How Should I Thank My Doctor?

Believe it or not, this is the most common question that Doctor D gets in his email!

I must admit I hadn't posted a response yet because the answer seemed kind of obvious: Your parents taught you how to say "thank you" when you were a baby. It should be fairly straightforward at this stage of your life. If you are grateful to your doctor tell him or her "thanks" and doc will have a better day because of you.

But as more "How do I thank my doctor?" emails poured in I had to rethink situation. I'd been thinking from the doctor side of the equation, but from the patient perspective expressing gratitude may be more daunting.

Doctors are intimidating. We hold life and death in our hands with a god-like power! Our lives are always exciting and sexy, as anyone who watches prime-time doctor dramas can tell you. MDs are so intelligent and knowledgeable that we cannot help but act like jerks to our inferiors! We are so universally admired and appreciated that your expression of thanks had better be impressive or we will scoff at you.

As a physician, Doctor D can personally assure you that all of that is BS! We only put up that ridiculous front because it helps us handle a stressful and scary job where people expect the world of us. Trust me, doctors are normal people: we always love it when people thank us for a job well done.

I had the son of a patient find me the other day, "Doctor D, I just wanted to thank you for saving mom's life." Did I save his mom? Maybe. I just did what any doctor would have done in the situation. But thanks to his gratitude Doctor D was had a spring in his step for the rest of the day. Everybody likes to be thanked.

So if you want to thank a doctor, go for it! Say it, write it in a card, bake cookies, whatever. Trust me, your doctor will be thrilled any way you say it.

Since everyone seems to want detailed strategies Doctor D will start a series of several posts on dos and don'ts of doctor-thanking so all my readers can tap into the intricacies of thanking MDs!

You're welcome!

Did you ever try to thank a doctor and have it just flop terribly or complicate your doctor-patient relationship? Doctor D always loves to hear your stories in the comments!

Part 2: How NOT To Thank A Doctor

Part 3: Delayed Gratitude

Part 4: Thank the Doctor, Not the Chart

Part 5: Why Are Cheap Gifts The Best?

Part 6: Spreading the Love

Why Do Incompetent Doctors Flourish?

Last week Doctor D answered this question in a way that made him sound like a frickin' hero:

How do doctors deal with colleagues that they know are incompetent?

Now that you all think I'm awesome, I have to make a confession: I have looked the other way a lot more often than I have saved the day.

Doctor D has known some bad doctors over the years. I don't mean doctors that make errors—we all do that sometimes—but doctors that flagrantly disregard patient safety and don't give a damn about right practice. And Doctor D usually kept his mouth shut.

The code of silence started early...

Doctor D's first run-in with reckless care was as a first year med student. D was working with Dr. Subethical who happened to teach the medical ethics class. Dr. Subethical who seemed so cool in class spent most of his clinic time screaming at patients and dictating physical exams he didn't perform. Lowly Medical Student D thought that this didn't seem right, but he never confronted Dr. Subethical or filed any complaint. Young D figured he must have just misunderstood the situation. Also Dr. Subethical was an honored professor while D was just some lowly student who didn't want a target on his back.

MD's usually have more power and more knowledge than their patients and other healthcare providers. This often keeps patients, med students, and nurses from confronting doctors. So it falls on other doctors to keep an eye out for bad care among our colleagues.

Unfortunately, we doctors do a terrible job policing each other.

Young D always kept his mouth shut in medical school, but he told himself that when he got that MD with some power and knowledge he would set the world right. He would stamp out crappy care and save the world from low-life doctards! Yeah, well old habits stuck around. D's been out of medical school for a long time now, and has seen quite a few doctards, and his number of confrontations thus far is a grand total of... one! To be honest, Doctor D only whooped some doctard ass at Crayzee Clinic after having incompetent care shoved in his face month after month till he couldn't ignore it anymore.

So in this anonymous blog Doctor D confesses:

"Hi I'm D, and I have turn a blind eye to bad medical care."

Doctor D's readers all gasp and shake their heads.

