Sunday, May 26, 2013

OUCH I must be a horrible doctor

Recently I began reading Dr. Kevin Pho's book, Establishing, Managing and Protecting Your OnLine Reputation. Last year I had encouraged patients to go to the Healthgrades to rate our office. It was helpful. My staff's friendliness needs some improving. My ratings were good but not fabulous. That got me to thinking about how to improve. Maybe it's because I am too straightforward? Am I not kind enough? Does my face show disappointment or frustration? 

The worst was looking at the site. There were only three ratings and the last one was abysmal, left in March of this year. I can't help but wonder what I did to anger  someone that badly. Was it the patient who left in a huff because a medical student came in first? (Yes, we warned him but apparently he expected me to accompany the student so we didn't properly explain it). Or the patient who was furious because I wouldn't give her a handicap sticker when her cardiologist refused to? Or the patient that I discharged from my practice when I found out he lied to me about his past drug history? The site itself is poorly monitored. It lists my internal medicine associate as a gerontologist with no address, my family practice associate as practicing at an address that she left five years ago, and my address is listed from four years ago. When I sent an email no one answered it. 

Most of the other sites listed were without reviews. It makes me wonder, with so many rating sites, how helpful can they be? Additionally our patients are asked to fill out a survey on Survey Monkey but the doctors aren't given the results. What good is that? 

Pondering my ratings I wonder, would using Motivational Interviewing improve how patients perceive my suggestions and bring something more tolerable and more workable for them? It's my hope to motivate, not lecture patients. If I see them as partners in their care, how best do I encourage their participation and help them?

Monday, May 13, 2013

Is Happiness a Value?

Glancing at my blogroll tonight I came across a recent post by Kent Bottles entitled, "How to Practice Medicine in a World We Can Never Truly Understand". While it is a little esoteric for this family doc's brain, reading it jogged my thought processes. He begins by discussing the pursuit of happiness, an ofttimes elusive goal in life. Is it unusual that happiness was never something for which I aimed? The closest value for me was satisfaction. As my children grew, I encouraged them to give the best they could in life--whether that was grades or friends or sports or art. Never once did I suggest they try to be happy. For me, happiness is something one may find, but when you make it a value, now there's a recipe for disaster.

My patients will tell me "I just want to be happy". They believe they will achieve that goal if they marry the right man, find the right job, get the right grades or buy the right ______ (insert necessary object here--car, house, dress, purse). Doing the best job in the job they are in, making the best grade in the most challenging class they feel competent to take, being the best friend to the friends they have...these are not enough. If they are not happy in their job or class or relationship, it is of little value, unless it can be justified as bringing happiness in the future. They search in chemicals to achieve happiness, be that legal (Prozac, Paxil, Adderal, etc) or illegal. If they are not happy, then something must be terribly wrong, even if they are unhappy for legitimate reasons; their mother just died, they lost their job, their boyfriend broke up with them. Their friends encourage them to take medications to be happy again.

This can be a type of cultural divide in an exam room. In the same way that language barriers can reduce good care, value differences make for dissatisfied patients who may intellectually understand that exercise will improve their health but if it doesn't make them happy to do it, it may not get done.

Happiness has followed me in my life many times. Most would consider me blessed. I wasn't looking for it. It's nice to have. But at the end of the day, I don't want to be happy, what I want is to believe that today's accomplishments were the best that could be done under whatever circumstances I found myself.

In other words, satisfaction without regrets. Happiness may follow.