DISCUSS THOROUGHLY WITH
PATIENT IN NONTECHNICAL TERMS THE DIAGNOSIS(ES),
WORK-UP, THERAPY, AND PROGNOSIS.
Probably the most common failing of physicians
is to explain health problems and the related issues
thoroughly and repeatedly to the patient. First, the
doctor may be so familiar with the illness that he
doesn't realize he is skipping vital basic
information. Sometimes, you may find you have to do
the reminding. Second, the doctor may feel you do
not want a lot of information; if so, ask questions
or simply say, "I need more information to
understand and cope with my hepatitis." Third,
some doctors believe that patients "can't
handle" the technical information or whole
truth about their problems. Such an antiquated
approach has little room in modern medical practice.
Remember, the doctor's responsibility is to the
patient, and as such it is inappropriate for other
family members--children, parents, siblings--to ask
the doctor not to discus the illness with the person
affected. It is the patient's health that is at
stake, and should be only his decision if he does
not wish information.
PRESENT TO THE PATIENT, WHEN
APPROPRIATE, ALTERNATIVE GENERALLY ACCEPTED
APPROACHES TO THERAPY OR TO REACHING A DIAGNOSIS
EVEN IF THE PHYSICIAN DOES NOT PERSONALLY ACCEPT
There are often several approaches to therapy or
to establishing a diagnosis. These will vary some
among physicians, institutions, or even parts of the
country depending on philosophies, availability of
sophisticated medical testing and therapeutic
equipment, and regional successes with therapy. The
physician should present to you the relative pros
and cons of each alternative approach.
RECOMMEND TO THE PATIENT
WHAT THE PHYSICIAN CONSIDERS THE BEST APPROACH AND
While it is important for your doctor to make
you aware of alternative approaches, it is just as
important for him to recommend what he feels is best
for you. To some extent, these recommendations
reflect his bias, but they also take into account
other factors which are peculiar to you. He will, in
recommending therapy, consider the disease as it is
present in you, your personality, your approach to
illness, your ability to comply with recommended
treatment, your work demands, your family support,
or whatever unique factors exist in your case. If
after this has all been explained to you, you are
still uncertain whether you want to proceed with
therapy, you must inform the doctor. Either the two
of you will be able to agree on an alternative, or
if not, he can refer you to another physician.
ALLOW ADEQUATE TIME (ON AT
LEAST ONE ADDITIONAL OCCASION) TO ANSWER PATIENT
QUESTIONS AND DISCUSS PATIENT CONCERNS.
Often the initial visit to the doctor is sort of
a blur. You may be nervous and you will not remember
much information. Questions will not occur to you
until you walk out the door. It is critical for you
to have time to adjust emotionally to a new
diagnosis or treatment. You will find yourself with
more unanswered questions. At least a second
session, if only for talking to the doctor or
counseling, is really necessary. This is also a good
way of making sure medications are taken correctly.
The doctor's failure to allow for, or the patient's
failure to take advantage of, this second session
can be a major factor in a breakdown of the
relationship. It can also lead to misconceptions
about the illness, misunderstanding about medication
regimens, and other problems.
PROVIDE ADEQUATE FOLLOW-UP
AND EMERGENCY CARE AND MAKE PATIENTS AWARE OF THIS.
Clear cut arrangements should be made for
handling emergency problems, or problems that occur
during non-office hours.
ASK FOR SPECIALIST
CONSULTATION OR A SECOND OPINION WHEN UNCERTAIN
ABOUT A DIAGNOSIS.
Every physician has had the experience of being
stumped. So much new information is generated
through medical research each year that it is
impossible for the internist to keep up on all
diseases. Most doctors realize that occasionally
they will encounter difficulties in diagnosis or
treating a particular patient. The same illness
never looks quite the same in different people.
Sometimes the doctor simply cannot be sure with
which illness he is dealing. At this point the
internist should arrange for a visit to a doctor
whose specialty likely includes the disease in
question. For example, a person with hepatitis may
be sent to a hepatologist or a gastroenterologist.
ASSIST IN OBTAINING RELEVANT
SOCIAL SERVICES OR REHABILITATION SERVICES FOR THE
The total care of the patient, especially in
chronic illness, extends far beyond the specific
treatment of the disease. Your doctor or his staff
should be able to refer you to the appropriate
agencies and assist you in obtaining these ancillary
services. Other problems may occur within the family
that required psychological or psychiatric
intervention. Appropriate referral for these
services should also be available.
KEEP COMPLETE PATIENT
It is both a legal and moral obligation of a
physician to keep complete care records of his
patients. This assures a smooth transition, for
whatever reason, of care from one physician to
another. It also helps prevent unfortunate errors
because memory fails on exact medication or on
exactly what was decided at what visit or during
what phone conversation. Finally, it is crucial as
documentation in any legal proceeding brought for
ASSIST IN A SMOOTH
TRANSITION FOR THE PATIENT TO ANOTHER DOCTOR WHEN A
RELATIONSHIP HAS BEEN ENDED.
If, for whatever reason, your care has been
transferred to another doctor, your former doctor
should facilitate the move by promptly forwarding
records (at your written request), and if necessary
discussing your case with the new doctor. This is
true also in situations where the change in doctors
is caused by your or his moving to a new location.
MAKE AVAILABLE TO PATIENTS A
LIST OF HIS CHARGES FOR THE SERVICES HE PROVIDES.
All physicians have some system for charging
their patients. Often, initial visits are one
charge, follow-up visits a somewhat lesser charge.
The doctor should have available a summary of his
usual charges so you will know what sort of
financial commitment you are making when you visit
him. Often, doctors will reduce fees for patients
who are not able to pay the full charge. Also
remember that physician fees do not pay for
laboratory tests or the services of other persons or
equipment that may be needed.