife's recovery from her brain surgery. (Maybe he's not that great. Maybe it's just hard to forget a family as sick as ours!)
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Old May 5, 2004, 01:49 PM   #5
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It is very important for doctors to have a good bedside manner. A lot of health care dollars could be saved. To encourage good doctor/patient relationship. Listening to a patients story is very important. Diagnosing can be done without expensive tests by this method.
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Old May 5, 2004, 04:23 PM   #6
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It's often said that countries like ireland and the uk actually makes better doctors because so much more emphasis is placed on history taking because we don't order so many tests which is probably due to the health budget.
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Old May 5, 2004, 08:55 PM   #7
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One major problem that plagues doctors is illegal substances. Something like 1 in 25 people smoke pot regularly, so we're talking about a potentially daily occurance for many doctors. Yet all to often, doctors act condescending, blame all of the problems on the drug, and refuse to seriously deal with the patient. Even the doctors that are professional about street drugs can't answer questions about drug interactions, something that has been discussed at length in other threads. Doctors ask that you be completely honest (and you really should be, with medical professionals) about such things, they should reward that honesty with some degree of human respect.

This isn't the raving of a druggie, this is a common theme i've heard in medical complaints. We're talking about 10 million Americans who are unable to be honest with their doctors. Not cool.

I agree with the other comments tho, doctors have become very brisk and that results in haphazardness. I know when i was born, in 1982, my mother had to plead with the doctor to perform a caesarian section. This doctor had not seen her and was completely unfamiliar with her case. To give you an illustration, my mom is about 5'2 and I was 11.3 lbs at birth. To top it off, she had spinal fractures that had at that time not been fixed. Finally after a nurse joined her plea, the doctor consented to c-section. He admitted later that he's not sure she would have survived a natural birth. Instead of taking 30 seconds to read her file carefully, or just listen to her speak, he nearly put her at great risk.

Not all doctors are like this, to be sure. I've had several that were excellent listeners, answered all my questions, and generally put me at ease. But i've also had those that, and i'm being honest here, refused to speak directly to me, only a nurse. WTF?? Doctors have a difficult job, they have to deal with a population that is consistently ignorant of the subject, many of them agitated, afraid, and uncooperative. It's got to be hard to simply do their jobs in many cases, patients that quite simply abuse them. But, there has to be some degree with which they really listen to patients, to judge whether this specific patient is merely a hypochondriac with dizzy spells, or someone that's having petīt mal seizures.

Of course I could rant about the insurance companies and HMOs ad nauseum, but everyone already knows about those things. They are, however, a large part of the problem.

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Old May 6, 2004, 04:09 AM   #8
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Quote:
Originally Posted by paulwhannel
One major problem that plagues doctors is illegal substances. Something like 1 in 25 people smoke pot regularly, so we're talking about a potentially daily occurance for many doctors. Yet all to often, doctors act condescending, blame all of the problems on the drug, and refuse to seriously deal with the patient. Even the doctors that are professional about street drugs can't answer questions about drug interactions, something that has been discussed at length in other threads. Doctors ask that you be completely honest (and you really should be, with medical professionals) about such things, they should reward that honesty with some degree of human respect.

This isn't the raving of a druggie, this is a common theme i've heard in medical complaints. We're talking about 10 million Americans who are unable to be honest with their doctors. Not cool.
paul
I took my son to the doctor early this year. I was wearing a t-shirt I received while volunteering for a local politician, Gatewood Galbraith. My doctor looked at it and said "All-right! A Gatewood man! I vote for him every time. Too bad he never wins." I had to turn to my six year old and say "See, a respected, church going, pillar of the community and a Gatewood voter. It's not only a bunch of junkies voting for him." (My six-year-old just nodded and said "We like Gatewood, too." I'm sure he had no idea what I was talking about, he just knew that I like Gatewood.) I was very pleasantly surprised to hear this from my doctor. Most conservatives and liberals that I spoke to love the politician that we were talking about. They all say that he is a great guy. "Mostly pleasant man you will ever meet" was said by one right-wing almost extremest friend of mine. Not too liberal, not too conservative, always fair and looking out for the "little man". The reason that he has never won an election, and why all these people who love him still won't vote for him, is that he supports the legalization of marijuana. He is an admitted marijuana smoker and says he holds a prescription for it, to use in court if they ever arrest him. I am not a drug user. I would love to smoke a little weed every now and then, but I would definately lose my job after the hair testing. But, I'm glad to know that in the future, if I ever do smoke a doobie or two, I can be honest about it with my doctor.
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Old May 6, 2004, 04:27 AM   #9
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Last year, the day after Thanksgiving, my wife started having major headaches. She went to the doctor thinking they were migraines, so he gave her migraine medicine and scheduled a follow-up next week. The headache persisted and worsened, so she went back a few days early. She described for him the hallucinations, and the way the pain felt. I told him about carrying her to bed several times, with her moaning and talking to me the whole way, only for her to later ask me how she got to the bed. He was afraid that she had meningitis. He sent us to a neurologist in Lexington in a very busy clinic. He came in, made no eye contact, and just kind of said "Mmm hmmm" while my wife was talking. I never thought he was listening. He looks in her ears and eyes, and feels her head and neck, all very quickly. He said "You're just having migraines. I can give you some new, stronger medications for it. But, for the most part you are just going to have to manage it, and deal with it." We protested, and he just treated us like "poor little thing can't handle her headache." We kept begging for him to try something else, run other tests, and he told us that he had other paying patients that were waiting to see him. I got angry, raised my voice, "what the hell am I buying insurance for" kind of statements. He finally, hatefully agrees to order C.T. Scans. While we were waiting for the the scans, my wife starts to have another headache. Several nurses come in and rush her to the machine, ahead of the line, while someone contacted the neurologist. They did her scans, and she layed in the hallway on a cot for about 1.5 hours until the neurologist came strolling in. He looked over the scan and freaked out. My wife had hydrocephalus, a build up of fluid on the brain. The neurologist was going to order an emergency surgery that night, but as my wife stabilized he put her in ICU and had the surgery the next afternoon. We were told that at the rate she was going, and the amount of fluid that was on her brain, she probably would have died within days. She's fine now, but if I ever run into that neurologist on the street, he may end up in ICU!
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Old May 6, 2004, 06:57 AM   #10
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That reminds me so much of the mock history taking classes we had this year. I had a girl come in who was complaining of headaches. I was talking away to her and it turned out that she was doing her finals, was really stressed, was studying all of the time and getting no exercise. I ended up focusing on that and kind of pushed any other cause to the sidelines.
When we finished the lecture asked me why i hadn't considered the possibility of a tumour,increased intracranial pressure etc. If i had read about it in a case study it would have been something on my checklist but when i was in their taking the history it didn't even occur to me and i went head on into her exams/stress/migraines etc.
The majority of the time i would probably have been right but that doesn't mean that it may not be a rare case.
Moral of the story for me was: for medical professionals it's a delicate balance to discern the common and rare cases and if ever in doubt always err on the side of caution.
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