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Posted on 30. July 2010

23 Seconds: Ready, Set, Go!

By Kris McFalls

Recently, I saw a specialist after I began experiencing symptoms I didn’t want to talk about, let alone write about. He did some poking, prodding and testing, and declared nothing was wrong. But, he did prescribe medication, as well as instructed me to reduce the stress in my life. Unfortunately, the medications never worked, and the symptoms got worse. So, after many more months of worsening symptoms, I returned to the doctor. And, the appointment went something like this:

Kris: Hey doc, I’m still having these symptoms and they are getting quite…

Doctor: Wow you look much better than the last time I saw you. Are you taking the medications I prescribed?

Kris: The medications just didn’t seem to help, so I stopped and…

Doctor: Do you think your job is causing you stress and anxiety?

Kris: My job is busy, but I enjoy what…

Doctor: Yea, you really should try to get your stress level down. Let’s do some blood work just to be safe. Take the medications as prescribed, and come back if you have more problems. It was great to see you. 

Fact: 23 seconds. On average, that is the amount of time research shows a patient will have to speak before the doctor interrupts. The appointment, including an exam, formulating a treatment plan and writing chart notes and prescriptions, will last 10 to 20 minutes

Fact: In a 2009 study, the CDC reported that the time required to deliver the recommended primary care is three times what is available per physician. To meet current guidelines for patients with chronic diseases, physicians would have to work 22 hours a day.

These facts can leave a patient feeling helpless and worried. And, the doctor is left feeling like there is no way he or she will ever be able to give the quality of service the patients deserve. 

In my case, I didn’t feel this particular doctor ever heard me finish a sentence and was more concerned about getting to his next appointment than figuring out what was wrong with me. Every appointment ended with the phrase: “Come back if you have any more problems.” Hello! That is why I went there - because I was having more problems. 

My doctor wasn’t rude, and he attempted to project empathy. He was demonstrating kindness with his countenance and encouraging me to come back any time.  I, on the other hand, felt like I was speaking a foreign language. It seemed the relationship just wasn’t working.

Given the lack of time both doctors and patients have, the key to a productive visit is building a good relationship. And, like any good relationship, compatibility matters. Some doctors and patients prefer quick, straight-to-the-point conversations. Others prefer slower, more detailed explanations for complete understanding. When the two sides mesh, good things happen.

Relationships take work, and the doctor-patient relationship is no different. Sometimes, the path to a better relationship is simply a different relationship. In my case, although I liked the doctor’s personality, it was apparent that we were never going to mesh. Changing doctors was the key for me. 

Give us your feedback. In a society where faster is better, how do you make your doctor-patient relationship work?

Scroll down now to leave comments for this post - let’s start the conversation!

Categories: Life With IG

Comments (14) -

Joanna Tierno
10:43 AM on Friday, July 30, 2010

I'm sorry your not feeling well & I hope you feel better!  I'm fortunate my doctors all seem to make time for me.  I can't say I ever feel rushed!  I have heard of lots of other patients that don't feel like their doctors listen.  Finding the right medical team is really important.  Good luck with everything. I hope you find a doctor that is a good fit for you.

Sharon Reisinger
10:54 AM on Friday, July 30, 2010

I've been lucky in the doctors I have..they do answer questions and if I feel like they are just poshing me over I tell them..I do not like a doctor to make a joke out of something I consider serious to me and my health..I also hit the internet for some look ups..with my PIDD I look up things all the time..this is lifelong and can be serious many times.
I want answers and I contact whom ever I think can help me.Kris McFalls has a godsend many times..Good Luck to all who have to deal with this on a daily basis..Blessings to all..

1:53 PM on Friday, July 30, 2010

Ah Kris- haven;t wea all been there? And isn't it wonderful when you find an MD who knows what is wrong with you- it is a whole new language and you are both speaking it!!

I have found that some MD's do not listen- especially to females. My worst experience was the MD who  1) yelled at me over the phone when I called with a severe headache (on a Saturday) and 2) interrupted me as I asked a question and said "Don't you want to have this cat scan to find out what is wrong?".
The final diagnosis delivered in front of a male med student was that I was post menopausal and having menopause related headaches.I also had the "same thing" as the woman in the next cubicle.

