Science and art

A few weeks ago I was in my vet’s office and while waiting for my turn (my dog’s, I should say) I picked up a copy of Reader’s Digest, April 2004—haven’t read it in years. The front cover caught my eye with an article titled “What Your Doctor Wants to Tell You.” Of course I read it.

A market research company conducted a nationwide survey asking Canadian GPs what they would really like to say to their patients. As examples:

• 96% of GPs wish they could say, “Be honest. If you’re not taking your medication as prescribed, tell me.” 
• 94% wish they could say, “If you’re taking herbal supplements or over-the-counter drugs or using alternative therapies, let me know.” 
• 88% wish they could say, “You don’t need a prescription.” 
• 88% wish they could say, “Tell me what you’re worried about right away, not when you’re leaving.”

I copied this article, put a few in my waiting room, and gave some to new patients to my practice and some to those I have followed for a number of years, and asked for comments. Admittedly, this was a very small sample size but the responses were strikingly similar. For the most part, they actually agreed with the comments in the article.

Almost universally they expressed the desire to be honest and up front with the doctor, but cited lack of time with the doctor as a major drawback to an honest, open relationship. Obviously there are significant differences between booking appointment times for GPs and specialists, but I found it interesting that even though I book 45 minutes for a new patient (and it often takes longer) it was perceived to be too short—certainly if I am expecting to find out all I need to know about someone and may not see that person again. I remember in my training the clinics assigned to residents/fellows allowed 11/2 hours for a new patient and 45 minutes for a follow-up. At that rate in private practice I would be bankrupt, but I would probably know my patients a lot better. I fully understand the GP booking one visit for one problem, but I can’t help but think that this is a disservice to the individual with complex medical problems.

With respect to the comments about being honest and telling the doctor whether the prescribed medications are being taken or other therapies are being used, the patients told me that they were reluctant to do so because they felt they would be letting us down and somehow admitting failure. We need to dispel this notion—in some cases the consequences of not doing so could be catastrophic.

The message I got from this was that most patients want to be actively involved with their doctors in their medical care but need to feel comfortable and in an environment where they can trust them with their concerns and fears at a pace they can absorb.

Our world is speeding up and I have difficulty keeping up in my own speciality with the explosion of medical technology and information. I feel that taking a few extra minutes with our patients in the office and at the bedside will go a long way to bridging the gap between the science and art of medicine.

—SEH