What we want in a doctor

Many of us are frustrated by our interactions with our doctors. They often seem rushed and only focused on tests and medication. Rarely do we see a doctor who just sits back and asks “How are you doing?”  Dr. Thomas Graboys was such a doctor. In his book “Life in the Balance” he describes what he seeks in a doctor now that he is sick himself with Parkinson’s disease. I thought it would be very beneficial to share his words with you.

Illness interrupts (book excerpt: Life in the Balance)

Thomas Graboys, MD

A few days before a regular six-month appointment with my neurologist, John Growdon, in late 2006, I was asked what, if anything, I would like him to do for me that he wasn’t doing already. My answer was quick and sarcastic: “I’d like him to call me every month to ask how I’m feeling,” I snapped, as if a busy doctor with hundreds of patients in his care would have time for that.

But the more I thought about it, the more I realized that my glib remark cut close to the truth. I want to be on his radar screen. I want him to be thinking about my case, not just when I am in his office, but when he reads about new treatments and new insights into Parkinson’s and Lewy body dementia. I want him to be turning my case over in his head once in a while, and I want to know that while there is nothing that exists today to reverse my dementia, he is thinking from time to time about how to make my life better.

When I saw Growdon a few days later, I asked if we could increase the frequency of our regular consultations from every six months to every three months, to which he readily agreed. Why? For the simple reason that the Parkinson’s path is taking me through very unfamiliar and forbidding territory. I want a guide — someone I trust who knows the medical terrain, someone who has been down the path with others — to be there in spirit and in mind.

I want someone mindful of the pitfalls, the traps, and the forks in the road. It may well be that little will change in my clinical condition over three-month intervals, but I don’t want to see Growdon every three months merely to size up incremental changes in my symptoms or to tweak my medications; I also want the comfort of his presence and to know that every once in a while we can, in [former New York Times literary critic Anatole] Broyard’s words [written while dying of prostate cancer], brood over my situation together.

In my own practice, I developed a keen sense of just how deeply appreciated and how profoundly comforting small acts of kindness and mindfulness can be for the patient and his or her family. Dropping in on a hospitalized patient at the end of a busy day, not to check the chart or to do a quick exam, but just to say “Hello, I just came by to see how you are. Is there anything you need?” Calling a patient at home a few weeks after their annual visit to see how their new diet and exercise program is progressing.

Writing a letter of condolence to the family of a patient who has died (a sorely neglected necessity, in my view). These small acts say to the patient and the family, “I know you ache, I know you suffer, I know you are in pain,” and allow doctor and patient to meet on the common ground of their mutual humanity.

I am not a surgeon, but when a patient of mine was scheduled for surgery, cardiac or otherwise, I always tried to pay a social visit in the hospital the night before, or tried calling them at home if they weren’t yet hospitalized. I can’t prove it, of course, but I believe such a visit or call decreases operative mortality. Such social calls were invariably welcomed and comforting. There is no way to measure the curative and healing power of such a bond between doctor and patient, but I am utterly convinced of its salutary effect.

It is also hard to overstate the importance of the doctor’s literal laying-on of hands. Years ago I had a patient, Mrs. H, who had been hospitalized with terminal gastric cancer. It was her cancer, not her heart disease, that was threatening her life; but every day, as I rounded with my medical students and stopped to examine Mrs. H, I routinely listened to her heart. One day, under pressure of time, I forgot; and as I turned to leave, she said, “Dr. Graboys, aren’t you going to listen to my heart?” I was embarrassed and flustered in front of my charges and immediately struck by the fact that although she knew her heart was not her major problem, she needed and wanted the reassurance of my touch.

As I reflected on the experience later, I also realized that Mrs. H. had interpreted my actions as a commentary on her condition. My failing to listen to her heart that day signaled a loss of hope in her situation. If I could no longer be bothered to examine her heart, it meant the cancer was so serious that it had rendered her heart problem irrelevant. Conversely, by examining her heart, I had been signaling hope that she was not succumbing to her cancer.

Similarly, a doctor’s words — as my mentor, Bernard Lown, [MD, renowned cardiologist and Nobel Peace Prize winner] has written — can maim or they can heal. The physician who offers nothing more than impeccable clinical judgment can, nevertheless, draw the cloak of illness tight around a patient with carelessly chosen words.

Too many times, patients have come to me and said that another cardiologist described their heart as a “widowmaker” or a “time bomb.” The stress and anxiety thus induced by the doctor can turn him into a prophet. Words that allay stress, words that allow room for hope — not false hope, but hope — can allow the patient to shift the burden of worry onto the physician.

So I know what I look for in a doctor.

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