Trust me. I'm your doctor.

I’m meandering my way through six questions that will determine your productivity as a family physician, to wit:

1. How fast do you work and think?
2. How many problems can you manage in an hour?
3. How much time do you spend on non-paying medical activities?
4. How much do patients trust you?
5. How efficient is your collection system?
6. How much attention do you pay to coding?

I do this under the (challengeable) conviction that when family physicians have met the enemy, he is us; that we can make specialist-level incomes if we pay attention; that the bio-psycho-social model is a time waster, and caters to the lazy or lackadaisical; and that, as TransforMED discovered (in perhaps its only useful return on an investment of millions), you can’t make a living seeing 15 patients a day – unless you choose the micro practice model, and you’re willing to empty your own trash and serve as an insurance clerk part-time.

Let’s walk into a minefield: Why does it matter how much patients trust you?

When I started in family practice, I was a big believer in patient education and informed patient choice. I’ve already told you how I discovered that most patients need an ounce of willpower more than a pound of knowledge. Since I believe in Original Sin, that wasn’t a big surprise.

The big surprise was that they really wanted me to be God.

I don’t like people who think they’re God. Many CEOs are ordinary people; but when I encounter a godlike CEO, I can’t get rid of them fast enough. (“Yes, you really do need to go to the Mayo Clinic for your $3,000 annual physical.” “No, I won’t see you at 6 in the morning.”) Give me honest, hard-working, unpretentious, blue-collar folks any day.

What I found with experience was that long-winded, derriere-shielding discussions with patients about the risks and benefits of ingrown toenail removal, including death, were promptly met with “What would you do, Doc, in my situation?”

Maybe my practice is eccentric. But that’s what I’ve found. My patients want to know what I would do. That shouldn’t be confused with What Would Jesus Do. But I’ve had to get over the discomfort of answering that question honestly.

It really isn’t the same as wanting me to be God. I was exaggerating. What they are doing is trusting my judgment, which is exactly the same thing I would do in their situation. After all, if I didn’t trust the judgment of my physician, wouldn’t I choose another?

So I got over it. I don’t have a dictatorial personality (at least in person), and learning to simply be grateful for the trust I am granted makes me a lot more productive. I don’t have to listen to myself talk, unless requested. A lot of problems are handled in a lot less time.

Trust has to be earned. It takes time, and exposure. I work with an excellent PA, but I decided early on that I wasn’t going to reroute routine colds and pains to my mid-level; those encounters are trust builders.

It takes honesty, including the humility to say, “I don’t know.” Be well-informed, and shoot straight. Sincerity is important, and eye contact is important. I have seen evidence that tapping on a laptop doesn’t hamper relationships, but I don’t believe it.

Here’s a pearl: Review the chart, including labs and the last visit, before you enter the exam room. Don’t pull it out of a slot on the door; then the patient knows what you’re up to. The point is to make them think you’re smarter than you are, or at least that you care enough to devote full attention from the moment you cross the threshold.

Kathy Saradarian, a family physician with a micro practice in New Jersey, recently wrote, “The PCMH die-hards are not allies. They are so caught up in this high-tech, low-touch, doctor-manager definition that they have forgotten who we are.”

That’s the ticket. There’s the danger. And it may not pay well, either.

Posted at 09:37AM Mar 16, 2009 by Doug Iliff  |  Comments[0]