Last week I discussed my worry that doctors would no longer have relationships with patients, but rather would plug us into pre-determined screening, diagnostic and treatment “pathways” without much regard for our personal stories.
Then I read the book When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests by two ER physicians, Leana Wen, MD, and Joshua Kosowsky, MD.
And they agree “cookbook” medicine is a problem. They see it all the time in the emergency rooms.
Medicine has morphed from thoughtful engagement between doctors and patients to cookie-cutter recipes that regard all individuals alike…this cookbook approach, defined by its rote and formulaic approach to practicing medicine, leads to less accurate diagnoses—and worse outcomes—for patients.
It’s a two-sided problem
Drs. Wen and Kosowsky believe both the doctor and the patient have to learn to help each other.
They point out that “medical education is often disproportionately focused on science and technology, and the desire to be an excellent clinician isn’t nurtured or fostered.”
Other physicians have recognized that the medical profession needs to improve the communication skills of its doctors:
Health care providers today are no more patient-centered in the way they communicate with patients than they were 30 years ago when research into the dynamics of physician-patient communication first began.
This is unfortunate for patients, providers and payers. It unfortunate for patients in that they are not getting the quality of care that they expect and deserve. It is unfortunate for providers in that they are not doing right by patients or themselves from the stand point of outcomes and satisfying, patient experiences. It’s unfortunate for payers in that they are not getting full value for their health care expenditures.
But patients have problems communicating their needs to doctors, also. In my experience, patients are
- too sick or scared to hear what the doctors are saying, let alone have a working relationship;
- conditioned to be quiet and not ask questions because the doctor is always right;
- unfamiliar with the medical terms the doctors and nurses use; and/or
- anxious to have the “best” care, which they think includes the latest, greatest technology and drugs.
Help your doctor help you
Doctors can learn to communicate better; patients can, too.
When Doctors Don’t Listen is a well-written, interesting guidebook for anyone who wants to take more control of his or her health care.
The authors present several scenarios in which patients came to the ER with relatively common complaints (chest pain, headache, shortness of breath) and were then caught up in hours or days of unnecessary—and super expensive—tests (CT scans, MRIs, spinal taps!).
Once you’re put on a particular diagnostic pathway—a recipe from the cookbook—it’s hard to get off.
Drs. Wen and Kosowsky then dissect each event to explain what went wrong and how the outcome could have been improved, by both the medical professionals and the patient. They write back and forth, as if having a conversation.
I appreciated the insight I gained from hearing them talk about each case. As a nurse, I know that in situations where there are multiple care providers—several nurses, medical students, resident, attending physician—a patient’s story can get garbled even in the best of circumstances. Patients reading this book are given “red flags” to watch for, signs that your doctor is not hearing what you are saying.
I really like that each chapter has highlighted boxes with “911 Action Tips” that repeat and emphasize what each patient could have done differently when they didn’t understand the plan and began to feel the situation was getting out of control.
How out of control? In one story, a young college student being treated for a bad headache from a hangover actually sneaked out of the ER before the doctor could perform a spinal tap to rule out a very unlikely brain hemorrhage!
I think the information in this book is solid and useful. But I would also recommend taking Dr. Laura Nathanson’s advice in her book, What You Don’t Know Can Kill You: A Physician’s Radical Guide to Conquering the Obstacles to Excellent Medical Care, and recruit an “advocate”, a friend or family member that can accompany you to the ER or an important doctor’s visit. An extra pair of ears is always helpful, as is someone who can help share your story with the doctor and listen for the “red flags” Drs. Wen and Kosowsky write about.
Read When Doctors Don’t Listen and then give it to your chosen advocate.
Sneaking out of a hospital or doctor’s office shouldn’t be the best way to avoid unnecessary treatments!