Pages

Sunday, May 22, 2016

The Good Doctor


There are four questions a patient might think about when he sees a doctor.

“Will he listen to me?”
“Will he make the correct diagnosis?”
“Will he prescribe the right treatment?”
“Will he do the right thing by me?”

That is, if the patient even thinks about it. More often a patient sees a doctor because of an ailment or injury which he believes the good doctor might help solve. Only if there are problems along this road might the patient think about such questions.

So the same questions are more often framed retrospectively.

“Did he listen to me?”
“Did he make the correct diagnosis?”
“Did he prescribe the right treatment?”
“Did he do the right thing by me?”

In the majority of cases a doctor can make a diagnosis within a few minutes of the patient sitting down in front of him. A specialist, who only has to deal with a limited number of possibilities, can often make a diagnosis within the first minute. But complex systems have many areas that can go wrong. Some are relevant to the presentation and some are not. Even orthopaedics, widely regarded as the least mentally taxing of the medical professions, has elements of obscuration. For example, a middle aged, diabetic woman presenting with carpal tunnel syndrome may also have trigger fingers. Surgery to address the obvious presentation (typically the carpal tunnel syndrome) can make the other condition worse. A middle aged man presenting with shoulder impingement may have a rotator cuff tear and a labral tear. Subtleties in the clinical presentation determine whether a repair of the labrum should be considered at the same time as the cuff repair if, indeed, either is required. Treatment algorithms help but cannot (and should not) dictate management.

When a client comes to a service provider - be it a mechanic or a doctor - he typically has a problem for which he is soliciting information and a solution*. A rumbling engine has many possible causes as does a rumbling tummy. The client is sometimes able to articulate the problem in language that makes it clear to the service provider. But more often than not it takes a bit of time to extract this information. The more complex the system the deeper the service provider has to listen and probe. Asking the right questions helps. Training and experience guides this process.

Clients should expect the service provider to have the capacity to provide the service advertised. In addition to this the medical industry as well as some other sectors of the workforce (eg the clergy, the police force and emergency services) are expected to have a certain duty of care. Some are legally binding whilst others fall in a vaguely-defined area of good social conduct. Medicine is specialised and complex enough that the clinical decision of it’s practitioners often lie beyond the critical judgement of those outside the profession. But not beyond the scrutiny of peers. A basic respect for humanity should underscore the wellbeing of the patient and the opinion of others. 

Not that I think it necessary for a doctor to “care” about the overall wellbeing of his patients. By this I mean he should take into account the factors that might play a role in the clinical presentation but not absorb any emotional burden that may come with it. A doctor’s life is hard enough as it is and there’s that fine line where “care” becomes unwelcome or just plain creepy. But a doctor, like all service providers, should focus on optimising results. After all, that is the job he is paid to do.

But, as elsewhere in life, shit happens.

There are four questions that a patient might think about when he sees a doctor.

“Will he listen to me?”
“Will he make the correct diagnosis?”
“Will he prescribe the right treatment?”
“Will he do the right thing by me?”

A good doctor makes sure the patient never needs to ask those questions. And if he does the answer is in the affirmative.



he could also be looking for a quote or a second opinion


No comments:

Post a Comment