Dr. Andy

Reflections on medicine and biology among other things

Wednesday, November 30, 2005

Doctors behaving badly

Now this is inappropriate
Patients say the problems come in many guises. The arrogant or dismissive doctor. The impatient doctor with his hand on the doorknob. The patronizing doctor. Or, as one young woman experienced, the doctor who is callous and judgmental.

The woman, who lives in Washington, asked not to be identified because she did not want her mother to know about her sex life. Her problem doctor was a new gynecologist she saw for a routine checkup. The doctor began the examination, inserting a speculum into the young woman's vagina.

"She asked if I was sexually active," the woman said. "I said I was. She asked if I was sexually active at this moment. I said yes."

Leaving the speculum in, and the woman with her feet in the stirrups, legs spread, the gynecologist walked to the head of the exam table and proceeded to lecture her on the perils of sexual activity outside of marriage. "I was so humiliated and so scared," the woman said. "And so embarrassed."

I agree that certain fraction of doctors have horrible bedside manner (in addition the general inappropriateness in this case) and for the most part no one does anything about it. I agree with the article that many don't even know.

We get very detailed feedback on how our patients rate us, almost to the point ridiculousness. Patients are asked to rate us on a five point scale encompassing poor, fair, good, very good and excellent. The ratings are then transformed to a 100 point scale (Children's Hosptial of Pittsburgh motto: even our worst doctor gets a 20!). They then report our ratings on a variety of factors to a decimal place! Like 93.7 means something different than 93.5 on this scale. My ratings are generally good, with the exception of parking, which I do poorly on.

Anyway, I am always mystified by patients reluctance to switch doctors. If you go to a restaurant with bad food and lousy service, do you go back? Of course not, you try somewhere else. So if you get a doctor you don't like, why do you keep going back? I think this has something to do with power dynamics; people somehow fear that doctors will find out they went somewhere else and be mad, although what exactly they'd do is not clear. I can tell you patients switch doctors all the time. Being in a small specialty I often see patients who want a second opinion or new allergist and know my patients leave me to go elsewhere. It is no big deal.


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