Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, September 15, 2006

The New Patient

I saw this post at Ripple of Hope (formerly Difficult Patient) following the link from Grand Rounds. Edited and posted here with her permission:
The New Doctor

Well, she's new to me. She is Dr. Barbie, and I have an appointment with her today for a physical. I'm nervous. How much do I share with her? How much does she really need to know? How do I tell her not to ever give me sleeping pills or anti-anxiety meds or anything stronger than ibuprofen for pain--how do I tell her these things without telling her why?

There is no way I'm going to transfer my medical records from Dr. G. I have a personal copy of my official records (no, I'm not going to share it with her) but I can only imagine the negative remarks Dr. G would make about me.

Yep, I think Dr. Barbie would drop me like a hot potato if she ever spoke with Dr. G. I really wouldn't blame her, but those records do not accurately reflect me (then or now)--they are defensive assumptions because Dr. G didn't have all of the facts. Yes, I know it's my fault that he didn't have all the facts, but that doesn't exactly help me now. I think I'll keep my answers brief and to the point. I like her, but I don't know her, and I don't really trust her.

Yep, I'll just leave the past in the past for now. Any suggestions on how to communicate with my new doctor without scaring her away?

Here's my response (expanded upon from the comment I left on her blog):

I hear you. I'm the doctor on the other side of that door. I wouldn't dream of comparing my anxiety to yours; I'm well aware that I wield the tools of authority, pain and humiliation (white coat and stethoscope, needles and probes, stirrups and gowns.) But anxiety is contagious; and just seeing you check in at the desk and sit in the waiting room, your obvious nervousness surrounding you like a cloud of worried gnats, makes me nervous just to walk into the exam room. So I'll take a deep, cleansing breath as I open the door, and resolve to project enough serenity so that at least some gets back to you even through your anxiety.

I'll introduce myself and shake your hand; then I'll sit down, put your chart to one side, look you straight in the eye and say, "What can I do for you today?"

And then I'll listen. Talk as long as you need to; tell me whatever you want.

I'll want to know why you're really here; there's no such thing as "just a physical." New to the area? (Welcome.) Old doc died/retired? (Sorry about that; I'll try to pick up where s/he left off.) New insurance? (Bummer, but I'll do my best with the new plan.) If you had problems with other doctors I'll want to know about it, mainly so I can go out of my way to make sure you don't have another.

As for your medical history, I'd like to have all the information, but if you'd rather wait and see instead of dumping it on me all at once, that's fine. I can wait. I don't mind giving you the time you need to get comfortable with me. In fact, spreading the whole story out over several visits is easier on my schedule.

If you're playing me for drugs you're going to be disappointed eventually, but I'll give you the benefit of the doubt to start with.

As for communicating with Dr. Barbie, here's my suggestion: be yourself. Tell her whatever you want, however you want to tell it. If you scare her away then she just wasn't good enough to be your doctor. Then again, you may be surprised to find her competent, caring and understanding. Consider giving her a break; it's what you'd like her to do for you, isn't it?

(Back off, all of you in your time-stressed, seven-patients-per-hour-or-else practices. This is what I do and how I do it, because I can. What anyone else does is irrelevant. This is the stuff that seems to be going the way of the dinosaur.)


At Sat Sep 16, 08:32:00 AM, Blogger Unknown said...

Well said, sir.

Regards - Shinga

At Sat Sep 16, 09:47:00 AM, Anonymous Anonymous said...

Thanks, Dr. D! Hmmmm, too bad you aren't located near me . . . ;o)

At Sun Sep 17, 01:16:00 AM, Anonymous Anonymous said...

I'm with Ripple on that one, Dr. Dinosaur. I'd give my eyeteeth to have someone like you locally. I'm in between docs right now ... and I have a feeling that I'm going to stretch the "in between" phase out as long as I can ...

Just found your blog through the comment you left on Ripple of Hope. Very nice blog! Blogrolling you.

At Sun Sep 17, 11:20:00 AM, Blogger #1 Dinosaur said...

This comment has been removed by a blog administrator.

At Sun Sep 17, 11:23:00 AM, Blogger #1 Dinosaur said...

