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what is ideal medical care?

By | July 30, 2009

i asked many of you, “Can you describe your ideal doctor? What are you looking for? What would your ideal medical care be like? What would be the perfect setting?”

i’ll tell you how I would answer those questions, myself (in brief):
“My ideal doctor listens, explains, cares, and understands. My ideal medical care focuses on prevention. The perfect setting would be homelike.” you and i have a lot in common! here are some of the replies i have received this summer:

Accessibility
Health care accessability and affordability would be priorities one and two for me.
To be able to talk directly to a doctor as opposed to going through an assistant.
I am looking for a new doctor. For the past few years I have been seeing a nurse practitioner working with my doctor. I never actually see him.
S/he would be willing to field the occasional brief e-mail or telephone call short of requiring a full office visit.
The main and most important thing for a baby doctor (as opposed to a grown-up doctor) would be availability. I would want to be able to talk to the doctor whenever the problem arises, and would want to have the baby looked at sooner than if it was “just” me.
The doctor would have a back-up other than the emergency room for those times when they are unavailable.

Time
I want a people oriented practice where the doctor spends much more than 5 minutes with me.
Not having a room full of people ahead of you or behind you to make you feel like you have to rush through your time.
It is very hard to be brought to a small room to see the doctor and have to wait upwards of an hour from the time I enter the room until the doctor enters.
My ideal doctor would take the time to listen and not rush through appointments.
She works directly with the patient, gives them the time they need to answer all questions.
Someone who will take the time to really educate us about the risks/benefits of things instead of saying “this is what you do.”
There’s nothing I like more than a doctor who says “I don’t know about that, let me look into it” and comes back with information.

Relationship: rapport
I want for my doctor to know me as a person, what inspires me, what gets me down, what my family is like – like having a holistic view of me. I guess my ideal doctor would have to be part psychologist as well as technician.
There’s enough of a relationship that I can ask if whatever is ailing me is something I need to come in for, or whether I should just ride it out, as opposed to coming from a CYA perspective where if I have the smallest of symptoms I absolutely should be seen by a doc.
I am looking for a Dr. that can follow me through life as I get older and someone with whom I can establish an ongoing rapport.
Knows me as a person rather than a number.
I like the fact that you would be taking my blood pressure and such yourself, and that you seem to offer a more personal touch to your care.

Relationship: communication
My ideal doctor would be one who is straightforward, and willing to explain recommendations and diagnosis without being impatient or disregarding my input.
I am looking for a doctor who is willing and able to communicate effectively. I would like it if they were able to back up their recommendations with facts and provide alternative choices. It would be nice if they could explain why they feel a certain decision is the best.
I don’t like doctors who use scare tactics.
I don’t want any secrets between my doctor and me.

Relationship: facilitation
i guess my ideal doctor would be someone who is willing to brain storm & discuss options with me, rather than just tell me what to do.
I am looking for a doctor who listens and translates medical jargon to me, and gives me some choice in what is done to my body or not done.
I ended up doing a lot of research on the computer when the doctors would just look at me weird. They got mad about my doing research too.
I would like for there to be handouts that are “Dr Leigh approved.”
I know the health care system can be quite overwhelming. I am looking for someone who can be more informative and help direct me in how to get answers I need. It’s hard when there are so many different specialists and insurance games and workman’s comp issues to make good decisions.
Ideal baby doctor- someone who has 1st hand experience as a parent, who can tell us what’s coming up around the corner that we may need to prepare for.

Relationship: respect
My ideal doctor LISTENS TO ME and doesn’t get stuck in something I’ve been diagnosed with before.
Come from a place where the patient knows herself better than anyone.
One that is willing to listen to me as a patient, because usually a person knows more about their body/conditon, then someone seeing them.
It seems like it needs to be a partnership, you listen to me, and I listen to you, we work together to figure out our health strategy.
Sense of team work – working together for my optimal health.
I want a doctor who helps me set goals for improving my health (and my family’s health) and gives me practical, real steps to reach those goals. As opposed to just “putting out fires.”

Holistic: attitude toward prevention
I am looking for a more naturally minded MD.
I am interested in prevention.
I like doctors who work in a holistic way and who are open to non-traditional as well as traditional forms of medicine.
I am interested in working with a Dr. that is willing to consider alternative medicine.
I tend to follow a lot of alternative information on eating and health.
I pretty much stay away from doctors. I find you stay healthier when you stay away from doctors.
I read extensively about all aspects & really believe in natural approaches/least invasive.
Ideally, I would love to have a doctor who thinks outside the box. I have noticed a lot of the physicians I have seen have preferred to treat symptoms instead of the underlying condition. I would love to have a doctor who had a more holistic approach.

