Regina George and Henry I. Miller
We’ve all had that one doctor we really didn’t like, the one who didn’t listen, was brusque, and gave you what turned out to be bad advice, right? You know, the one whose bedside manner was somewhere between Don Rickles and Bill Maher. Well, there’s a dirty little secret that most doctors hide: They’re people, too. They have that cringe-worthy patient whose name on the schedule ruins their day, the one whose presence requires a deep, calming breath before entering the exam room, the one for whom you tell your assistant to come get you if you don’t come up for air in 20 minutes, the one who makes the staff cry.
That comes as a surprise to most people, who may love to complain about their doctors, but never think about whether their doctors complain about them.
Like most physicians, we went into medicine to help people and generally really like our patients. But now and then we encounter one who ruins our workday. This is something we have thought about a lot, and assuming that being a bad patient is unintentional, we have made a list of how to become a good one, in an even dozen easy steps.
And yes, we do recognize that the patient’s job is not to please the doctor; our suggestions are really about getting the most out of your appointment and making your health care expenditure in time and money more cost-effective.
1. Arrive on time. But wait, doctors always run late, right? Yes, that is often true, but a large part of that is due to patients arriving late, especially early in the day. If your appointment is at 8 a.m. and you arrive at the door exactly on the minute, you may think you’re right on time. But by the time you check in with the front desk, get your insurance straightened out, get the nurse to take you to the exam room and do an intake interview, it is now 8:15. Starting your visit with only five minutes left in your 20-minute appointment is not conducive to getting the most out of your visit (or keeping the doctor on schedule).
2. Be nice to the staff. But I have to yell and scream, otherwise I won’t get that appointment, you say. Well, that kind of behavior does get back to your doctor and can make for an uncomfortable visit. The staff members in our busy practice have to work hard, have a long commute, and often have kids at home. Most of the time, the problems that patients get angry about are completely unavoidable.
3. Allow the nurse (or physician’s assistant) to take an intake history. This is the best way to make the visit efficient and to make sure the doctor addresses your concerns. The nurse will note your concerns and record your vital signs, and then the doctor will come in prepared with all that in mind and be able to budget his or her time in order to address it all thoroughly. Which leads us to no. 4.
4. Do not save the real reason for your visit when the doctor is about to leave. This is called the “hand on the door sign.” The doctor has a hand on the door, about to leave the exam room, when the patient finally mentions the most important issue, which may require a lot more time, questioning, and further examination. And there goes the schedule.
5. Come prepared with questions, preferably not ones suggested by consulting Dr. Google. The internet is replete with quack claims and bogus suggestions. Decide what is most important to you and focus on that. The “laundry list” patient who comes in with 25 concerns not only strikes terror into a clinician’s heart, but ultimately may not get a thorough review of any one problem, let alone all.
6. Be appreciative when special needs are met. For example, if you were added to the schedule urgently. It is much appreciated when a patient offers thanks. And if the nurse or receptionist was really helpful on the phone, write a small note to her supervisor, which will go into her file.
7. If a procedure is scheduled, pay special attention to instructions about restricting food or fluids before the appointment.
8. If any tests – such as blood tests, X-rays, or EKGs – were supposed to be performed before the appointment, be sure that they were done in time for the doctor to have received the results.
9. Write down what medications you are taking. Making reference to the “white cream” or that “little pink pill” is not helpful to the physician, and much of the visit can be wasted tracking this down. Moreover, because of the possibility of drug-drug interactions, it can be dangerous if your doctor does not know all your medications. Better still, bring the pill bottles.
10. No, a picture is not worth a thousand words. You might wonder whether you can just send a picture of the new spot on your skin. Actually, no. That dark spot on the photograph could be a harmless freckle or a deadly skin cancer that can often be accurately diagnosed only with a special skin-examination scope. So, do yourself a favor and schedule that in-person appointment!
11. Spend your time wisely. This is not a social call. While it is nice for us to catch up on a patient’s life and family and is part of what makes our job rewarding, you should not spend too much of the visit recounting your vacation, telling the latest jokes, or expounding on politics. Spend the time on your health care!
12. Payment issues can be devilishly complicated. What you pay for the visit does not go into the doctor’s pocket. It pays for the receptionist who checked you in, the nurse who did the intake interview and changed your wound dressing, the security guards, the rent on the building, the cleaning staff, the heating and air conditioning, the malpractice insurance, the prior-authorization specialist, and the time after hours transcribing the visit. Take up any issues with the billing office, your insurance carrier, or by sending your doctor a letter. But don’t let that take time away from your visit. Again, spend that time on your health care.
At the cost of being slightly snarky, we have tried to offer some useful advice about how to make a visit to your doctor as pleasant and productive as possible. Perhaps in no other context is it truer that we’re all in this together.
Regina George is the pseudonym of a physician who practices in the San Francisco Bay Area. Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute. He was the founding director of the FDA’s Office of Biotechnology.
Using these vague “policy violations,” Google is now threatening to demonetize us. It’s part of Big Tech’s effort to silence conservative voices.
I used to call on docs as a Pharma rep. I had one doctor who actually fired a patient for not following his advice to treat his diabetes. I thought, Good for you. If you’re not going to follow his recommendations, then YOU’RE FIRED!
I have only one quibble with this. If they want me there fifteen minutes early, make that my appointment time. If they give me an 8:30 appointment, that’s what I put on my calendar, not 8:15. It’s really annoying to be told “And please arrive fifteen minutes early.” One advantage of the “pandemic” is that there are fewer patients. For once in a long and underperforming life, I check in and barely sit down before I’m called back. A doctor once told me that if he wasn’t running behind, he wasn’t making any money.