This is a time of medical wonders -- artificial hearts, organ transplants, test-tube babies. But what about this? A doctor who talked to his patients and invited them to talk back.
I spent an evening some years ago in the waiting room of Dr. Marvin Belsky, a successful Manhattan internist as well as a family doctor who for almost three years tried a bold experiment. Every other week, he asked several patients, new and old, to join him -- without charge -- for three hours of talk. His aim: "Feedback. I realized that feedback to physicians is often very limited."
Nine patients and Belsky sat in a circle. "I'd like to start," he said, "by asking, 'What is a good doctor?' "
A woman in her sixties said, "You. I think it's your intense personal commitment." She told of another doctor who was uncaring and rude. But "when Bernie her husband was sick, you called for another opinion. We felt you cared."
"Have any of you ever been angry with a doctor?" Belsky asked.
"Yes," said a balding, middle-aged man. "When doctors told me I was getting better and I felt worse."
"What gets me," a sharply dressed salesman said, "is when the nurse becomes the doctor on the phone and starts giving you orders. Sure, the doctor is busy, but you want him."
Had anyone ever been irritated with Belsky?
"Yes," said a sophisticated-looking woman. "When my daughter was sick, you were so busy introducing yourself and telling her about her rights as a patient, and her throat was so sore! She was angry that you weren't helping her right away."
A young model said: "I remember when I had that severe asthmatic attack. I needed reassurance, and you were so professional. And cold."
"You are upset with me!" Belsky said, a bit surprised. "Doctors," he explained, "sometimes become 'professional' when they are a little concerned and scared. But I'd never have known you were upset until you said it tonight."
The model was not finished. "I've never been really able to open up to you and tell you how I feel. I've never really given you my complete confidence. You're the doctor, you're the minister, you're everything. But I'm opening up to you tonight."
Belsky ultimately halted these sessions to spend "the many hours of time" they consumed listening to individual patients instead, and trying to lead them toward healthier life styles. But he had learned, he says, "about my own lack of omnipotence" and "to listen not just on one night but all the time."
Now, he says, he tells all his patients, "Feel free to say what's on your mind. If I confuse you, say so. If you're upset, let me know."
Reports indicate that many doctors are paying more attention to pleasing their patients. The busy Mayo Clinic in Rochester, Minn., which treats up to 2,000 patients a day, has placed a "patient's representative" in its lobby to hear complaints. One reason, says Mark Brataas, a clinic administrator, is the need for doctors to "market" themselves in the face of today's growing competition from increasing numbers of health plans and doctors.
"The most important thing is a satisfied patient," Brataas says. "If we can't satisfy patients, everything else is a waste of time."
The American Society of Internal Medicine offers copies of a brief questionnaire, reprinted below, called "How Well Did I Serve You?" to its internist-members. "I am anxious to give you and all my patients the best possible care," the pamphlet reads. "To help me become aware of processes in my practice which might not be entirely adequate, won't you please take a minute to answer these questions."
The doctor signs the pamphlets, and they are handed to patients. Patients need not sign, and may answer on the spot or through the mail.
"We've had this for some years," William Ramsey, the society's executive vice president, reports. "But there's an increase in its use now." Why? "Competition. And I think physicians are trying to be more human, more humanistic."
Dr. Barry Lubin, a Norfolk internist who started a new practice six months ago with two colleagues, uses the questionnaire. "We want to find out what's on people's minds and make sure they understand us," he says. "And it lets them know how we feel, that we're looking for feedback." He also sees it as part of "selling medicine" in the new competitive age. The practice, he says, is doing very well.
Washington internist Devra Marcus and her partner tried such a questionnaire for a time, but the answers were "so positive, I didn't trust it," she says. Instead, she suggests, "At the end of a session a physician can ask, 'Do you have any questions or comments? Are you happy with what we're doing?' Then that opens it up."
Some doctors, unhappily, behave in a way that stifles any feedback before it can start. Their manner and indeed the whole atmosphere of their office -- busy, super-efficient, computer-like -- discourages questions.
It takes a whole environment, a whole mood, Belsky says, to encourage the patient's full participation in a doctor-and-patient effort.
"I expect my patients to feel comfortable enough to tell me if I'm not clear, or to say, 'I feel you're not listening to me,' " Lubin sums up. "It sometimes takes another visit to handle it, but I need to ask the patient, 'Do you have anything else on your mind?'
"No matter what you say, your nonverbal signals tell the patient that you're genuinely interested or you're not. Very few physicians do well because they trained at Massachusetts General Hospital. What sells physicians is this: Do they show patients genuine interest?"
Patients deserve nothing less.
Next Week: Most doctors are trying harder to please their patients. Is yours?