The other day, walking down a hospital corridor, I ran into a doctor friend who stopped and said, "I know you. You're the guy who keeps saying we ought to spend more time talking to patients."


Last June I wrote a column titled "Dealing with a Silent Doctor." The subject was some chilly doctors who don't really listen, "never tell us much, never call us by the name we'd be comfortable with, speak only in gobbledygook, give us only a rushed few minutes with hardly any chance to utter a question or comment and in other ways give us 'the silent treatment.' "

The column triggered a small flood of responses. :: :: ::

Mary-Lane Walker of Fairfax called this "a disturbing problem common to many doctor-patient relationships." Annie Chau of Falls Church said, "I have known some doctors like that. All they worry about are time and money."

"The 'silent treatment' between patients and doctor is very common," wrote Tin V. Trinh of Falls Church. "My doctor rarely talks to me, let alone smiles. The nurse takes notes on my medical history. My doctor first glances over the paper and seriously listens to my heart. It seems like he's dealing with a medical case and not with me, the anxious patient . . . Patients do need to 'speak up,' as most doctors would tell us. The task is not easy."

"If a patient leaves the doctor's office without a complete understanding," said Amy Woodland of Alexandria, "then he is being overcharged and not reacting. It is necessary to be prepared with pertinent, intelligent questions so the doctor senses the patient's interest."

I've italicized that last part. If we sit in silence, it may be construed as a signal that we do not want to know more.

"Do not be shy," Quochien Ba Vuong of Springfield urged. "Do not feel stupid when we have to ask the doctor something which may be trivial to him, but we do not know and it is important to us. I used to be afraid to ask questions when I went to visit my doctor but not any more. Thanks for your article."

Thank you, Mr. Vuong.

But another reader, Judi Johnson of Alexandria, was pessimistic about changing any doctor's behavior. "If we as patients are planning on modifying our doctor's behavior to suit our expectations, we are deceiving ourselves . . . {Advice to speak up} does not ensure a satisfactory relationship. In other words, it may not change how your doctor talks to you."

I'm not at all sure about that, at least in many cases. A good many doctors in the Washington area say they are more conscientious these days about listening and communicating. There are indeed pressures that make many doctors rush us -- the fact that doctors are paid far less for "talking" than they are for "doing things" (giving us tests or operating); the pressure, often unanticipated, of other patients who have to be cared for; and pressures from many health plans to be more "productive," meaning seeing more patients and spending less time on each. :: :: ::

There are also new pressures in the opposite direction, however.

There is increased competition in medicine, and many doctors are working harder to please their patients and keep their waiting rooms filled. There is a real increase in doctors' awareness of the need for a return to "caring," if doctors are to have the public's support. This message is repeated again and again these days in doctors' publications.

And there is also the pressure of patients' complaints and awareness. I think these often count.

It's not always possible to succeed, but we should keep trying. :: :: ::

Another patient, Betty Christensen of Fairfax, writes: "There have been so many negative articles about doctors, how about doing a positive one on a family doctor?

"You couldn't find a better subject than our Doctor Mac, Dr. Alan Mackintosh of Annandale. We call him our Irish leprechaun. He is originally from Ireland.

"Twenty-five years ago, when my husband and I moved to Fairfax County from Illinois, a co-worker of my husband's recommended him to us for a family doctor. He has given our family of three superb care, emotional support, compassion and understanding during a multitude of non-serious and serious illnesses all the years, including cancer, miscarriage, urology problems, emergencies, et cetera. Our 20-year-old daughter has been cared for by him since she was two days old."

What's so special about Dr. Mac?

"He always calls his patients by their last names -- 'Mrs.' or 'Mr.' Before any examination, he sits down, makes himself comfortable and listens to what his patient has to say. He will ask if what he has said is understood, or if we have further questions. He has the attitude that the mother of a child knows that child well enough to provide valuable information and insight . . .

"Dr. Mackintosh and I get along well. Other doctors find me a difficult patient. I hate taking drugs. It is hard for me to give the control and care of my body into the hands of another, no matter how qualified they may be. Dr. Mackintosh allows this of me, treating me with a sense of humor, doing all in his power to let me retain my dignity, as long as it does not interfere with necessary treatment."

And Dr. Mac evidently does not feel that he knows it all.

"More than once he has smoothed the way between me and a specialist he has recommended. When Dr. Mac feels it is to his patient's benefit to use the further expertise of a specialist, he does not hesitate to recommend one. But he follows closely the treatment given, visits his patient while in the hospital, stays in contact and counsels with the specialist . . .

"Perhaps I am spoiled, perhaps in this day and age Dr. Mac is unique. All I know is that after having him as our family doctor for over 20 years, I could not, would not settle for less than the superb care and dignified treatment my loved ones and I have received from him."

Thank you, Dr. Mac.

Next Week: A few more laughs about our ills.