Thanks for the kind words, all, and thanks, Moof, for the blogroll. I've been lurking on yours for a while, and have now added you to mine.

At Sun Sep 17, 11:29:00 PM, Blogger Geoff said...

Good advice
It's always scarry going to see a doctor. even worse with a new doctor, you don't know them, they are a total stranger and your just puting trust in the proffesion as you don't know the person at all.
I normally leave things till I NEED to see a doctor.
Like leaving my ganglion for 20yrs before having anything done

At Mon Sep 18, 07:11:00 PM, Anonymous Anonymous said...

That is a very nice post, I will try to remember it the next time I find myself in a physician's office.

I was interested to see that you want to know about any problems your new patients may have had with previous physicians. I always thought this was the kiss of death as far as building a relationship goes. I mean, why start the relationship by hauling out all the baggage? IME most physicians would rather not hear about it, especially if it involves something really negative, e.g. a bad misdx, medical injury, unexpectedly bad outcome, etc.

Some of us keep our secrets for a reason. I have a new doctor who's seemingly a nice guy and I don't want to scare him.

At Tue Sep 19, 06:44:00 AM, Blogger #1 Dinosaur said...

I didn't say I needed to know everything all at once. I agree that it's a good idea not to go bringing baggage along on a first visit. But eventually you want to know he's not just a nice guy, but someone who can handle the emotional aspects of your problems as well as the merely physical ones.

At Tue Sep 19, 01:03:00 PM, Anonymous Anonymous said...

Thank you, I did note that you said the getting-acquainted process often can unfold over several visits.

It is a fine line for all of us: how to be honest without alienating the other person or unloading on him/her.

At Tue Sep 19, 01:31:00 PM, Blogger Dreaming again said...

Ooooooh I found a new blog! (found you through Ripple of Hope.)

Love your demeanor.

I posted yesterday about a relationship with a former doctor, we had the privilege of seeing him yesterday after a 10 year skip. He gave me the room to get to know him, and taught me how to communicate to a doctor.

Because of him, I can now communicate well with my Dr. Barbie. (who, quite literally looks like an adorable little Barbie doll ...although, a little preggers at this point *grin*)

At Fri Feb 02, 01:24:00 PM, Blogger DDx:dx said...

I think this is part of why primary care is dying. We have a system that promotes mutual admiration and trust. Which is good and necessary for the faith of growth, learning, getting better. But it can be perverse. Patients pursue doctors"like them" or that fulfill some need, and doctors cultivate a patient population that somehow satisfies their needs or addresses their insecurities...Mutualism. Now if all involved have a similar goal(health, growth) and are honest and open, the general benefit if accomplished. But the ability to maintain a larger perspective and deal with painful/ unpopular issues is dear. I admit to not confronting the smoker on the first visit in an attempt to "establish rapport" or was I just being a wimp. Do I insist on weighing the woman who refuses and risk "losing a patient"?When do you make the difficult judgement evident? The dance, the dance.

I was attacted to this blog because I have called myself a dinosaur for 5 years now. Just this year I quit after 17 years of family practice. Still studing options

At Sun Jun 17, 07:38:00 PM, Blogger XE said...

I know this post was written a long time ago, but I just wanted to say: you rock! I sincerely hope my next fam doc will have your attitude.

At Thu Jan 29, 10:20:00 PM, Blogger D.P. said...

Wow, it's been awhile since I wrote the post about Dr. Barbie . . . but I had to come back and comment. I moved again (last year, actually) and had to have that first appointment with a new doctor yet again--for that dreaded annual exam, of course.

This time, it went smoothly . . . she's like you, not exactly solo, but only two doctors in the practice. They are small, and every visit is scheduled for half an hour--just in case. But the docs do a lot of work themselves--no MAs or nurses. Well, the receptionist is a trained MA--lol, and one doctor's husband takes care of the IT end.

Anyhow, I was totally upfront about my past issues, Dr. G "firing" me, etc. She listened and was understanding; there has never been an issue--for either of us.

Seriously, this post was key in my relationship with my current doctor. ;o) Thanks!


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