In the old days, physicians were evaluated by word of mouth, among their colleagues and their patients. A medical practice, its reputation, and the charts were a tangible asset that could be shared, passed on, and even sold.
Of course, this has all changed. In the Internet age, physicians are evaluated on the web, and every patient, and even some non-patients, have an opportunity to be “heard” online. As a result, there are numerous services (such as Healthgrades, Yelp, and Zocdoc) where doctors are graded and ranked. It’s the virtual form of “word of mouth,” which can sometimes be useful as a guide to patients seeking a physician.
But this is a one-way process, and there are no such websites to grade patients! Yes, there are good patients and bad patients, and I sometimes wonder where the grades might fall if the evaluation process were turned around.
What makes a good patient? I don’t mean to be judgmental. But consider that it takes two people, doctor and patient, to maximize the benefit of a medical visit or a course of treatment—and the ultimate purpose of that visit is to cure or at least improve the health problem the patient is suffering from.
Let’s get the basic courtesies out of the way. If you make an appointment to see your doctor, please show up! You have asked the doctor to reserve time for you and arrange his schedule to accommodate your visit. Of course, if there is an emergency or you have changed your mind, or perhaps your problem resolved, that’s OK too. But a phone call to let the office know is helpful and makes you appear to be responsible and respectful of everyone involved. It is particularly perplexing when a patient calls for an emergency visit and then fails to show. But, again, no problem—just call to let the office know.
When you come to see the doctor, the idea is to get the most value out of your visit. The more relevant information you can bring, the more helpful the medical decisions and treatments will be. Some patients write things down and then, somewhat apologetically, take out their list and start reading. I have no problem with that and I appreciate the fact that they have thought about the issues before the visit. If you have tests, medications, pictures, etc., from other doctors, please bring them. Remember, the more facts we know, the better the outcome.
Our job during the interview is to listen to you and elicit information, either from what you volunteer to us or what we discover through questioning. This is an interactive process, and both physician and patient need to listen to each other. This dialogue can be very productive—we not infrequently get a sense of the diagnosis even before examination—or it can be less helpful.
Negative factors here are when either the physician or the patient is in a hurry or when we don’t listen to each other. As a patient, you need to listen to, and carefully think about, what the doctor is asking and then answer as accurately and truthfully as you can. Do you really exercise three times a week? Are you really watching your salt intake? Don’t let understandably wishful thinking color the truth. Do you really have just “the occasional” drink? The interview is not a judgmental inquisition but a fact-finding exploration that will inform your treatment.
Should you do Internet research before your visit? I actually prefer that patients make themselves knowledgeable in this way—it makes their questions more informed and guides the conversation. But keep in mind that there is a lot of garbage on the web, a lot of self-promotional material which reflects a specific purpose or point of view. A great deal of time can also be wasted looking up conditions that you don’t actually have and treatments that may not be appropriate. While online factual information (or misinformation) abounds, what patients lack is the perspective to appreciate what is true or false, what is frequent, and what is rare. This is why I am always happy to discuss such material during the visit—to help the patient sort out relevant from irrelevant, factual from promotional.
Once a diagnosis (or a short list of possible diagnoses) is made, the process of sorting out or verifying them begins, either with tests or trial of treatment. For example, a doctor may think you have GERD, based on some items in your history or examination—but if you don’t respond to an appropriate course of therapy (diet and lifestyle modification, medications), then the diagnosis may have to be reconsidered. Obviously, this process requires that the patient complies fully with the doctor’s recommendations. Did you finish your medications? Are you drinking enough water? If the patient says “I’m trying” and then points to a full bottle of water, it doesn’t inspire confidence. Remember, again, that the treatment process is an implicit social contract between doctor and patient and requires that you both comply.
As an ENT taking care of singers, I have many patients who travel, either touring in other parts of the country or abroad; I also see visiting singers who have come here for performances. With my patients who travel, I will often give them an emergency medical kit in case they cannot get to a doctor. If you are visiting, your medical visit may be an emergency or a one-time consultation. If you are a visiting patient, you can help the doctor by carrying a list of your medications as well as any pictures of your larynx that may have been taken elsewhere. It gives the doctor a baseline for comparison and is helpful for further treatment. Also, please ask the doctor what he gives you for treatment, especially injections. You may need this information in the future, seeing another doctor in another city.
At times, my patients will call and ask for a prescription over the phone. Different doctors have differing philosophies about calling in medications, sight unseen. Those of us who treat performers are probably more open in this regard. But—if the doctor asks that you come by the office later for an examination, you should do so! This is not only because repeated calling in for drugs is discourteous, but it is also bad medicine. We need to confirm what your problem is or how you have responded to the treatment.
Without an examination, you may be getting the wrong treatment or incomplete treatment, or some other important problem may be missed. If you don’t have a primary doctor and you just use walk-in centers sporadically, you are not getting the best medical care. You may see a nurse practitioner or another non-MD health care professional on these visits, and their treatment may or may not be appropriate for your problem. Of course, if you are a visitor with an emergency, these centers are useful—but not if you live locally and just haven’t bothered to establish a relationship with a primary doctor.
If you have a bathroom cabinet full of leftover pills, there is of course a temptation to self-medicate. I fully appreciate the intent—to get better quickly and to avoid having to see the doctor. But the problem here is that even if you are taking the right medication (like leftover antibiotics) you may not have enough to complete a full therapeutic course. Feeling better after taking three or four antibiotic pills does not mean you are cured, and it may set you up for a more resistant infection next time. Even more inappropriate is taking a friend’s medication. You may be taking the wrong drugs or drugs that are inadequate, possibly expired, and ineffective.
I would recommend that as a singer you “invest” in a relationship with your ENT. Once the doctor knows you, your health, and your voice, you will be able to call, e-mail, or text in case of emergencies, and the doctor should be more willing to accommodate you with call-in prescriptions or emergency appointments. Mutual respect is the link that connects good patients with their doctors, and the outcome will be to your benefit.
