Your Doctor Should Know You Well
Reimagining the Patient-Doctor Relationship
I had a great doctor when I was finishing my family medicine residency at UCLA. Dr. Egelsee knew me, listened, cared, and never made me feel awkward. Of course, he knew his stuff, too, which matters but not as much as someone caring.
The Modern Family Medicine Doctor
In the insurance-based healthcare system, the role of a family medicine doctor is strange. They’ll see you intermittently, and you’ll never quite feel like they know you or vice versa. Visit after visit, it feels like you’re rehashing the same topic, making little progress.
The doctor’s job is to avoid getting sued and not get into trouble with the state medical board. Their main goal is to finish the work for the day and collect their paycheck, which isn’t all the different from different jobs.
The thing is, family medicine is different in that you can’t do much for the patient if you are treating them at an arm’s length away. You can prescribe one medication after another and skip them around from specialist to specialist and never get to the bottom of their problem.
Today, a family medicine doctor working in the insurance system is getting paid by the insurance company, not directly by the patient. Before they can prioritize the patient’s needs, they have to answer to their employer, the state medical board, and the insurance company.
Getting To Know My Patient
I don’t tell my patients this, but it’ll probably take me around a year to get to know my new patients. That’s how long it takes to understand them, hear their stories, have them drop their guards, and have me drop mine.
The two of us may have to get into a minor tiff, resolve it, and become an even better patient-doctor couple. My goal is to get to know my patients well, and my patients’ job is to look deep within themselves to bring up uncomfortable topics. We solve problems, look ahead, plan, learn, and hold each other accountable.
When you understand another person, you can be so much more effective as a physician. Because health isn’t about blood tests and medications - I know that’s what Western Medicine has promised, but it hasn’t yet delivered that, except for acute care stuff - we’re doing well in that department. The again, most of my patients are dying from diabetes, obesity, dementia, and cancer. The days of gunshots, mining accidents, and smallpox are over.
The Cash-Based Primary Care World
There is hope in the cash-based primary care space. Here, doctors are saying no to health insurance because they know that most patients just need a good PCP. If together, the patient and doctor can identify the patient's disease risk and work on habits and choices that will prevent the top 5 common killers, that’s money and time well spent.
Why do we have PCPs? It’s not to get meds or referrals; there are much easier ways to accomplish that today with faceless telemedicine companies. We want someone in our corner to keep us healthy and help us navigate healthcare should something go wrong.
In the cash-pay system, the doctor keeps most of what they bill the patient so they can spend more time with the patient. There is much more transparency, which makes it so much easier for me to connect with my patients. And the patient gets my undivided attention, not worrying about being just a medical record number in a sea of patients.
Getting to Know My Patient
What my patients say in idle chit-chat gives me the best insight into who they are and how they approach life. Some tackle problems head-on; others prefer to brush them under the rug. Each subtype benefits from a unique approach by their guide - me. I can’t beat around the bush with the first and can’t get too sciency with the second.
How the two of us tackle small decisions determines how we tackle bigger ones. A simple cough that goes away by Monday is a great start. And it’ll prepare both of us to tackle the Lupus that’s there to stay.
I want to get to know my patients because I’ll be so much better at what I do. Healthcare can’t be about statistics and numbers because we, as doctors, know that the patient in front of us never behaves like medical school textbooks.
Getting to Know Your Doctor
My patients get to know me, too. They know when I’m distracted, when I’m overexplaining something, and when I’m excited about something new I learned. They know not to ask me something too scientific because I’ll nerd out on it. They also know that if they start with “I’m really worried about…” then I’ll switch into my hyperfocused mode, and that’s a safe place to be with your doctor.
Your doctor will make mistakes. They’ll forget to call you, and they’ll prescribe the wrong medication. They’ll forget to add the one lab test you specifically asked about and they’ll confuse a part of your history with one of their other patients. But if you get to know your doctor, you’ll know that about them and can anticipate it.
The bond a patient and doctor form is sometimes called the patient-doctor relationship. Unfortunately, that’s a legal term, or the law heavily guards it. Really, it’s just a relationship; any relationship you nurture returns far more than what you invested.
In health, we are at the mercy of our habits, environment, healthcare system, genetics, chance, and doctors. It’s worth it to have someone who can guide you through the things you have control over and help you accept the things that are far beyond your control.
Building a Good Patient-Doctor Bond
Ask a lot of questions
Do a lot of chit-chatting
Communicate openly
Be vulnerable
Explain as much as you need to
Do your homework
Express your doubts
Feel your feelings
Trust your doctor
Ask for support
Expect empowerment
Seek explanations
Expect accountability