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Six Rules Doctors Need to Know

Posted Nov 30 2008 12:20pm
Six Rules Doctors Need to Know

This article by Tara Parker Pope appeared in the New York Times on August 7, 2008.

It truly struck home because in the world of the women who we hear from at our Foundation, some of these rules seem to be broken consistently.

Most women do not want to pour out their souls to their health care provider concerning sexual health and intimacy concerns. First of all they are concerned that their doctor may not take them seriously, and unfortunately for some, this is such a private issue, many express that they are embarrassed. They are uncertain how their doctor will react. Plus, they fear that they will be dismissed and told "it is all in your head" . At that point, any expectation of compassion has just gone out the window.

One woman told us that she went to her doctor to discuss sexual health concerns post surgery and essentially her provider told her that she was just overly sensitive and was acting like a little girl. Another rule broken. A patient's feelings are HER feelings and to be demeaned in such a manner did not help this woman one bit. Now this woman tells all of her professional colleagues this story, which probably has made it to the moon and back on the Internet blogs.


What we as professionals should realize is that we are providing a service, and if a client is not happy, she will express it. More often than not, it is not expressed to the professional who they are irritated with, but it is expressed to friends, family and colleagues and the Internet.

Why are patients mad at doctors? Maybe, suggests medical blogger Dr. Robert Lamberts, it’s because doctors aren’t following the rules.

Doctors have always been a hot topic of discussion on the Well blog. We’ve talked about the rocky relationship between doctors and patients, a doctor’s disdain for medical Googlers, and whether doctors should lecture patients about their weight. And every time, hundreds of readers comment about how frustrated they are with doctors and the medical system.
Dr. Lamberts, an Augusta, Ga., physician and writer of Musings of a Distractible Mind, notes that he has a few simple rules that help him get along better with his patients.

Rule 1: They don’t want to be at your office.

It may seem odd to patients, but most doctors forget that going to the doctor is generally unnerving. We work there, and being in a doctor’s office is normal to us. Not so with most patients. The spotlight is on them and their health. They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing….There is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table. The best thing to do in response to that is to show compassion.

Rule 2: They have a reason to be at your office.

They don’t come to the office to waste the doctor’s time. Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor. Why come in for a headache? Why come in for a cold?…It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in. Sometimes that reason is simple: they have terrible pain that needs to be treated. Other times, however, the reason is more subtle. When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer. If a person has chest pains, they are afraid it is their heart. On every visit I try to identify the real reason (or the real fear) that brings them to see me. I don’t end the visit until I have addressed that reason.

Rule 3: They feel what they feel.

Patients will often tell me their symptoms in a very apologetic tone. They seem to think that they have to come to me with the “right” set of symptoms, and not having those symptoms is their fault. Sometimes those symptoms make no sense to me at all, and I am tempted to dismiss or ignore them. But as a physician, you have to trust your patient….Yes, some may exaggerate what they feel out of anxiety or out of fear that you won’t hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint. I have heard from many patients that their doctor “did not believe” their complaints because they did not make sense. If you don’t trust them, why should they trust you?

Rule 4: They don’t want to look stupid.

People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….”

Rule 5: They pay for a plan.

What do people pay for when they come to the medical office? They pay for opinion, yes. They pay for knowledge as well. But what they really pay for is a plan of action….They want to know what is going to be done to help. I try and give a plan, either verbal or written, to each patient that walks out of the exam room. What medications are given and why? What medications are to be stopped? What tests are ordered and what will the results mean? When is the next appointment? What should they call for if they have problems? The better I can answer these questions, the more confidently the patient will walk out of the exam room. The days of paternalistic medicine are over - no handing a prescription and just saying “take it.” Patients should know why they are putting things in their body.

Rule 6: The visit is about them.

With all of the stresses in a doctor’s office, I get tempted to complain about things. Who better to complain to than someone who feels much the same way? But patients are paying for you to take care of their problems, not the reverse. I keep my personal gripes or frustrations to myself as much as possible.
To read the full column by Dr. Lamberts, who goes by Dr. Rob on his blog, click here. He also promises a future post on rules patients need to know, so stay tuned.
What do you think of Dr. Rob’s rules? Does your doctor follow them?
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