Hurting My Patients

An email to Doctor D:

What does it feel like to cause pain or disfigurement to a patient? Is it troubling or do doctors not let it affect them?

Believe it or not, most doctors are not sadists.

Hurting patients is distasteful to those of us who went to medical school because we wanted to "help people."

But the fact is that the really cool gadget that Dr. McCoy waves over sick people to fix them hasn't been invented yet. "Dammit Jim, I'm a doctor not a butcher!" Unfortunately, for the foreseeable future even high-tech medicine will involve some butchering.

People come to Doctor D feeling rotten and I sometimes stick them with needles, electrodes, blades, and tubes which at least in the short run makes them feel worse.

Sorry, I know, it sucks.

Doctor D fully realized the cruelty of his profession as an intern when he was performing a lumbar puncture on a squirming, screaming 2 year old with meningitis. The terrified kid couldn't understand why sticking a needle into his spine was required. He just thought we were torturing him. It sucked. That day D wished he had chosen another profession.

But young Doctor D got over the trauma he caused. The fact was that the lumbar puncture helped save the kid's life. Many of the painful things we do save lives, so we grin and bear it.

After a while we get used to hurting you:

It doesn't help patients for doctors to get emotionally distraught every time we cause pain. You want me thinking clearly so I can do procedures quickly and efficiently, with as little pain as possible. The doctor who hesitates to do an urgent painful procedure can be dangerous to patients.

Empathy must kept in check by necessity.

But occasionally the doctor gets too hard... forgetting your pain altogether and focusing only on the job.

Or even worse, we enjoy hurting you. It's easy to feel for a helpless toddler we have to hurt, but a whiny grown up who asks to be "knocked out" just to get an IV and has more tattoos than skin is a lot harder to feel for. Patients who thrash around can be dangerous to work on because needles and scalpels get knocked all over the place. "STFU and be still!" We sometimes even fantasize about performing painful procedures on belligerent patients.

Our work in proximity to so much suffering has a natural hardening effect. Doctors must constantly be wary lest we become cruel.

I believe that we can find a middle ground in which we perform the difficult task of hurting to heal without losing our compassion.

If I must cause pain adding kindness and understanding can sometimes be more therapeutic than morphine.

Doctor D always enjoys hearing your stories and perspectives in the comments.

What are your experiences with doctors causing pain? What was done well? What was handled wrong? Have you ever felt a doctor was being intentionally cruel in a painful procedure?

A Voice In The Wilderness

So you're probably wondering why there hasn't been a post this week.

Doctor D is visiting primitive relatives who still live in the wilderness beyond the world wide web. He only briefly escaped to connected civilization to send out this message.

Next week he will return with a new answer to your questions.

Spreading The Love!

The Last Post of How To Thank A Doctor.

Okay we've almost beaten this topic to death. You asked Doctor D and you received! You now know every nuance of the physician psyche in the realm of gratitude. Your thanks should now reduce MDs to putty in your hands!

But one last pearl of wisdom to take home:
If you thank a doctor and then treat the staff like crap, you just come across an insincere ass.

This should be totally obvious, but you wouldn't believe how many people do it.

"Oh, thank you so much Doctor D for diagnosing my UTI. You are awesome!" Then they go disrespect the nurse who had to crawl under their panus to get the in-and-out cath. Not cool and not really grateful.

The truth is that doctors get thanked too much for what nurses, phlebotomists, paramedics, and other healthcare staff do. We get to ride in at the end with the triumphant diagnosis. All the people who do the hard stuff rarely get thanked.

You thank Doctor D he'll probably think you're a cool patient. You thank the phelebotomist who stuck you and he'll recommend you for beautification. You cuss out the phlebotomist and D's cool vibe about you vaporizes.

What if the phelbotomist really deserved to be cussed out? I know the healthcare system has a few jerks in every job, but if you let them bring you to their level the only person you shame is yourself.

So spread the love! Treat the healthcare team nice and your doc will love you. By the way, it's Nurses Week (which is totally a more legitimate holiday than Doctor's Day) so go hug a nurse or something!

There you have it! You know all there is to know about thanking doctors.

But honestly, as long as you're polite you don't really have to thank your doctor. We work in a service profession. It's not like we are war heros or humanitarians. You don't always have to thank someone for doing their job, but it is nice when you do.

Thanks for reading!

