It’s a small worry, but it’s plagued you for weeks now, maybe years. Your primary care doctor has already brushed it off, told you to keep him posted about any changes, not to worry now. There’s been no change, but it still crops up regularly -- not enough to sideline you at all, just enough to remind you again of your worry that something’s amiss.
Is it time to ask someone else? Get a second opinion? Maybe replace your doctor altogether?
Phyllis Hollenbeck, MD, is on a mission to open the eyes of both patients and physicians, to bring us all back to what healing and health care can and should be still. In her book, Sacred Trust, she illustrates what she calls The Ten Rules of Life, Death, and Medicine with unexpected compassionate warmth and poignant story-telling from her 30 years as a physician.
Perhaps the fact that I found her level of humanity and caring to be “unexpected” says something about my own experiences, professionally and personally, with doctors.
The Problem For Us All
If you’re like most women, you find a doctor -- especially when it comes to your gynecologist -- and stick with him or her for as long as you can. It’s a tactic that’s smart for several reasons. It’s good for what practitioners refer to as ‘continuity of care’, meaning essentially that the same set of eyeballs are reading your patient chart, theoretically tracking your health’s changes over time.
Of course, we all know that insurance coverage, if you’ve got it, and out-of-pocket affordability have bearing on who you see, too. Some of us may want to wander the health care practitioner terrain, but we simply can’t pay the bill that would be rendered.
There are other reasons why we don’t stray from the comfy confines of our (typically) assigned primary care doc’s realm.
For one thing, we’re loyal. As humans, that is, females are good about forming emotional bonds pretty quickly, especially with those we perceive as helping us, and then we’re even better about living the concepts of fair play. You take care of me, I’ll return the favor by remaining a patient in your medical practice.
Another reason women and men stand by their docs is our limited understanding of what physicians know and our related awe of their supposed skill set. Bluntly, we tend to think of them as deities, all-knowing and altruistic. Sure, we may be smart enough to know better, but the truth is that most patients really do expect more from their docs than most (any?) human can give.
Dr. Hollenbeck shines light on the realities of medical school and residency programs with apt and humorous description, and realistic dialogue.
Hollenbeck, the long-time single mom and care-giving daughter of elderly parents describes the state of being a patient: “The role of a patient means being infantilized, or worse, blown off by (usually) a guy wearing a white coat, whose training was essentially an enforced adolescence.”
Amusing. Scary.
I asked her about the idea that all docs start off with the inter-human skills of a typical teen.
“Adolescents have a lot of information thrown at them, just as doctors in training do. One day it seems easy, the next, you feel like an idiot. You’re also at the mercy of people who can either teach you and bring you up right, or people who aren’t very good at explaining ‘here’s how to become a grown-up’. You get yelled at a lot by people with your future in their hands. So whether it’s a question of getting the car keys or passing that course, you can be really stuck.”
Hollenbeck continues in detail about the medical educational process that is still a mystery to most Americans. “A lot of the trainers are people who worry you’ll surpass them in knowledge and skill -- they actually want to keep you down because of their own insecurity. You’re in a rigid environment for many years, with a standardized curriculum -- which has been a good thing in terms of the U.S.’ quality of medical advancements -- but just like in high school, you’re in lock step. From medical school, you go into residency for anywhere from three to seven years of additional training depending on your specialty.”
“Depending on who’s teaching them, they can come out as a more mature person -- with great empathy for people, a greater sense of humanity, of what life is about, its heartbreak and its beauty -- or they can make no emotional progress from the person who was a premed student.”
The Solution
So, I ask, worried that I know the answer already: how do we find a doctor like Phyllis Hollenbeck, MD? Or at least, what knowledge do we need, steps can we take to enlist the services of a physician who thinks and toils as much with her heart as her head and hands?
First, we might ask about their early years and undergraduate training.
Hollenbeck, a science-loving cheerleader who loved writing in her childhood, was turned on to the medical arena in Senior high school. She was fascinated by human stories and was able, thanks to Brown University, to combine majors in English and Premed in a program now called Liberal Medical Education.
Okay. Maybe we won’t be so lucky as to find a physician with that history.
Dr. Hollenbeck, who has managed to finesse her book and its message into a few medical schools’ reading lists, says she hears the question all the time.
“How do you screen through the jerks and find doctors who haven’t broken all the rules?” she posits. Her knowledge and experience give Hollenbeck an enviable position as a health care consumer. “I’m looking to give everyone the benefit of the doubt when I’m a patient, but I’m going to know within 60 seconds if you’re a jerk or not.”
In addition to understanding the rules as put forth in Sacred Trust, here are Phyllis Hollenbeck’s tips on Finding Dr. Right:
1. Become a tough customer of health care. Do you feel worse when you leave then when you went in? Or even if you got a distressing diagnosis from a doc, did you walk out thinking not so much about the sadness but about being connected to someone who wants to help?
2. Talk to people you trust who are enamored with their own doctors. This is especially important if you’ve moved to a new location. If you know no one in the area, search the Internet. Besides the location info and details on the doctor’s practice, try “to get a sense of what the individual is trying to put out there,” suggests Dr. Hollenbeck. “Who they are, what’s in their biography; it can give consumers an idea about the physicians’ attitudes.”
3. If you’re curious about a practice, be willing to pay a bit to explore further. “You pay the copay, you go in, and say ‘I’m here to check you out’. I’ve had people say that, and I really enjoy it! It’s an adventure for everyone.” Hollenbeck likens it to dating. “I put inquiring patients at ease by acknowledging how uncomfortable this might be, to go see a strange doctor and you’re really not sure how strange they are… As a physician, you have to know who your audience is and how to connect to them.”
Rules You Must Read
I get a lot of books to read and review. Phyllis Hollenbeck’s Sacred Trust is immensely readable as well as educational. My guess is that, like me, you’ll enjoy reading her Ten Rules and think about all the physicians you’ve known, wondering if some of them have ever entertained similar notions.
Be assured: these rules are for physicians and those who think they may want to tread that path. Hollenbeck continues to work toward finding more avenues through which docs-in-training can grasp the importance of such ideas as “Bodies Don’t Read Medical Textbooks” and “Hospitals Are Why Stations.” Just as crucial, though, is spreading the word to health care consumers about what they can expect from professionals in whom they entrust their very lives.
Consider this: there may be a handful of medical training programs that use innovative techniques to engender empathy for patients. A couple of examples that have existed but are not standard training include
- male students being required to strip from the waist down and “assume the position” on a gyn exam table with stirrups.
“It’s not to humiliate them. It’s to more literally put them in the patients’ shoes,” says Hollenbeck. “I’ve told my students, sure, surgery‘s invasive, but this is the original invasive procedure.”
Dr. Hollenbeck has used stories from her practice, from her own family, her experience as a patient, and those of her colleagues to illustrate what a good doctor, a really good doctor, is or can be.
“We’re all students of medicine at one time in our lives,” she says. “There are renaissance professionals out there.” Charlie Parrish, a third year Senior family medicine resident from her past, is one such physician whom she describes as “using skills from both sides of his brain.”
Phyllis Hollenbeck ventures one thing that will eventually change how physicians are trained and, therefore, the quality of their interactions with patients is the increased advancement of women into the field. “They don’t do things better because they’re women, but they change the conversation overall. For now, we have a system of like-choosing-like. I see consumers playing a role by doing things like bringing this book and similar into their practitioners’ offices, even into medical schools, and talking about the need for human connection in medicine.”