…I know I said that I would be back in a week, but something happened today and I need to write about it. Writing is cathartic for me. Hopefully writing about it will make me feel better.
I saw a specialist this afternoon to follow up with the isn’t-cancer-but-is-still-lingering condition. The visit was terrible. I kept thinking, I definitely didn’t pay for your opinion on these issues & why are you only spending 2 minutes on the condition that I consulted you for??? Chronic patients need someone more than an expert; they need someone to recognize that their condition might be complicated and they may need extra assurance to follow through with a new treatment direction. They need someone who listens to them and cares for them on a human level; otherwise, how do we know that you’ll treat us well as scientific subjects?
Dr. Voluble met all these criteria for being a terrible doctor; (my responses are in italics):
1) Diagnoses you before he talks to you or examines you by skimming through your file
I call doctors like this scientific. Maybe a better descriptor would be robotic. They stereotype your case into one of three possibilities; (interesting how by virtue of walking in the door, you have one of three conditions!) If I wanted a generic evaluation like this, my physician would have ordered a phone consult.
2) Doesn’t actually look at the notes in your file for why you were referred & doesn’t take notes at all when talking to you, especially for a thirty minute conversation
One of my pet peeves is when doctors don’t look at my medical chart and then proceed to ask me questions about things that are clearly stated in my chart. I understand that you want me to tell my story in my own words, but don’t walk in and then ask me if I’ve ever seen other physicians for this condition. The answer is: Yes and WHY haven’t you looked at my chart??? Plus, you clearly don’t value my thoughts enough to actually be noting down anything I’m saying, so are you really listening or did you just walk in to dump your pre-ordained diagnosis on me since insurance won’t pay for this consultation unless you actually talk to me?
3) Tells you when he enters the room that while he knows that you came in to discuss something in his speciality, he wants to set that aside for now and talk about other things because he thinks those are more important
This is a terrible, terrible sign. It would be like taking your dog to the vet and the vet giving you a thirty minute discussion on topiary. Ummmm, I don’t really care if the way my backyard is laid out is stressing out my dog. I came here to see about the thorn in his foot!! And if my topiary is really a problem, I should be talking to a gardner about making changes to it. Can you please pretend to take me seriously? I’m consulting you about something in your field of expertise because it’s important to me to understand what’s going on there, and another physician believes that your expertise would be beneficial.
4) admits that he’s not a psychiatrist (or other type of specialist) but claims that in my case, he knows more than they do
Another terrible, terrible sign, especially since I have something that is not straightforward, which he would know if he actually looked at my chart!
If you have to revert your personal history in order to establish credibility, something is wrong. Your credibility should be based on logic of how you came to this conclusion and the signs and symptoms present in the case. If you’ve treated a million dogs for schizophrenia, it doesn’t make you a better vet for removing the thorn in his foot!! He’s not schizophrenic and definitely not the other million dogs!!
6) when you mention that you have other physicians that he may want to consult with, he replies that actually he doesn’t need to consult with him because he knows that he’s right
Another terrible, terrible sign. If the only reason that you’re running a diagnostic test is to prove to me that you’re right (especially about a pre-ordained diagnosis), your credibility is going way down. Experience tells me that if the diagnostic test comes back negative, you’re still going to want to treat me for what you think I have because “tests aren’t really that accurate”. This is not the proper use of science in medicine; science means that you follow a protocol that makes sense in this case, not a protocol that is one of the three options you always exercise.
7) corrects you when you try to explain your medical history and your explanation doesn’t fit his pre-ordained diagnosis
Something about this tells me that you’re not listening to me and you don’t actually respect me enough to accept the possibility that there may be something you’ve overlooked.
8) spends a total of two minutes on the physical exam and the actual issue you came in for and spends another thirty minutes talking about things that are either outside his medical speciality or not even related to medicine!!
I left this visit completely uninformed about the issue that I came to consult with this specialist about. I know it’s not cancer, but I already knew that before. I still don’t know if there’s something abnormal because you didn’t spend enough time to determine that and you didn’t even look at my face during your two minute exam. If I was grading you, you would get a 0 because you failed to meet the demands of the assignment.
9) insults his patient’s intelligence by repeating everything over and over again and refusing to address legitimate concerns of the patient
Just because I have a chronic illness doesn’t mean that I have the intelligence of a twelve year old. Neither does the fact that I might look like I’m twelve. I’m in graduate school and provided you with the majority of the information that you’re using to make this diagnosis (since you failed to examine my chart.) Plus, I was referred to you by another M.D. for something that he felt was serious enough to merit a consultation with a specialist. If you dismiss the reason that I came to see you, you are effectively dismissing his judgment. Since he’s spent a lot more time with me and I have an established relationship with him, this also diminishes your own credibility.
10) spends so much time off-topic and away from medical issues that the patient has to politely but firmly nudge him, Can we not talk about this any more?
There are no words…
11) knocks on the door after he already opens it even though the whole reason he left was because proper medical protocol requires a female present for the actual exam
You’ve established that you think you rule the world. You don’t have to demonstrate it again.
12) is sure that his pre-ordained diagnosis will totally turn your life around and knows that only a great mind like his would have seen this
I’m sorry, but even if you’re right, I’m electing for treatment with someone who respects me enough to listen to my concerns, thinks about how this might fit into my existing treatment, and honors my intelligence and decisions. And, so far, you haven’t done a very good job at establishing credibility; I just know that you think you’re really something.
This visit reminds me again and again how blessed I am to have physicians like Drs. Leo, Mark, & Samuel in my life. I know that I can bring up the issue that Dr. Voluble flagged to any one of them, and we can discuss whether or not it’s something that needs to be investigated. They will take the time to listen to me and consider this issue because I brought it up and asked for their help. If it’s not something important, they’ll tell me so and tell me why. Then we can move on. And if it’s something that needs to be addressed by someone who specializes in that issue, they’ll refer me to a colleague. They won’t spend time criticizing Dr. Voluble or dismissing my feelings regarding this consultation. They won’t tell me that they’re not interested in an issue that I bring to them. And something tells me that this makes them better doctors. It certainly makes me feel less stressed about managing my own very complicated medical journey.