Next week Doctor D shall take on more interesting questions... Email me some!

Be Cheap!

Cheap Gifts Are Better!

Part 5 of How To Thank A Doctor

Doctor D has been amazed at all the kind things readers have done for their doctors, but D's a bit disturbed by the funds some of you are putting into your gratitude!

Believe it or not, the less money you spend on thanking your doc the better! A doctor is not your niece at Christmas who will only be impressed if the gift put you in debt. In fact, any gift you obviously spent money on is likely to make your MD uncomfortable.

Why?

Reason #1: Lawyers

As I've mentioned before, we doctors live in constant dread of bloodsucking lawyers. A clever lawyer can turn even a friendly gift into a felony, so doctors have all been taught to shun gifts of any value.

A gift worth anything can be legally considered a payment for services. If Doctor D took care of you for free and you give him a gift he loses all of his "Good Samaritan" legal protection and can be sued vigorously. If I accept a gift from someone who already paid through insurance I'm in even more trouble. One of those slippery lawyer-types could point to Doctor D's gift and scream, "Fraud! Kickbacks! Felonies!"

Doctor D likes his job and doesn't want to lose it on a legal technicality, so please keep the gifts worth nothing: a written-in card or some cookies you baked is as valuable as you should go.

Rule of thumb: If your doc could conceivably resell your gift for more than $1 on eBay, don't give it!

Reason #2: Doctors Are Overpaid

Let's face it: physicians aren't hurting for purchasing power.

While the business of keeping a medical practice afloat may be frustrating and getting worse, the actual annual salaries of those of us in medicine are usually much higher than our patients'. Doctor D is in one of the worse paying medical specialties and he still makes almost twice as much as his friends. D isn't getting rich doing this, but he's never going to worry about keeping food on the table.

I also know how much medical care costs: way too much! A serious workup or a chronic illness can bankrupt you. I'm glad you're thankful, but when you bring me an expensive gift after you just paid thousands to be poked, prodded, and embarrassed in the medical meat grinder it just kills me. I don't need things of value. I wish you'd spent the money on yourself, and just written me a heartfelt thank you note.

If you like giving really valuable gifts then give them to teachers or police officers. Those guys sacrifice just as much as doctors to make the world a better place, and the pay they get is just sad.

Listen to Your Inner Cheapskate When You Thank Doctors!

Doctor D tries to politely decline expensive gifts, but it still ends up awkward.

So go cheap: really cheap—don't even worry about paying Hallmark for those fancy cards. The patient gifts that Doctor D treasures most are simple homemade cards, produced with simple paper and pen.

Have you every given or received an expensive gift in a doctor-patient relationship? How did it go? Ever have a gift declined?

What is the coolest "worthless" gift you ever got?

Doctor D always loves to hear your stories in the comments!

Thanking The Doctor, Not The Chart

Part 4 of How to Thank A Doctor:

"How do I avoid my thank you note being scanned into my medical records?"

Doctor D recently got an email from a patient who was horrified to find that a thank you note she wrote her doctor had been filed in her chart. WTF? Why the heck would a doctor stick a personal display of gratitude in the chart with a bunch of lab results?

Yes, we doctors are kind of obsessive about our records. The record is supposed to log every interaction we have with our patients. Most docs don't count a thank you note as a medical encounter, but some docs are just going to err on the side of being anal and put anything in there. (It's not our fault that we are meticulous about records. We live in constant fear of lawyers who are out to use medical records to destroy us.)

One question you may want to ask yourself:
Is is so bad to have your thank you note on the medical chart?

It may be odd, but it usually isn't a real problem? Unless your note is creepy, having a note on the chart makes you look like an awesome person to anyone who sees the chart later.

But if you are a private person who doesn't like your feelings being preserved in a permanent record there are a few strategies you can use to keep that Hallmark card out of your chart:

• 1) Don't mention details of your treatment or symptoms: Just stick with your feelings of gratitude. If you say, "Thank you so much doctor, but I just wanted you to know that since my treatment I've had this funny tingling in my fingers..." then you have just asked about your medical symptoms and therefore an MD is legally bound to keep record of these symptoms—usually by scanning the entire note into the chart. Keeping off the medical stuff will avoid forcing your doctor's hand on this.

