Asthma.net interviewed Sr. Bowser about how to help a loved one manage asthma
As a physician, mother and patient, I have seen the role of physicians from many sides. There are many stories about good and bad doctors, I am striving to be one of the good ones. But what actually makes a good doctor? There is no foolproof formula for being a good doctor, but after years in practice, here is what I have learned and consider important:
We all want our doctors to have good basic knowledge of medicine, and particularly, the conditions we want them to treat. Basically we want “the nerdy doctor” (as one of my friends once told me). The doctor who spent all her time studying in medical school rather than the “party girl.” So let’s discuss what doctors are going through to get to the point of practicing as a physician:
After college, we go to medical school for 4 years, the last 2 of which include actual clinical rotations working in a hospital under the supervision of physicians. We often work overnight shifts while also studying for our boards. Once we pass 2 steps of licensing exams, we start residency and work overtime for very little money, “enjoying” very little sleep. The length of residency depends on the specialty (e.g., 3 years for pediatrics, vs. 5 years or more for surgery). After residency, many physicians will complete a fellowship for a subspecialty such as pediatric dermatology, cardiothoracic surgery, or allergy.
This may seem like a long time and a lot of work to get there, but the long years of training are necessary for what good doctors will be facing. And – as crazy as it sounds – I actually enjoyed my training time! But being a good medical student does not mean the same as becoming a good physician as pointed out in KevinMD.
But that is not the end of it. After passing the certifying exam (at the end of residency/fellowship) and getting a license to practice medicine, physicians are required to participate in ongoing learning activities. We need to get 100 Continuing Medical Education (CME) credits every 2 years. This can be achieved by participating in online activities, reading medical journals and answering questions about the subject, or by attending medical conferences or live lectures.
The internet and social media has changed the way how physicians keep up to date. We are now much better connected to other physicians and also experts in our field. I have the option to post a question for an expert on the AAAAI website and usually get a good answer within 1 week. Through the Physician Mom’s group (PMG) on Facebook, I also have access to female physicians of many specialties and often get an answer to my medical questions within minutes. Don’t worry, this group is only accessible to member physicians, and no confidential health care information is ever posted. Every physician has to determine by themselves which authority to trust, but so far, my experience of help from my online colleagues has been very good.
Most patients want a physician who takes the time to listen and will consider your fears and thoughts about what may be wrong.
One of my good friends recently found out that her child had leukemia. For weeks, she had a feeling something was very wrong with her child–he kept losing weight, was pale, and felt tired. She brought it up several times at the pediatrician’s office, and asked for blood work to be done. Instead, my friend was counseled about better nutrition for her son. She kept pushing, however, and when blood tests were finally done several weeks later, they revealed low levels of red blood cells, white blood cells, and platelets. Those findings suggested a bone marrow problem, and after a few more weeks of tests, a diagnosis of leukemia.
How could this happen? Pride may get in the way of listening to the patient or the parent, or admitting we were wrong about something. As physicians, we sometimes reflexively tend to feel we must know better than the lay person. After all, we spent so much time studying and training, so we must be smarter than “Dr. Google” and whatever the parents have read online.
One of the first things I was told in pediatric residency training was to always take the parents’ concerns seriously. Parents know their children best, and are very sensitive to changes in their behavior. It is surprising how much we can diagnose just by taking the time to listen carefully and letting the parents/patients talk. Imagine how much better medical care could be if every doctor spent just a few minutes or more listening carefully to each individual patient or parent!
Being a good listener is not only important for establishing a diagnosis, but also for coming up with a good treatment plan. For example, nasal sprays and pills are both effective for allergic rhinitis, better known as hay fever. But maybe a patient just can’t stand the thought of spraying something in their nose, yet would happily take a pill; if I treat them with the “one-fits-all” approach and order a nasal spray without discussing it first, that patient may not take the medicine and they may never admit it to me out of embarrassment or guilt. The hay fever won’t improve, and nobody wins.
And this leads right to the next point:
Physicians who include patients in the decision process about their treatment are more successful in getting good compliance (i.e. do they take the medicine) and better control of the disease. If a patient feels her/his preferences are taken into account and her/his particular lifestyle is being considered, they will also pitch in their part of the deal. In the end, less medication may be required.
I treat many patients with chronic conditions such as hereditary angioedema (HAE). Patients with HAE get severe sudden swelling of the abdomen, face, throat, and extremities . They suffer severe pain during episodes, and it can be debilitating and render them unable to work. In between episodes, they may be completely asymptomatic and live a normal life. Most of them come to me after having lived with that disease for 10-20 years. They know more about what would help make their life easier than me. How could I have the audacity to determine the right treatment for them without considering their preferences? I know about the disease process and the treatment options available, but I need to include them in the decision process. I can outline what medication is available and how and when it needs to be given, and then the patient can decide what option fits best for their lifestyle. The patient needs to be guided but ultimately feel in control over their treatment options.
I think that many patients have given up on being treated as “part of the team” by physicians, and have therefore moved on to alternative health care providers. This brings me to the next and final point:
Unfortunately, we often encounter conditions which are not curable. Of course everybody thinks “cancer” immediately. But even hives – despite being harmless – can be extremely frustrating and debilitating. I have to admit that hives are not only frustrating for the patient, but also for the physician. Physicians get frustrated when we can not find the cause for something. In those cases we need to be even more patient and compassionate. It is understandable for someone to be depressed and angry when they can’t sleep due to the severe itch, or when they fear breaking out in hives in public (e.g, a wedding ceremony), that must be taken seriously. If physicians can’t feel for the patient and their quest for “a cure,” then no wonder they get disillusioned and go off to alternative health care providers.
For the record, I don’t want discredit alternative medicine. In fact, it can often be helpful. For example, acupuncture provides substantial relief for chronic back pain, migraines, and even helps labor pain. Herbal medicine can be used instead of commercial medications, but sometimes may have similar side effect profiles. Massage, meditation and prayer has shown to reduce pain, anxiety and speeds up recovery from any conditions. In fact, prayer was found to be the most commonly used alternative medicine. While not all studies show a medical benefit of prayer, there are some surprising findings, including several studies suggesting that prayer improved outcomes in women undergoing fertility treatment.
In conclusion, a good doctor should know her field and be passionate about practicing medicine. At the same time, she should be humble and compassionate and spend the time to listen to her patients. If the patient feels safe, understood, taken seriously, and well taken care of by a physician, they will do better overall.
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