What do I want in a doctor? (1964) | Hacker News Reader

What do I want in a doctor? (1964)

lettersofnote.com

53 pointsbookofjoe19 comments

It's important to stop calling them by the generic name doctors.

They are Physicians.

There are lots of doctors, but only one group has spent 300,000,000 dollars on limiting competition and propping their own profession with exclusive privileges.

That's Physicians!

Occasionally, I start to think I’ve left the grounds of mediocre and may even be a good writer. Then, I read someone like Steinbeck and understand that I have many decades of mediocrity ahead of me. This is a good thing...:)

Steinbeck is amazing. He would recite his books as he wrote them - he believed that words were meant to be spoken. He wrote for the spoken word rather than the written word. I also saw a few pages of his revisions on one of his books - he revised his "standard" sentences into "colorful" sentences. So his writing was definitely a result of hard work and creativity - and in my mind moves his writings into the realm of true art.

It's a bare minimum - try reading your paper/report/whatever aloud some time and you will realize that it's the only effective way to proofread.

If you haven't already, read Log from the Sea of Cortez, and Travels with Charlie. Maybe my favourite books of all time.

He has much higher standards than me. I just want someone who has my health as her top interest instead of bankrupting me.

One neat trick I use to assess doctors is look at their legal history. These records are all public, and your local court probably has them searchable online[1]. I wouldn't avoid a doctor just because they've been sued, but a bunch of malpractice suits are a bit of a red flag.

[1] https://www.masslegalservices.org/content/how-look-court-rec...

Primary care is so much about forming a lifelong relationship between doctor and patient, finding a way for the patient to inject their own hopes, worries, dreams feels so important, and beyond the proscribed tick boxes.

I think primary care should be more about the doctor using his knowledge of the patient's lifestyle, gained over time, as context for proper diagnosis and treatment. Empathy without competence is sort of pointless from a medical professional. IMO, of course.

What you're looking for is a therapist.

My primary doctor is a nice person but she's a busy professional and I'm not going to waste her time talking about my hopes and dreams. That stuff is almost entirely irrelevant for most medical issues.

If a doctor doesn't know what outcome the patient is looking for, how are they going to recommend a course of action?

1. What is your understanding of where you are and of your illness?

2. Your fears or worries for the future

3. Your goals and priorities

4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?

And later, 5. What would a good day look like?

https://www.nextavenue.org/atul-gawandes-5-questions-ask-lif... (Just for an example)

There's a story about a marathon runner and a cardiologist. Determines dude has some risk factor.

"Can I still run?"

"I determine the condition, you determine the benefit."

Unless your goals are physical in nature(I want to be able to check the mail again or otherwise return to a level of mobility, become a body builder...etc) I see very little benefit.

"I want to not die, and if I must, preferably at a later date." About sums it up.

My problem is when doctors are rushed, I can't really communicate with them effectively. Probably 90% of what I feel like telling a doctor is useless to them, but that last 10% could be vital.

We have a cult of "busy-ness" in our culture, where if you're busy, you must be important. But "busy" is not the same as effective.

Maybe they could more effectively treat patients if they slowed down a beat with them.

If you're wealthy enough you can sign up for a concierge medicine service and get exactly that. But it's simply impossible to deliver that level of service to the general population. There wouldn't be enough primary care doctors to go around (we already have shortages in many areas) and there's no realistic way to fund drastically expanding the number of doctors any time soon.

I'm not asking for anything extreme. Just patience and a few more pauses in the conversation.

If I remember correctly Steinbeck's doctor was a friend from his days at Stanford. So we aren't talking about traditional doctor/patient relationships.

This is the Correct Answer.

I have multiple chronic life threatening illnesses. I dread switching care providers. Continuity of care is key to my survival. My primary recently switched to a concierge model, $50/mo and consults are open ended, which has been fantastic for me.

The sweet spot for choosing a new primary doctor is late 30s. Recent schooling means more up to date knowledge. And you can age well together.

Some exceptions, of course. My proctologist and neurosurgeon are the best in my city. I've had terrible luck with dermatologists.

I wonder what kind of life you lead in which it could be meaningful to imagine having a "lifelong relationship" with any given medical practicioner. That just isn't... I mean, my health insurance situation changes often enough that it's a new network almost as often as I ever have to go see a doctor.

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