When I interrupted to say I had a hysterectomy at 33 and had long gotten over those hot flashes etc. he told me I could have them and headaches again 20 years later.

What is sad is this MD was described to me as the "best headache MD" in my state. What is more sad is that his med student was taught women of a certain age - it is all menopausal.

I switch MD's easily now and even go to MD in another states to find the right diagnosis. LOve hearing that understanding language.
And the headaches- they were sinus induced or migraine and relate dto my IGG#3 deficiency- correctly diagnosed 10 years later.

Sheila Rothstein
2:21 PM on Friday, July 30, 2010

Hope you feel better soon Kris.  
I had two primary care docs that I really liked in the 8 years I have lived here. Unfortunately, both closed their practices.  One due to health and the other moved away.  Then I chose another primary doc that I went to for about 9 months.  The original visit went O.K. when he took my history, etc.  Then when it was time for a visit to go over my labs for my prescriptions it went down hill.  He sat behind his lap top and read my numbers and renewed my scripts.  I mentioned that I had been coughing at night and in the morning and maybe it was the weather?  He never came over and examined me.  He kept just sitting behind the computer.  I heard later that if you don't go in for a sick visit then he won't check you.  I've never been to a primary care doc that doesn't check you over so I left.  Luckily I got into a practice that was closed with a really great doc by writing her a letter.  She is great and when she checked me over I mentioned the doc before never did.  I said I won't mention his name and she said I think I know who you are talking about.  Apparantly I'm not the only one that thought that was odd.  

Joanne Pease
4:54 PM on Friday, July 30, 2010

I have learned over the years to be a speed talker, hitting the most important aspect of the problem right away and then expounding on it as the doctor starts the exam.  Usually works for me.

8:26 PM on Friday, July 30, 2010

Hi Kris:  Sorry to hear your not feeling well - living with the situations that we have medically can be up and down.  Not fun but always challenging.  I went thru 2 neurologists before finding the one I have now.  He never sets up appointments or blood work or anything.  So I do alot of my own stuff - blood work - do through my primary doc (love her) and when I have questions I call his nurse (love her also) and she takes it all down and then either she gets back to me that day or he will call me that evening answering all my questions.  I kind of like our arrangement.  Only once did the nurse call to say he wants to see you.  The nurse gets all the pre approvals for my treatments and I set up my own appointments with the nurse in the hospital.  In other words I have really taken control of my medical and when I don't get the results that I need I have other resources to make it happen.  When he has to be involved (like approval of the sub Q) I write him a long letter on why and how (I know he hates that) but we go back and forth and somehow meet in the middle.  Last time we met he said he didn't think it matter what he said since I was going to do what I was going to do anyway.  That made me cry but when I had a situation in the hospital to get my Plasmaphersis the nefrology (Q) doc said I couldn't do my treatment because of my condition and I said I wasn't leaving he had to call my doctor and he said let her do it.  So he comes through for me when it counts - plus he is a great doctor.  So Kris, keep looking and get what you need.  I always say to my doctors - you bring the knowledge but I bring the body so it's equal.  Hope your better - stress is a killer on the body.  Donna

nynah mason
8:34 PM on Friday, July 30, 2010

    One complaint I've heard in my PCP's waiting room is that you *always* seem to have to wait a good bit beyond your appointment time.  I've made a point to tell folks that it's because he's a good and very thorough doc.  When I have to wait I know it's because someone needs extra time and he is taking that extra time with that patient.  This also means that when YOU need extra time, he will take that time with you. I also take a list of questions/concerns whenever I see any doc so I don't forget to ask about something.
      If you are sick and/or KNOW something is wrong and a doc blows you off once, there is no point in making a second appointment, just scratch their name off your list.  Also, when I moved to a new state I made up a list of docs within a reasonable driving distance and called their offices and asked questions.  I then made a brief visit to the ones I felt might be a good fit and asked the docs themselves a few questions.  It wasn't difficult to figure out who would work with me.
     Hope *everyone* here has a good group of docs to work with them!  