"But wait, I can explain!"

There are lots of reasons good doctors are always letting the bad ones off the hook:

• Nobody Likes Tattletales: You might assume that Doctor D's heroic battle with Crayzee Colleague looks good on his resume. Nope! D has a big FAIL stamped right across his forehead. Nobody wants to work with a goody two-shoes who rats out his buddies when they break the rules. Even the excellent docs got kinda distant while I was fighting Crayzee Colleague. If I called out bad doctors wherever I worked before long I wouldn't have a job.

• Nobody's Perfect: Our culture expects perfection from doctors. Of course, we all make mistakes, and many of us live in dread of errors. We want people to forgive our mistakes so we are willing to accept that other docs make errors too. Now there's a big difference between understandable human error and the doctard who makes a habit of flagrantly and willfully doing stupid shit. Unfortunately, this unspoken "culture of forgiveness" in medicine protects the guilty as well as the innocent

• Everybody Hates Lawyers: Every MD lives in constant fear of a malpractice case, which is a professional and personal catastrophe. We usually keep our mouths shut about bad care because discussing possible malpractice is taboo. If you accuse a colleague of malpractice you might as well send the poor schmuck in front of a firing squad. There just isn't any safe environment where we can confront other physicians. It's ether shut your mouth or throw your colleague to the dogs.

• There's More Than One Way To Skin A Cat: Every doc remembers that abusive attending in medical school that yelled that there was only one right way do do medicine, which happened to be his way. Later we learned there are a lot of different right answers in medicine. Every doc has a different treatment style. Nobody wants to grow up to be that jerk that attacked others' legitimate care because it wasn't the way he did it. So sometimes when we see obviously bad care we shrug and say, "Well that's not what I would do, but maybe it's just a different approach?"

• Second Hand Information: Most of the bad care I know about is hearsay. I usually don't have time to sit around and watch my colleagues practice. I hear things from patients or read charts that sound concerning, but I wasn't there. I tend to give other doctors the benefit of the doubt: "Maybe there's a good explanation for this?"

• We Expect Lawyers To Do Our Dirty Work: Every good doctor can probably think of an incompetent doctard who they secretly hope will get destroyed in a malpractice lawsuit. (Yep, Doctor D is thinking of one right now.) Malpractice is horrible, but some doctors deserve it. Why should we waste our time confronting bad care when lawyers will take out the garbage for us? Unfortunately, this is a total cop out. Malpractice does a terrible job policing medicine. First of all, the lawyers and juries don't understand medical care very well. Second, lawyers don't bring malpractice cases to improve medical care. Lawyers bring malpractice cases to hit the jackpot. The malpractice system creates a mad scramble where big money gets awarded or denied based on the lawyer's cleverness or the jury's mood, rather than the doctor's competence. Good doctors are often screwed while bad doctors get off on legal technicalities. Malpractice doesn't really improve medical care—it just makes doctors afraid to discuss bad care.

Of course, all these are just lame excuses. Doctors should step up and call out the bad ones who are endangering patients. Doctor D can think of a couple that need to be set straight, but after his adventure at Crayzee Clinic he isn't too eager to try any more heroics. He's keeping his mouth shut and venting anonymously on his blog.

So Doctor D has taken the first step: he admitted he has a problem. Any ideas for 11 more steps that could motivate D and the other good doctors out there to remove the incompetent doctors from their midst? I've got no answers on this one.

This is an intervention!
Your favorite blogging doctor has a serious apathy problem, but he is totally unmotivated to change. Use the comments section below to convince Doctor D why he try to be a hero again when the first time was a big fail!

The Battle Against Incompetence

A while back Nurse K asked a really good question:

How do doctors deal with colleagues that they know are incompetent? Keep your mouth shut? Frank discussion with the medical director? Anonymous letter?