• 2) Ask to keep it off your chart: Most doctors want to respect your wishes. If you say "don't file it" then as long as it isn't very medical in nature we will try to leave it out of the chart. Of course, there are some anal doctors that just can't help but stick everything in the chart, and for those doctors there is always option #3.

• 3) Ask the doc, "If I send you a thank you card will it end up in my chart?" If doc says "Yes" and you feel strongly about your card not entering the record, then express your thanks verbally. Despite what the gift card industry would have you believe, you can sometimes say it just as well without a card.

• 4) Say "Thank You" with an interpretive dance. There is absolutely no way to enter dancing into the medical record! On second thought, don't do that—it might come across as creepy.

Have you ever been frustrated to find you doctor charting personal communications that you felt shouldn't be in the medical record? Have any of you health professionals felt like you had to file a thank you?

As always Doctor D loves to hear your thoughts and stories in the comments!

Delayed Gratitude

Lots of people thank their doctor, but if you are reading this series chances are you're aiming to up your game and make your gratitude stand out from the rest.

So Doctor D is going to let you in on a little secret for how to thank your way into a doctor's heart:

The biggest factor in gratitude magnitude has nothing to do with the thoughtfulness of a gift or the wording of a note.

The most important factor for impact of a "Thank You" is how much time has passed.

Everybody says thank you right after a doctor does something for them. It is the socially appropriate way to end an interaction. We even thank people that we really don't like just because it is a social norm. While there isn't anything wrong with ending a visit with a heartfelt "Thank You," it won't really stand out in a doctor's mind.

...but thanking a doc the next time you see them shows it mattered to you enough to bring it back up. When this happens Doctor D thinks "Wow, that is so nice of them to remember that from the last time I saw them!" This just makes doctors feel good.

But the real grand slam of gratitude is to express thanks many months or even years after a doc did something good for you. Most patients never do this, even if the doc totally saved their life. It's just human nature—we get caught up in the stresses of life and forget.

When out of the blue a patient writes a note or says at a visit, "Hey Doc, remember when you did this for me? I just wanted to thank you and let you know that it meant a lot to me," that patient instantly becomes Doctor D's favorite. (Extra points are awarded if the doc doesn't even recall the good thing they did for you! Your remembering guarantees your doctor will never forget you or anything about you again.)

It's just human nature, we all feel appreciated when people bring up our good qualities we've displayed in the past.

As an extra bonus Doctor D will point out that delayed gratitude works with everyone in your life—not just doctors. So go out and thank some people for things they did for you long ago! You'll suddenly become the most popular person around.

Doctor D would love to hear your stories about how you surprised someone with a delayed thanks, but he's a bit bummed that his patients aren't half as cool in how they thank MDs as the readers of this blog.

Okay, enough of a pity party. Doctor D really needs to go out and thank all the people that did cool things for him years ago!

How NOT To Thank A Doctor!

Last post I said there's really no wrong way to thank a doctor. While that is usually the case there is one very wrong way to thank a doctor...

Doctor D's number one rule for thanking doctors:
Don't be creepy!

The only way that you can mess up a thank you is to make it creepy. And by creepy I mean very, very inappropriate. Most patients don't need to worry about coming across this way because they have no twisted ulterior motives. I don't think anyone could be this creepy by accident:

• Showing up at Doctor D's doorstep at 1:00 am to thank him.

Stalkerish and not cool.

• Saying, "Okay Doctor D, now that you've saved my life I am bound to be your personal slave for life!"

It might have been okay if the patient was joking, but when said seriously it's just a little too much gratitude for Doctor D to handle!

• Telling Doctor D how awesome he is right before you ask for a prescription for high-dose narcotics.

Maybe the gratitude was heart-felt, but when combined with a request for controlled substances Doctor D can't help but suspect he's being manipulated.

• Making a very obvious attempt to feel up Doctor D while thanking him.

Yeah that got her discharged from the practice, and it almost got her an ass-whoopin' from Lady D!

Now most of the patients that read this blog don't have that psycho-killer vibe and therefore expressing gratitude like this never occurred to you. But if you do happen to be a bit on the creepy side a good rule of thumb to remember: if an action has ever gotten you a restraining order it probably isn't a good way to thank your doctor.

So "No Creepiness" is the only absolute don't of Doctor-thanking that D can think of. Does anybody know anymore no-no's for thanking doctors? Anyone have great stories about creepy gratitude?

Doctor D will be back soon with some tips on the right way to thank an MD in your life!