What are the most important things to expect of a doctor? Dr. Marvin Belsky, a New York internist, says there are four:
While time can be measured by the clock, the clock is not always a fair judge of a busy doctor. A doctor may sometimes be having a hectic day yet still give you a period of undivided attention. Even if a doctor has a full waiting room, "You should leave feeling your important questions have been answered," Belsky says.
Dr. Oliver Sacks of Albert Einstein Medical College in New York tells fellow doctors: "There is only one cardinal rule. One must always listen to the patient." While you are with your doctor, you are entitled to full, calm attention, without interruption for non-urgent phone calls.
One woman told of how her doctor apologized once after being too busy day after day to return her calls himself. She merely got calls from his nurse with his curt messages. "If you're that busy, I can understand it," she told him. "But then you're too busy to be my doctor."
Then there's the story of the Silver Spring pediatrician who was given a surprise party by grateful patients because, as one said, "He always makes you feel you are his only patient."
Compassion? The all-too- frequent lack of it is one of the most discussed subjects in medicine. Doctors themselves write in their medical journals about "lack of caring," "dehumanization," "thoughtlessness" and "bad manners." One called compassion a "lost skill."
"Something has gone wrong in the practice of medicine, and we all know it," Drs. Richard Gorlin and Howard Zucker of Mount Sinai Medical School in New York recently wrote in the New England Journal of Medicine. "It is ironic that in this era, dominated by technical prowess and rapid biomedical advances, patient and physician each feels increasingly rejected by the other."
We can all think of encounters with physicians where this was emphatically not true. Many of us believe we have caring doctors.
Yet Dr. Judah Folkman of Harvard Medical School tells of a 4-year-old girl, a cancer patient at one of the nation's great medical centers. The girl was surrounded by specialists -- pediatricians, oncologists, radiologists, surgeons and more. But the patient's mother was in tears.
What she wanted, she said, was "a doctor."
If you have this feeling, if you're dissatisfied or uncomfortable with a physician, if you feel there is no caring, you may have the wrong doctor.
One patient's Dr. Monstrous may be another patient's Dr. Miraculous. We all relate to different kinds of people. "As a regular physician," says George Washington University's Dr. Thomas Piemme, "pick a doctor you like and trust. But, remember, we also have some austere, difficult super-doctors, and sometimes you need one."
Which brings us to competence.
This may be the hardest quality of all for a patient to judge. Yet most of us eventually develop a gut feeling about whether or not our doctor is competent. If you have doubts, you may be right.
"If there is no compassion, if the patient doesn't understand or doesn't feel he is being cared for, there is no effective competence -- competence is thwarted," Dr. Belsky believes.
He tells the story of a woman whose daughter was dying of leukemia. She urged their doctor to help comfort the child. "What do you want, somebody to hold her hand?" he answered. "I suggest a minister or psychiatrist."
"I don't believe you're a doctor," the woman said.
"He wasn't," Belsky says. "He wasn't human either. They go together."
Communication? Dr. Jay Katz, Yale professor of law and psychiatry, has written a new book called "The Silent World of Doctor and Patient" (Free Press, $15.95). He calls "physician silence" -- failure to communicate, failure to listen, failure to involve patients in making choices -- a crippling form of "psychological abandonment."
"Things have changed over the years," says Dr. Luella Klein, president of the American College of Obstetricians and Gynecologists. "People don't go to their physician to be told what to do. They expect information and some input into decisions. They want to know about their disease and various treatments. They want to make up their own minds."
A Los Angeles internist told Medical Economics, a doctors' magazine, "The average American no longer wants or needs a distant father-figure for a doctor . . . [but wants to be] treated as a thinking, rational being rather than as a wayward child."
That speaks for most of us.
Coming Dec 19; The Responsibilities of Patients.