One of the things I often do is compare what I expect of others to my expectations of myself. As I’ve started to focus my business on OBGYN clinics, doctors are my current subject of scrutiny.
What I’ve realized is two-fold:
- I expect them to make the best choices for my health.
- My expectations of my doctor are unrealistic.
1. I expect them to make the best choices for my health.
What I mean by this is that, if I my OBGYN doctor prescribes me a birth control implant, I would expect them to know the interactions with my heart/diabetes/immune/etc medicine, regardless of how long they have been around. I expect them to know every new development in their specialty and even outside their specialty. I expect them not to make any mistakes and to remember every detail of their 8+ years of training and education. I expect them to listen to me and provide patient-centered care, always, every day. If I’ve been there before, I expect them to remember what I talked about last time. Finally, if I have sent my records over in advance, I expect them to read all 20+ years that I sent them and also have narrowed down the potential diagnoses.
I believe that these expectations are OTT (Over the Top).
As a female entrepreneur focusing on OBGYN clinics, birth control comes to mind. Birth control as an oral pill was only created in the 1960s, though the most popular birth control method, the single-rod implant, only entered the market in 1998. That means that for most popular birth control, there has only been about 20 years to test its interaction with every other medicine, of which there are 1453, according to the FDA on 31 December 2013.
Even taking that outdated number as our reference, that would be a study completed every 5.02 days for the last 20 years on the interaction of every FDA approved drug versus one type of birth control. That also means that for every additional birth control option, we expect our doctors to remember their interactions also, which is like a million+ studies.
Its simply unrealistic. Yet, up until I ran the numbers and wrote this article, I had that expectation.
One study found that a new article published to the National Library of Medicine was released every 40 seconds. Besides the development within medicine, there are also constantly changing policies in hospitals, state governments, and national governments that medical professionals must keep up with. As one doctor puts it, “Our office got an insurance memo that said we must now add extra codes on our billing forms….As if doctoring wasn’t time-intensive enough, now we must enter and re-enter data that has very little meaning to anyone except the pencil-pushers in insurance land” (Starla Fitch MD).
A mistake in healthcare can have HUGE repercussions, so of course, I expect my doctor to make no mistakes. Yet, even with a huge justification for having this expectation, it is also unrealistic. We are humans, and it is IMPOSSIBLE to not have human error, and with some good reasons.
For one, there is evidence to show that human errors can almost always be blamed on bad policies and processes by the hospital rather than the doctor (NCBI). If that’s the case, it would be better to check out hospital ratings rather than doctor ratings when choosing a doctor.
With our focus on limited English proficiency patients, it is important to note that a a huge cause of medical errors are due to inadequate patient records, which could be caused by poor or lack of translated records.
According to WebMD, patients reported that they expect the following to be the top qualities of a doctor:
- Confident: “The doctor’s confidence gives me confidence.”
Did you know that several studies, including one by the Harvard Business Review, show that smarter people are less confident? In fact, a study on JAMA Internal Medicine demonstrates that a doctor’s confidence actually can be poorly correlated to accurate diagnoses.
- Empathetic: “The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.”
One study suggests that a doctor’s ability to empathize decreases the longer they have been in the practice, which is ironically what makes them more experienced and confident. Another study suggests that “stress and the hormones secreted when we are stressed….disrupt emotional empathy.”
- Personal: “The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.”
I hate to break it to you, but your doctor probably barely remembers who you are. According to a 2013 survey by the American Academy of Family Physicians, the average physician serves 19 unique patients per day taking about 22 minutes per patient. Additionally, the physician has approximately 2,367 patients under there total care. That’s very little time spent with a lot of patients already, and yet the need for doctors to fit in more patients per day is increasing.
- Forthright: “The doctor tells me what I need to know in plain language and in a forthright manner.”
The use of jargon begins in medical school and continues into the hospital as it helps medical professionals communicate with each other quickly, efficiently, and without mistakes (which we want to prevent).
Jargon becomes an issue when doctors speak with patients, who don’t understand medical speak. However, patients who have worse health literacy suffer worse medical outcomes, so the power is also in the patient’s hands to educate themselves. Additionally, patients often feel too intimidated to voice their concerns, so doctors are not aware of where there are misunderstandings.
- Respectful: “The doctor takes my input seriously and works with me.”
For me, this point feels relative to our recent article about being respectful in political communication. Ultimately, when emotions are involved and subjects are personal (like your health), we stop acting as rationally and we forget our communication skills. While ideally, a doctor would remain respectful even after they’ve dealt with hundreds of patients, disrespect is a coping mechanism, and no one is dealing with everything in an ideal way. But there are ways that you can show up to your appointments and make your doctor’s life easier.
- Thorough: “The doctor is conscientious and persistent.”
I believe this one is related to a previous point about keeping up with new developments in the field. Our idea of what “conscientious and persistent” means may not be realistic when we take into regard the amount of new information that is coming out every day.
WebMD wisely points out that technical knowledge did not make the list.
- Patient-Centered Good Listeners
This one is awesome, and especially in regard to limited English proficiency patients, it is becoming clearer that it is extremely important. However, being a good listener and patient centered seems to be based on several factors, including gender roles, one study by Harvard suggests. On the patient’s side of the coin, you can’t expect every doctor to be a good listener, and it is up to you to advocate for yourself. If you feel like you’re not being heard or your care isn’t patient-centered, then you need to voice your concerns (is a respectful way) .
2. My expectations of my doctor are unrealistic.
This part is purely opinion, but I believe we need to break this idea that doctors are super-beings and make them human in our minds. They don’t know everything and they are not perfect, and there is much more that each person could be doing to take responsibility for their own health.
While a doctor should certainly be making choices that benefit your health, they are, by default of being human and looking out for themselves first. This doesn’t mean that they are looking to do harm. More than likely, they are also probably looking to do good (hopefully!), but you cannot deny instinct, and it is natural for doctors to think of themselves first. The best doctors are doing their best to get past instinct and put you at the top of the list, but everyone has a bad day when they are consumed with themselves, their problems.
Therefore, again, it is UP TO YOU to advocate for your health. Re-evaluate your expectations of your doctor, and see where they may be unrealistic. Speak up when you think something is a bad idea, and tell them why. Speak up when you remember some random patient history, even if you’re not sure if it is relevant. Educate yourself about health and get involved, because, higher health literacy and involvement in your health means better health outcomes for you.
You can come prepared to your next appointment by ensuring your medical records are translated into English. Check out our Medical Translation services here.