A Matter of Trust

Hmmmm….

The adult looks rather tense.

The kid’s getting ready and it’s not even his turn yet!

He’s even comforting dad by holding is hand.

Is it just me, or does the doctor looks slightly like a mad scientist?

I swear I’ve seen that face in a “B” horror movie.

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John decided not to fire his endocrinologist after all.

Remember the mess with the medications that had me so fired up?

John went to his next appointment with Dr. Endocrinologist.

Seems there was a bit of confusion.

Dr. “Endo” got the impression that we had moved to New York and were trying to have him renew perscriptions from our new location. According to him, the pharmacists were not clear in explaining the reason behind the “loss” of five months of renewals.

Okay….

That explains why he would not order renewals.

But…

Why didn’t Dr. “Endo” bother to pick up the phone and respond to either the professional-sounding phone call from John or the “you-got-some-’splanin’-to-do!” challenge from me?

One phone call. Two minutes.

That’s all that would have been needed to (1) resolve the confusion and (2) keep the goodwill in the physician/patient relationship.

Well, the goodwill is still there.

John didn’t fire him.

He likes Dr. “Endo”.

For some reason, I don’t trust that doctor.

And I can’t put my finger on exactly why.

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What exactly does contribute to trust in a physician/patient relationship?

• The subjective feeling that the doctor actually cares about the patient as a person as well as a constellation of diagnoses. To the doctor, you aren’t just a number or just another patient.

• Communication: knowing that the doctor is willing to answer questions as they come up. Knowing the physician will call you back when you have a question or a problem.

• The trusted doctor encourages patients to educate themselves on health issues and is not afraid to address an article or an internet reference.

• Knowing when it is time to call in a consultation or refer to a specialist. The doctor you can trust knows when they don’t know.

So the onus is all on the physician?

Not at all.

• The patient keeps appointments as scheduled or gives adequate notice if unable to do so. Doctors are busy and they run tight schedules. The appointment you don’t keep is an appointment someone else could have used.

• The patient exercises patience if the doctor is running late with their appointments, knowing that medicine is anything but orderly and urgent matters arise. The patient understands that the doctor does believe the patient’s time is valuable and tries to adhere as closely to schedule as possible.

• The patient is compliant with the medications and plan of care developed with the doctor. If they cannot be comply, they are honest with the physician in describing the issue(s) that interfere with compliance.

• If the patient disagrees with the way a doctor deals with a medical problem, the patient is honest about their feelings and discusses the issue with the doctor. The first inkling that there is a problem should not be the request for their records to be transferred to a new office.

If these factors are present, trust in the physician/patient relationship can flourish.

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So, the patient needs to agree with everything the doctor does.

Absolutely not!

Examples:

Our pediatrician of 27 years would never give anything to stop vomiting. Nada. No Phenergan suppositories no matter how many times I phrased the question.

• I could have easily obtained anything I wanted from any ER doctor I worked with, but I did not. Why? Because I knew I could trust my pediatrician and while I had a different opinion on the use of medications in vomiting, it didn’t mean he was wrong.

• The outcome? Three adults who survived every bout of pediatric gastroenteritis intact. And hydrated.

Same pediatrician: my son had his first febrile seizure at the age of about 2 years.

• A prolonged post-ictal phase ended with Son running up and down the ER saying hi to everyone about 8 hours later.

• Negative spinal tap. I was a wreck.

• The ER doctor could not get my pediatrician to admit my son for overnight observation.

• Dr. Pedi said it was not a necessary admit, that because I was an ICU nurse, I was able to provide adequate observation at home. The ER doc was ticked. I was ticked (and told Dr. Pedi at the follow-up visit).

• The outcome? An EEG later that week (this was pre CT era) and a totally uneventful course for the rest of the illness. And an unnecessary hospitalization prevented.

• Did I want my son admitted? Yes, so I would not have to deal with the fear that witnessing another seizure would surely ignite. Did I change pediatricians? No. The hospitalization would have been for my benefit, not my son’s. Dr. Pedi had his eye on his patient.

One final example.

My bout of chest tightness was diagnosed as esophageal reflux/spasm. Home from the ER I go armed with a prescription for Protonix.

I did not believe it was reflux for one minute.

I had heart problems. I knew it.

So I express this concern to my new internist and he runs an additional EKG, listens to my concerns about being written off because I’m a woman, and wants a run-down in detail of exactly how the chest pressure began and progressed.

Diagnosis confirmed. Reflux with esophageal spasm.

So do I drop my internist because I don’t agree with the diagnosis?

No. And why?

Because he listened to me. He cared that I felt brushed-off in the ER. He did his own evaluation.

And for the record: he was right.

It wasn’t cardiac at all.

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So John feels he can trust his endocrinologist.

He’s comfortable with the man’s style and was satisfied by the explanation of communication break down.

I can live with that.

He loves his new family practitioner, also. Even if she did use the dreaded “c” word.

You know the one.

Colonoscopy.

In the end, he has two doctors he feels he can trust and whose opinions he values.

Who says you can’t have it all?