Help Your Doctor Help You

This week, I wrote an article in Slate with the provocative theme of "10 Types of ER Patients". 

My intention in writing the article is not to stereotype or imply that patients don't have good reasons for coming to the ER. 

Rather, in my work as an emergency physician and separately as a patient advocate, I've met many patients who are frustrated by their care. I've seen the same missed opportunities and miscommunication happen over and over. This is my attempt to provide advice and guidance before they came to the ER.

The 10 Types of Patients I See in My Emergency Room

What do you think? Is this advice helpful? I'd love to hear your thoughts.

ER Doctor = Detective

Being an emergency physician is an honor and a privilege.

Along with primary care physicians, we ER docs are the frontlines of medical care. We have to be able to take of every patient, no matter their age or ailment (or, thankfully, their ability to pay).

Our job is often very challenging because we have to make decisions with little information. It's often easier to second-guess decisions we made, because the answer is always clearer in retrospect.

My latest NPR article discusses the challenge of being an ER doc and practicing medicine in a fragmented medical system.

When Facts Are Scarce, ER Doctor Turns Detective to Decide on Care

Please read, and comment! I'd love to hear your thoughts.

Does Your Doctor’s Gender Affect Your Care?

My patient, a 40-year old woman named Sally, broke into a wide grin when she saw me enter the room. 

"Are you my doctor?" she asked. I nodded and started to introduce myself, but she cut me off. "I'm so glad that I have a woman doctor! I think women are much better than men."

That's in stark contrast to the previous patient I had seen just before Sally. Frank, a 72-year old man, looked at me askance and asked me if I was sure I wasn't his nurse. His wife explained (nicely) that they preferred a male doctor. 

These preferences don't always abide by gender or age divisions, either; plenty of female patients have said they prefer male doctors, and vice versa.

A new study from the University of Montreal finds that there may be real differences between the care provided between female and male doctors. Female doctors are more likely to follow evidence-based guidelines, and they score higher on care and quality, according to the study. Other research has found that female doctors tend to show greater empathy and are perceived as being better listeners. 

Some researchers have hypothesized that the differences are cultural and rooted in our upbringing. From an early age, girls tend to serve as confidantes to their friends, which may then result in greater attention to listening in the clinical context.

At the same time, I have worked with many men who display great empathy and care deeply about their patients. I also know of female doctors who don't hold up to the traditional gender stereotypes and don't like to spend time listening. 

In selecting a doctor, gender is one component. For some people (like Sally and Frank), it may matter a lot, in which case it should certainly help guide your choice of doctor. Other people just want to find someone who they can trust; they aren't as concerned whether their doctor is male or female.

So how can you identify a good doctor? Here are some characteristics to look for—regardless of gender:

Your doctor should listen to you: Research shows that 80 percent of diagnoses can be made just by listening to your story. Listening leads to better care, and your doctor should make an effort to hear you out and learn about you.

Your doctor should view your relationship as a partnership: Today's medical care is not about the doctor telling you what to do; rather, your doctor should involve you in your care as an equal partner. He or she should actively involve you in every step of the decision-making process about your treatment. 

Your doctor should be willing to ask for help: There is so much information on diagnostics and treatments—one person cannot possibly know everything. A good doctor is one who isn't afraid to admit that he or she doesn't know everything. Asking for help doesn't mean your doctor is incompetent; rather, it should increase your faith in his or her abilities and humility.

Your doctor needs to be available: It's unrealistic to expect that your doctor will be at your beck and call 24/7; however, before you leave your doctor's office, he or she should communicate to you how you can get help if necessary. Make sure you understand your follow-up plan. Are there any specific signs or symptoms you should watch out for? What should you do if something new or worse happens? 

You should feel comfortable with your doctor: This is perhaps the most important of all. If you do not feel at ease with your doctor, you might not share critical information, and important pieces of the puzzle might be missed. That's the most compelling argument for choosing a doctor of a particular gender—and only you can decide whether that's a characteristic that matters a lot to you.

One of my heroes, the Nobel prize-winner, humanist, and cardiologist Dr. Bernard Lown, talks about how a doctor is someone who should always make you feel better after having seen them. You go to your doctor because you want to feel better. You should find someone—female or male—who helps you accomplish this goal.

This article was previously published in Women's Health Magazine (posted here with their permission).