Regarding listening and other ambulatory skills: 5/31/02
Although we family physicians might have had some impact on our colleagues, I think it is fair to say that doctors still don't listen to patients or provide stellar service, at least from the limited perspective of my patients in an academic FP clinic, a mix of medicaid, indigent, and employees.
On one recent half day I removed one foreign body from a patient who came to me because there were few doctors left east of 72nd street and she likes the family doc approach, plus she and her family plan to stay put in eastern Omaha. (most prefer to escape). They have an easy lawsuit, but because they are nice folks and maybe because I listened last time and this one and acted fairly swiftly, there will likely be one less lawsuit. Another benefit of family practice that few will likely measure.
The next patient begged me to take care of her elderly neighbor across the street because she cannot find a doctor who listens to her. They will both be back in a month. I then saw a follow up ear and a preop physical on an employee.
The next patient was a work in. She had recently had a first attack of pancreatitis. She left one hospital due to her perception of poor care and then had trouble at another one. The nurses and doctors would not listen to her when she objected to repeated and unsuccessful arterial sticks by a nurse. She called me on the phone at my office across town during the episode and I told her who to call at the hospital to get things changed. My nurse worked her in today as a hospital follow up and she was able to ventilate to me and work on her pain. I will see her regularly for awhile. She continues to function despite multiple episodes of abuse dating back to childhood. She fought through these and has a good family and boyfriend and job. Her 13 year old daughter has stepped up to care for the other kids. This teen also defended her mother in the hospital when the nurses were not particularly helpful at a time when she was weakest. I made the mistake of asking this teen which law school she planned to attend. She stated she wanted to be a doctor. I told her I thought she would make a good one. Usually I am the one encouraging health careers for my underserved patients. Made a note not to assume a legal career just because someone is a good defender and stands up for things.
Another patient dropped in for a lost narcotic script on a Friday PM, usually a bad sign, but my nurse listened to him and realized he needed more so she had him wait to see me. He keeps his meds on him because of previous problems of theft and accident in his neighborhood and home (and hassles by us when he loses the meds or presciptions). He has had 5 surgeries in about as many months. I see him regularly along with his wife, mostly to refill the medicines and arrange specialty follow up. The reason that he lost his medication was because he was arrested for disorderly conduct. When he came home there were 20 police and gunshots and he was trying to get into the house to check on his wife and dogs. The disorderly conduct was his attempt to get in his own house to find out what was happening. His wife is unable to control the dogs in such situations and he knew it. He was too late. His dogs were killed by police, one was shot 20 times, in a raid with little if any probable cause since they were looking for a person who does not ever have entry to the house. The dogs were contained in a room until officers demanded access to this room, then control was lost. The dogs have never injured anyone. I could only listen as this man talked about the loss of his constant companions, clearly valued and trusted family members who have treated him better than any of his kids have done. He feels that the dogs have also helped end gang grafitti and the trashed out condition of the immediate neighborhood for the last 3 years. He is more fearful now. Other than refilling the meds I could only listen and pray with him. I prayed for healing and for him to continue to be an example to others of one who overcomes, something I am proud of about him and continue to tell him so.
I saw his wife in a "free" encounter at the front desk where she waited for him. She was basically still in a stunned state. We will work through this trauma also. I had asked her to call her psychiatrist. She did and she noted that they ventilated on her about her last two missed appointments. She was bitter but contained her emotion, in fact she was containing all emotion. They said that they could see her in about 6 weeks. Apparently other physicians and other professionals need to do more listening to those they are supposed to serve. I will see them next week.
Oh, and by the way, thanks to you my fellow family physicians, for listening. I am Ok. The day has had its ups and downs but I feel pretty good. It helps to know that I had the chance to serve and continue to have the privilege of caring for such brave folks. And fortunately my family is occupied and does not need me right now. Keep serving, and praying.
Also thanks to Lucy Candib, I have always enjoyed involvement with patients, some of my collegues think I enjoy it too much, but after reading more of her work I have enjoyed watching how my patients do shape me.
When we keep in touch with our patients, we in Family Medicine will continue to do well. If trends continue, and admissions committees continue to select poorly, and our training is less emphasized, and doctors choose to ignore such training after graduation, and doctors are pushed to higher volume and more documentation and other efforts with little meaning, we in Family Medicine might be the only ones worthy of the honor of being called a physician, and the only ones worth going to.
Robert C. Bowman, M.D.
Family Physician