Yesterday I had a most unimpressive doctor visit. It left the patient in me feeling somewhat unsatisfied, and the patient experience professional in me disheartened. I have had bicep tendonitis for the last two months. This is an extremely uncomfortable condition that constantly reminds me how much movement and involvement the shoulder has in every day and every night activities!
I am spoiled by the compassion and focus my primary physician Dr. J. gives me. I am a concierge member, and concierge medicine allows the physician to spend more time with patients and truly to help them with their health, not just their diseases. Two weeks ago, during my annual exam, I discussed my shoulder condition and apprised Dr. J. that I was seeing a massage therapist and physical therapist every week. She agreed with the physical therapist’s treatment course. However, although I am gaining increased range of motion, the pain seems to be getting worse. So I called for an appointment. Dr. J. was booked, but I was able to get an appointment to see my primary’s partner, Dr. X.
The visit did help me with the shoulder pain and I finally slept through the night. However, it did not by any means knock my socks off in the caring department. There is not one thing Dr. X. did that was “bad”. Instead, the experience was filled with missed opportunities to make me feel cared about as a human, knowledgeable about my own body and needs, and involved as a necessary part of my own care.
It started with his introduction, made standing over me as I sat in a chair.
- Doctor: “Hi, I am Dr. X, what brings you in today?”
- Me: “Hi, nice to meet you. I’m here because my shoulder tendonitis is becoming more painful.”
- Doctor: “Now, when you say ‘shoulder tendonitis’ is this something you are calling it or has someone…a medical professional, actually diagnosed you?” He asked me this as he leaned back against the wall, arms crossed, glancing down at me with a questionable look.
- Me: “Dr. J. and I spoke about it when I was in to see her a couple of weeks ago. I am also working with a physical therapist as well as having massages for the compensating muscle tightness.”
- Doctor: “Are you seeing our physical therapist here, or someone else?”
- Me: “I am going to Momentum Physical Therapy and seeing Mike. He is amazing. He originally ran me through a series of diagnostic tests to rule out a rotator cuff tear and determined that it was likely a bursitis that turned into tendonitis. He has treated me with dry needling (here Dr. X gave a supportive nod), ultra-sound, passive range of motion exercise, ice therapy, and an exercise program. I’ve seen him four times and had three massages.”
- Doctor: “Oh, well that is good. It is good he is having you do exercises as that maintains and will rebuild strength. However, most patients don’t really do them. (He gave me a look of serious doubt). What has worked for you to alleviate the pain thus far?”
- Me: “Well, I do think the exercises really help, as it feels better when it’s warmed up and been moved around. Ibuprofen and naproxen were really working pretty well for the pain, but I started getting gushing bloody noses and have had to stop taking them as much.”
- Doctor: “Are these bloody noses every day? Did it happen once? And what do you mean by gushing?”
- After I answered, he said, “OK, that sounds like it could be an issue.” He prescribed a muscle relaxant and an anti-inflammatory medicine less likely to cause as many side-effects.
The entire time we were talking, I found myself trying to get him to relate to me as a person, to believe what I was telling him, to acknowledge my pain and feelings, and to see me as an individual who has done my best during eight weeks of intense, debilitating pain. Finally, at the end of the visit, after I had asked him about his medical career and what brought him to family medicine in a concierge clinic, he cracked a bit of a smile and walked me to the door. He relayed that I could come back and see him if things did not get better, or I could see my primary and they would talk. I appreciated his gesture but thought, “No, next time I will wait as long as it takes to see Dr. J.”
Sometime in the future I may encounter Dr. X again, but I will do so only in times of necessity. I would not recommend him to anyone else, even though medically he is likely as good as most other doctors out there.
Today, upon reflecting on that appointment I can’t help but wonder if Dr. X. would be more gratified in his work if he would step in a bit more, if he were to relate to me as a person, and use words and body language that let me know he cares. I wonder if he might experience greater satisfaction and better fulfill the hopes he had when becoming a doctor if he saw himself as a partner on my healthcare team. Finally, I wonder if his patients, like me, might have better outcomes if our interactions felt different and left us appreciative and impressed for having spent a bit of time with him.
As healthcare providers, we have an opportunity to make each moment with our patients and family members meaningful to them far beyond basic medical care. I challenge you to think about your practice and how small changes using advanced communication skills might make a difference to others, and also will more than likely result in helping you return to your reasons for being a doctor, to feel more engaged, and to experience less burnout.