Doctor D has two ways of answering this question. One makes him look really awesome, and the other exposes him a part of the problem. Doctor D will start out all the heroic stuff and then tell you more in the next week:

Doctor D once worked at a place called Crayzee Clinic, because he really wanted to practice primary care in an underserved community. (What a saint! Let's give Doctor D a Nobel Prize or something!) Unfortunately the clinic came with a partner we shall call "Crayzee Colleague."

Now Crayzee Colleague was pleasant enough, but the medicine she practiced didn't even remotely resemble proper standards of care. Doctor D, being the totally nice dude that he was, thought maybe Crayzee Colleague was just behind the times and hadn't heard of the cool new stuff doctors have been doing for these last fifty years. D mentioned his concern in the gentlest possible way, but would you believe it, Crayzee went nuts! She called D a "young doctor who doesn't know shit."

So Doctor D printed out some info for Crayzee Colleague on how medical care is done in this century to prove that he isn't the only one who believes in things like vaccines, mammograms, and such. Unfortunately nothing changed about Crayzee Colleague's incompetent care.

Doctor D was worried because he shared patients with Crayzee Colleague and the stuff she did wasn't exactly safe. From time to time he sent her pleasant little notes reminding her about sensible medical care as he was cleaning up her disastrous work. After a few months of this our hero realized Crayzee Colleague had no interest in changing anything.

Since Crayzee Clinic was federally funded, Doctor D figured he should go up the ladder and speak to "The Man." The Man isn't a doctor, but he has a fancy title, sits behind a big desk, and supervises a whole lot of doctors. D figured his colleague would surely listen to The Man. So D informed The Man that he was very worried about Crayzee Colleague's care. The Man said "Doctor D you are right. Crayzee should step up her game."

And then nothing happened.

Crayzee Colleague kept providing downright dangerous care, ignoring D's still friendly but increasingly firm reminders to at least try to practice something resembling primary care.

Finally, Doctor D had enough of Crayzee Colleague doing dangerous shit to his patients. He blew the whistle as loud as he could. He warned every healthcare bureaucrat he could find, "Look, if Crayzee Colleague keeps doing this stuff that endangers patients I will resign from Crayzee Clinic and tell every patient I see on my way out that I'm leaving because the care here is a treat to public safety!" And still nothing happened.

So Doctor D did exactly as he had threatened he would.

At the end of our story The Man's bureaucracy remained intact, Crayzee Colleague was still at the clinic, and Doctor D had all his principles but no job in the middle of the Great Recession.

...but Doctor D is still proud he opened that can o' whoopass on medical incompetence as well as The Man and his Crayzee Clinic.

Please feel free to praise the fearless Doctor D in the comments section! Get his ego good and inflated because next week he has to make some confessions that will disappoint you.

Overcoming Doctorphobia

An e-mail to Doctor D:

"I am absolutely TERRIFIED of doctors... I have avoided doctors like the plague... how do I get around my fear of doctors?"

Doctorphobia is a common but curable condition. It can start with your first shots as a child. Throw in an uncomfortable exam of a body orifice, add a few run-ins with jerk doctors while you are wearing nothing but a paper gown, and you can end up with a full-blown phobia of anyone in a white coat.

If you had any idea what a bunch of nerdly social misfits we doctors really are you would be more likely to laugh than tremble. Unfortunately doctors, like dogs, can smell fear and often exploit it. When nervous greenhorn medical students first realize that patients are terrified of them they should respond with compassion. But when they realize being feared makes them feel special and powerful the “god complex” begins.

Here are some techniques for taking the fear out of your doctor visits:

• The Honest Approach: You wouldn't believe how many patients have started their visit with Doctor D by saying, “I hate doctors. They scare the shit out of me!” This reminds Doctor D that he should be friendly and calm. Honestly confronting them with this truth should induce your doctor to respect you. If a doctor is mean right after you admit Doctorphobia then you can move on—you don't need that jerk.

