MGordon_MD
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Jun 16, 2011, 12:05 PM
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By Dr. Michael Gordon
It’s the kind of discussion I try to avoid when I am doing my clinic – the patient or family starts complaining about their family doctor or another specialist.
I avoid such discussions as I am not in a position to judge what transpires between a patient and another doctor, and it does not generally achieve the goal of getting the best care possible. Of interest, though, is that when there is a complaint, it most often revolves around communication and the rapidity of the interaction and lack of time to “explain” things.
I recently saw a patient who was accompanied by a daughter. The latter seemed very reasonable and well informed. As I reviewed the records that were sent to me, I noted that another geriatric assessment had been done and the conclusion was congruent with mine. When I enquired why my second “opinion” was being requested, the daughter said that like the arrangement in my office, her mother was first seen by a resident, as it, too, was a teaching centre, but when the consultant came in he spent five minutes and left without some very important questions and issues being addressed. The daughter was concerned and was left dissatisfied since the diagnosis was one of dementia, which has some very important implications for treatment as well as prognosis and future planning.
Many of the complaints made to the College of Physicians and Surgeons of Ontario, the regulatory body of physicians, are about communication or lack thereof rather than the competency in medical decision-making. When such issues are brought to the attention of the physician about whom a complaint is being made, it is very common for the physician to be unaware that there was a problem in communication. When it is brought to the physicians’ attention, most are sorry that the patient interpreted what transpired as a lack of caring and dedication, rather than a fault in the communication process or perhaps communication style or skill of the physician.
It was therefore of special interest that the opinion piece in the Feb. 27 edition of the New York Times featured an article by the renowned physician Abraham Verghese titled Treat the Patient, Not the CT Scan. In it, the special focus is on the pre-eminence that modern medicine has given to computer technologies that assist physicians in making proper diagnoses, something that is paramount in good medical practice. But Verghese argues that sometimes what we are losing with this technology is the human touch, the important component of medicine, which is reflected in the “laying on of hands.”
Patients, especially older ones, and their families expect a lot from us as physicians. What they expect is in essence what we promised to deliver when we took on that special privilege of being a doctor. Even with the most sophisticated aspects of contemporary medicine, it is important to remember to examine our patients with our hands, eyes, ears, stethoscopes and tendon hammers and then to speak in a way that is readily understood, always leaving time for those necessary, clarifying questions.
It may take a number of visits to achieve all of these goals. This is part of the important ritual and art of medicine that is no less important than its science. When both aspects are addressed and combined, physicians can best achieve the goals of comprehensive and humane care-giving.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto.
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Moments That Matter: Cases in Ethical Eldercare: A Guide for Family Members, is available online at Amazon.ca.
His latest release is Late-Stage Dementia: providing comfort, compassion and care. It is available at Amazon and Indigo.
Visit Dr. Michael Gordon's website.
(This post was edited by MGordon_MD on Jun 16, 2011, 12:13 PM)
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