Jody Bowles
8:30 AM on Saturday, July 31, 2010

I am sorry to hear that you are feeling unwell Kris. I deal with my doctors by putting in writing my list of symptoms. I write in bullet points and let them know that I am giving them "their" copy and that I have one for my records. I date every piece of paper I give them. I have also learned (after a 3 year misdiagnosis during which I was given high dose long term prednisone AND high dose chemotherapy- 3 times the dose they give to cancer patients) that as bad as I hate to change docs, it is easier than dealing with the aftermath of wrong medicines. In my case that was osteoporosis and 4 compression fractured vertebrae. The scary part is that I have already lost 2 docs due to the coming Obamacare but I am on Medicare. I still think that putting everything in writing is the best and least comfrontive way to let them know that you are keeping a record.

Good luck Kriss, I hope this helps.

Brian Erlandson
9:05 AM on Saturday, July 31, 2010

Another "right one" blog by Kris.  I think we can all relate to this scenario as we have all been there repeatedly.  I have one terror story after another about docs that just wouldn't or couldn't take the necessary time to get to the bottom of things.  I thought I was like Cinderella in that I had to kiss a thousand frogs to find just one prince, but I finally found him.  I never have kissed him, but I would like to take him fishing!  

My advice is simple.  Keep searching for that one elusive doc out there that will FINALLY take the time and actually LISTEN to what you have to say.  Don't for a minute think that you are also responsible for your own wellness plan and stay informed.  Read IG Living every month, I find the articles not only enlightening, but hopeful and refreshing.  

10:28 AM on Saturday, July 31, 2010

I can relate to all the comments above.  I was incredibly lucky to find a great primary care physician years ago.  Dealing with the specialists is another story.  Its a hit and miss game.  When I was first diagnosed, I was seeing an Oncologist/Hematologist.  As crazy as it sounds, I live in Los Angeles and in my area there were no Immunologists who were administering IVIG.  I have sympathy for those who don't live in large cities.  The process was smooth with insurance and getting infusions but the doctor was quirky.  My appointments were primarily discussing whether he should buy a home or not (I work for a bank).  It didn't bother me that much in the beginning but I finally told him it was a decision he had to make for himself and I needed and this was my appointment to talk about my IVIG and treatments. But soon after that he became aloof and I found I had a weight loss/gain from month to month.  I figured it was the IVIG.  It was only after he said after the weight gain month - did you get enough to eat last month?  Thankfully I had gotten enough answers out of him by then and found IG Living and other support sites I decided I was done with him.  Did I report him to the AMA?  No.  His bedside manner wasn't up to my standards but if I had cancer I would go to him in a heartbeat.

My search for an immunologist was through the approved doctor list.  I found one which was not close to me but he was also considered and this is a direct quote "the rock star" of immunology.  And he was in the field of research and conducting clinical trials and dealing with drug companies.  He was clueless in patient care and had no clue as to the administering of the IVIG.  and things didn't go well with him or the administering of the IVIG and I said no more.  

I again went through the approved doctor list and I called each one on the list and talked to the doctors over the phone until I found the only one in my area who adminstered IVIG.  Their practice is like a dream come true.  But the only snag has been (and this is learned by trial and error) they don't want to deal with side effects.  So back to my wonderful primary care physician. We have developed a pattern where he knows I have more questions than most and makes time for that.  

There are ups and down with all doctors.  You have to form a relationship with them just like any other people and find out what their strengths are and if they fit with your needs. If you talk to them in the beginning and tell them what you would like your visits to consist of and list the reasons why:  my immunologist does not want to deal with side effects, I need to have my chest listened to every time, I dont need to be weighed (he loves that one) and then tell him I usually will have a list of questions.  That way he can book a longer appointment with you.  Sometimes my primary care doc has to refer me to a gastrointerologist or another specialist because he is straight with me - he doesn't know.  
I recently had to take more time off work with a bizarre series of severe nosebleeds which resulted in surgery. Yech.  But, I went to 2 hospitals ERs because I wasn't satisfied with the treatment of the first one.  2 specialists, 2 trips to the primary care doc and surgery postponed due to emergencies with both doctors.  FOR A NOSEBLEED.  My other point is I hold up the surgery and talk with the doctor before hand to make sure what he is going to be doing because the paperwork said "nasal endoscopy".  Thats great but then what - cauterizing or stitches or packing or splints or pain after etc.  So he walked me through it (actually they were busy trying to find a vein for the IV.)