• Remember that doctors are scared too: What your mom told you about snakes in the woods is also true of doctors: “They are more frightened of you than you are of them.” Medicine is an anxiety-producing business, and doctors are nervous most of the time. We are responsible for the life and health of our patients, and most of what we do is based on educated-guesses. We live in constant fear of screwing up. It's enough to give anyone an ulcer. We hide our anxiety well, but you can rest assured that the scary doctor is often more nervous than you. Like middle-school boys, the doctors who strut and yell are usually most insecure. Any doctor that intentionally tries to scare you is more worthy of your pity than trepidation.
  

• Remember that you are the boss: Economically speaking, your doctor works for you. You pay them for a service and if they don't work out you take your business elsewhere. No, this doesn't mean you can order a boat-load of narcotics Michael Jackson-style, but it does mean you should feel more empowered in your doctor-patient relationships. You can always fire your doctor.

• Change doctors: Some people love no-nonsense, semi-abusive doctors, but aggressive docs are not good for people with Doctorphobia. Consider moving to a doctor with a different doctoring style. “Buddy” and “Parent” doctors are usually more gentle (although they do have their problems).

• Picture your doctor naked: This is a time-tested method for overcoming anxiety. Doctors are about the only strangers who can legitimately ask you to disrobe, so you should have no qualms about turning the tables on them in your mind. No doctor can be scary in their whitey-tighties. (Warning: This technique may be too distracting if your doctor is as handsome as Doctor D.)

Any readers have other tips for beating Doctorphobia?

Why Are Doctors Such Jerks?

Let's start with a question I know that you have been wanting to ask:

Why are so many doctors jerks?

Excellent question! As any nurse will tell you, doctors are notoriously difficult to work with. We doctors have a much higher percentage of jerks among us than the general population. Even Doctor D (on very rare occasions) has been known to be downright ornery towards patients. There is a epidemic of condescending, difficult, foul-tempered doctors, and you the patient are the one who suffers!

Some doctors have been jerks their whole lives. Maybe they weren't hugged enough as babies. These docs just love having a position of power so they can make others feel small. Such natural-born jerks can be found in any profession, and just one of them (especially as a customer service representative) can make anyone's day miserable. Such doctors will never change. It is best to avoid them whenever possible (unless you need surgery).

But the relatively few natural-born jerks in the world just aren't enough to explain the over-abundance of jerk doctors. This only leaves one explanation: many doctors become jerks by becoming doctors.

The number one reason everyone says they want to go to medical school is "to help people." Believe it or not, we were all once innocent wide-eyed young medical students who really cared about you.

Then they fed us through the decade long meat-grinder of training involving sleep deprivation, endless memorization, calling patients by their diseases, and getting yelled at regularly by our jerk-doctor teachers. At first we hated those other jerk-doctors, then we felt sorry for them. We worked till we were dead tired, and then got told heathcare is cutting back so we had to do the same work twice as fast next time. Patients expect us to work miracles after watching too much TV, and don't see any reason for dieting or quitting smoking since our purpose in life is to cure everything. Despite our good intentions people keep destroying themselves with bad habits, and nice people keep dying, and everyone is angry we can't turn them back into twenty-year-olds. Add to that lawyers promising irritated patients that they can hit the jackpot, if they just sue jerk doctors--It is enough to turn even the nicest medical students into misanthropic bastards.

As a patient that just wants to get your check-up none of this is your fault, but you are going to bear the brunt of this. Your best bet is to look at your doctor, and try to imagine him/her as the kindly, altruistic, and terrified student that showed up on that first day of medical school. Somewhere in your doctor lurks that annoying humanitarian impulse that doesn't die easy.

Look your doctor straight in the eye and say, "Doc, I really appreciate you taking care of me." Only say this and nothing else! Under no circumstances then ask for something or launch into a list of every odd symptom you had in the last year. Just say something nice and leave. A jerk-doctor hasn't seen human kindness and generosity in years might just feel a warm spark of caring in his/her cold heart. Doctors have a bad habit of forgetting we work on real people. Suddenly you become a real person and not just a patient. Trust me, doctors actually care about real people. You just have to remind your doctor that real people exist.

Who knows, your doctor might even be nice to the nurses after seeing you?

Any Questions?