Holistic: attitude towards intervention
I’m looking for someone who sees health as the norm & is wellness oriented – who if something would develop in the future would not automatically look to pharmaceuticals.
Have a good knowledge of alternative health care and work with me on them – pills and western medicine are not usually my first choice.
I’m not looking for a regular Dr who just prescribes drugs at the drop of a hat.
I am weary of a doctor who prescribes the newest drug on the market just because they have a sample of that product in their office. I would much rather have them prescribe a cheaper, equally effective alternative and only when it is really medically necessary.
My first preference is to do things as naturally as possible. I’m a big believer that the body knows how to heal itself if given what it needs to do the healing. Of course, there are times when the intervention techniques of western medicine are an absolute necessity, and I respect that as well.
I have mostly used herbal healing methods and acupuncture as my first remedies, but I also embrace parts of western medicine, especially in acute situations.

Office
The clinic would be basic, not flashy, comfortable and not sterile feeling.
An ideal office would be light/bright with plants & a staff that is friendly & helpful.
An atmosphere that is family friendly with calm and comforting decor.
The clinic would be clean with a place for kids to play.
If it were in an old house that was converted to an office, that would feel the best.
I like practices that are located centrally, since I am not a car owner.
People often get upset about having to see a doctor, so the more comfort that can be offered, the better.
The important thing is feeling like it is a private, one-on-one space.
People are more comfortable talking about the social/emotional aspects of their health if they are sitting eye-to-eye, rather than with their feet dangling off of the exam table.

Connections
I want a doctor who has good connections in the community, so that if we need to see a specialist, we can get set up with someone compatible.
Good knowledge of community resources (this may take you a bit of time to acquire).

Insurance
I’m interested in finding a doctor who has your qualifications and will also take Medicare/Medicaid/Oregon Health Plan/ my insurance.
I need to have a doctor who can take medicare after I turn 65.
If you can accommodate patients with medicare, then I think my husband might be interested in a new doctor too.

…

sometimes i think about our images of doctors – what we visualize when we expect to see a doctor.

when i was growing up, the only doctor i saw regularly on television was Dr McCoy of Star Trek (on tv for only 3 years!); he had magical analyzers and handheld machines that enabled him to diagnose and cure the diseases of all sorts of life forms, without causing pain – without even physically touching them. on ER (15 years) and Scrubs (9 years), and others, everyone works in a hospital, where patients briefly appear with one acute problem, are “buffed and turfed,” and are never seen again. on House MD (6 years so far), there’s never a hint of prevention, only sudden emergencies, with a relentless emphasis on detecting one isolated pathology, which then (after some disastrously bad guesses) is rapidly cured (or else the patient dies). it’s really a detective show – finding the murder weapon wraps up the case (or else the killer gets away). the remaining hospital shows are just romantic dramas. the only tv medical shows not based in hospitals, that i can think of, were Northern Exposure (5 years) and Dr Quinn (6 years), and those were only very vaguely medical, set so remotely in time and place that we can’t see them as realistic models for our own care.

when we are old enough, or if we have chronic issues, our expectations echo our experiences with real-life doctors. these experiences are not always pleasant. the priorities that you and i mention, as patients, are very difficult to meet in a standard medical office setting. the legal status of doctors as professionals is traditionally oriented around the idea that they will be independent practitioners, caring for their own little flock, that they know well, and feel responsible for. but the advent of managed care, as a way of reducing unnecessary medical costs, has limited health care accessibility altogether, while encouraging the development of doctors who are basically interchangeable technicians. the technical services they personally provide have become more and more limited. so now every doctor is expected to have a squadron of assistants and nurses providing the hands-on care, phone calls, follow-up and monitoring; the doctor is merely an administrator (and a “diagnostician”). i have often heard physicians say, “i didn’t go to medical school so i could measure blood pressures” (or do throat swabs, or clean out ears, or do pregnancy tests, etc). that’s how the system is organized.

what does all this deliver to us, when we need care? we often get the opposite of everything you said, up above, there. we need to think hard, as a society, about what we visualize doctors doing for us, and ask how well the system lets them do it.

how can we get the medical care we want?

well, isn’t that the billion-dollar question today? in fact, doctors and lots of other voters are rallying for national health care in washington d.c., today, the 44th birthday of the medicare program. (one doctor walked there from chicago – note: he is uninsured because he is self-employed).

what does this mean for you?

as you know, my goal is to provide maximum accessibility (book your own appointments; after-hours, urgent, and home visits too) and plenty of time (30-60 minute appointments), to develop trusting relationships, in which we can make sensible health plans that work for you – for the same cost you’d pay at a regular “large group practice” clinic. i keep my operating expenses low, so i’m not required to see 30-40 patients a day to pay the bills; i can see 8-10 patients a day instead.

but if i had one magic wish, it would be for a medical practice that was more like a community garden, and less like a grocery store. our employer-insurance-based system doesn’t make this easy – yet. i know a lot of doctors who are working on alternatives – the “subscription” service that i offer is one common version (although it’s still not a “collective” model). another is the “robin hood” practice, in which dues paid by some members are available to fund the care of others who can’t afford it. maybe you can help me – and our lawmakers – think of other, better, ways to make good care affordable.

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