The science of medicine continues to expand rapidly, and this is obviously good for humanity. The art of medicine, on the other hand, has been largely forgotten. This skill is the basis of the time-honored physician-patient relationship and is an important aspect of good patient care. So why have so many physicians forgotten this basic skill? Why would a caring physician disregard any expertise that would benefit his patient?
In today’s atmosphere of third-party payers, physicians are buried under excessive paperwork, besieged by malpractice attorneys, and if they’re surgeons, their malpractice insurance premiums are often astronomical. Physicians find it difficult to incorporate all of their duties into an eight-hour day so they work longer hours. This makes them seem hurried and irritable. Patients pick up on this and feel the doctor is callous, uncaring, or worse, arrogant.
Because the insurance company is responsible for most, if not all, of the patient’s bill, patients only go to doctors who are covered under their plan. This makes the physicians feel their patients are disloyal. Besides that, the insurance companies insist on referring to physicians as "health care providers," thereby clumping them in with anyone who interacts with a patient. This term ignores the fact that many physicians have undergone fifteen or more years of training and would prefer to be referred to by their correct title.
The Art of Medicine
So what is the art of medicine and what does it have to do with any of this? It is a multifaceted approach to patient care that takes into consideration the patient’s emotional, as well as his physical, state of being. All good doctors recognize the role that emotions play in an individual’s illness. In addition, the patient’s interest must be placed above all others. If the doctor always does what’s best for the patient, he never has to be concerned about his ethics. Therefore, the patient’s interest must come before that of the doctor, the insurance company, the hospital, or the surgery center. This is particularly true if the surgeon owns a financial interest in the surgery center.
In general, patients want to know several things when they visit a doctor’s office, such as "What is wrong with me? What diagnostic tests will I need? When will I get the results of the tests? Will the results be explained to me? Will I need surgery? If so, how much is it going to cost? How long will I be out of work?"
The Art of Full Disclosure
One of the most important aspects of good patient care is keeping the patient fully informed. If the physician uses a variety of methods to inform the patient, seldom will the patient have questions. When he or she does, the physician must set aside time to answer any and all questions that arise. The physician should be seated when explaining things to a patient. It puts the patient at ease.
If surgery is to be considered, the procedure should be discussed in detail covering all the possible benefits and complications. Ideally, this should be done in person. However, there are several ways a surgeon can accomplish this in a busy practice.
Camcorders are inexpensive, and there are easy-to-use editing programs available to allow the doctor to produce his own DVDs. Sitting at a desk in front of the camcorder, the doctor should carefully explain each procedure using illustrations to emphasize how the surgery is to be performed as well as all the possible known complications. The patient needs to understand the complications because if one occurs, he will know what to expect. After the patient has viewed the DVD with family members, the surgeon should see them and answer any questions they might have. The patient should also be given a printed brochure that further explains what the surgeon covered on the DVD. With this approach, the surgeon seldom has to elaborate. Not only is this helpful for the patient, but it saves the doctor valuable time.
The Art of Listening
The physician should take time to listen to patients. Studies have shown that during the initial interview with a patient, the average doctor interrupts the patient’s story within the first seventeen seconds (Ann Intern Med. 1984;101:692-696). This frustrates the patient. Doctors want a chronological history but unfortunately most patients don’t relate their symptoms in chronological order. They wander around, thinking of things as they pop into their heads. This frustrates the doctor.
When a patient is in the hospital, the good physician/surgeon makes rounds twice a day. That requires a few minutes at the foot of the patient’s bed going over the chart and answering questions. This can be done in three to five minutes. During these visits it’s permissible for the physician to stand. Patients know that doctors have more than one patient in the hospital and that they’re busy.
On the day of discharge, however, the routine should be different. The doctor should pull up a chair and sit down. Then he or she should say, "I’ll sit here as long as it takes to answer your questions." The fact that the doctor has taken a seat tells the patient that the doctor has set aside that time for him only, and is not going to rush off to see someone else. If the doctor has prepared the patient properly, the visit will still take less than five minutes, but the patient will feel well served.
Any surgeon who states that he never has surgical complications is not being honest. Even the best surgeons have them. If the patient has been fully informed, that patient will accept the fact and do the best he can to endure the problem. The caring surgeon will say something like, "We discussed this possibility before surgery. I’m sorry the complication occurred and I will help you through this difficult situation."
The Art of Compassion
Following a surgical complication, instead of making rounds twice a day, the compassionate surgeon will do so four or more times. This lets the patient and family know the doctor is on top of the situation and is concerned about their well being. In difficult or unusual cases, the secure physician will suggest a second opinion before the patient or family asks for one.
So why is the art of medicine important? It establishes the time-honored physician-patient relationship. The patient will have respect for and confidence in his physician and will trust him. Patients will have a positive attitude going into surgery and accept a complication should one occur. Most of the time, they will not consider a malpractice suit because of a complication.
If the doctor-patient relationship is strong, patients will remain loyal to their physician and may even fight the insurance company in their doctor’s behalf. Not only that, but they will refer their friends and family members to their doctor. The most secure practice a physician can develop is one that is patient based. Even in today’s practice atmosphere, happy patients can build a solid practice for a caring and compassionate physician. ENT TODAY
Michael E. Glasscock, III, MD, has been a practicing otologist and neurotologist for over 30 years and is the past president of the American Otologic Society. He has published in excess of two hundred and fifty scientific articles in peer- reviewed journals and three textbooks during his career, and founded the American Journal of Otology.
Eric M. Kraus, MD, is an otologic surgeon at The Ear Center of Greensboro, PA and an adjunct clinical professor at the University of North Carolina-Greensboro.