And so it goes.

Bottom line is you have the right to made your needs known ahead of time.  Remember you are not their only patient and they are not mindreaders.  If they cross the line, you also have the right to say I'm sorry,this is my appointment.

This are complex issues we have and unfortunately there is not a one stop shop. But you need to be your own advocate (thank you Kris for that).  With the doctors, insurance companies, work, state dsability yikes.  My sister calls me the Terminator when it comes to red tape.  And I have learned the hard way honey gets you farther than harsh words and I have to REALLY work with that.

Godspeed and save travels in your path.  You can do it.  

9:41 PM on Sunday, August 01, 2010

Kris, Really sorry to hear about your lack of doctor care. It can be frustrating when you know something is wrong and you don't feel heard. After all you are the one that will go home and try to make some semblance of your life. I have come to realize that Doctors are human so continue to fight for your rights cuz bottom line...you are the customer and can find someone else. I might use my first 2 se3conds to say, "I hear you are a good doctor" or " my friend XXX reconmended you because they said you were a good doctor." If doctor think they are overworked now, wait till Obama's plan kicks in!!!

Chrystal Byrd
5:05 PM on Friday, August 13, 2010

If Obama's plan is what it takes for a nation to become healthier, for healthcare costs to decrease, and for a change that is long overdue than I'm all for it... I get frustrated too, but of course I am blessed to have insurance, which many of us do not have.  Since we are in a recession, anyone interested in going to medical school?  There should be plenty of job security down the line...

Kris, I usually quickly type up a symptoms-list and what I would like to rule out and how we can get it accomplished.  I don't go for, "come back if it gets worse."  I have actually picked up my purse and left in the middle of an appointment after the doctor contradicted herself and THEN told ME I needed to make up my mind when I had been telling her that I wanted xxx procedure the whole time!!!  I do not let them rush me, as they so often like to do. My life is too valuable to let them miss the mark...

Lee Pfeiffer
12:56 PM on Sunday, November 14, 2010

I see many physicians within short periods of time.  For every new physician, they recieve my complete medical history that includes the history of each dease process with table of contents.  Each physician receives the updated system's review, medication and nutriceutical list, medication, food, and substance sensitivity list, immunoglublin chart with all of my results, and number of days since last IVIG.  The entire history is 46 pages.  The short form is 6-8 pages.  I also go in with my list of questions.  Some physicians remark, derogatorally, "Yea, I read it."  Most physician chart notes mention the "scanned" history.  And several surgeons who were required to dictate a complete "history and physical" prior to surgery, express appreciation that it is well organized and easy to read.  For me, regardless of what transpires in the physician encounter, the details and "truth" are in my written record. There is one physician whom I intend to replace, apperently he feels threatoned by the multiplicity of my conditions, that as a nurse, I've researched all my conditions, that I still administrate my chiropractic orthopedist husband's office and who is knowledgeable of and participates in my care.

Nynah Mason
12:29 PM on Friday, November 30, 2012

This past year saw me trying to build relationships with new docs -and and failing completely.  Had I not been able to travel 3000 miles to see the docs who had been treating me I doubt I'd be posting.  The new immuno - with no real exam, no questions, no blood work during this time maintained, "its just inflammation".  I appreciate that I'm a complicated, time consuming patient with 2 relatively rare diagnosis.  My immense gratitude to the docs who take some time with me and support me by trying to ferret out the underlying cause of 11 months of illness cannot be overstated.  We desperately need more PCPs and internists; more NPs would also be good!  A national program that would forgive most of a new practitioners college debt would help a great deal.

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