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The following is a concise list of general advice to
practicing rheumatologists/physicians that I have learnt from my
esteemed professors and over years of practice. I hope other
rheumatologists will find them of benefit to them in their practice
too.
Listen to patients: although doctors might sometimes diagnose
patients as they walk in through the office door (patients with
ankylosing spondylitis for example who walk in stooped forwards) or
when they have spoken only a few words, yet it is important that
doctors listen to all or at least most of what patients want to tell
them about their symptoms. Patients are not doctors; they don't know
which piece of information would be relevant and which would not be
relevant in helping the doctor with their diagnosis. At the same
time, many of them have their own beliefs and conceptions about
their illness and causation of their symptoms that, although
scientifically might be funny yet they make so much sense and logic
to the patients themselves. So it is always acceptable (within
limits of course) that patients take the chance and reveal the
details that they believe might be related to their symptoms.
Listening is not only to diagnose. It is also to manage. Patients
feel better when they have vented out and have expressed all the
irrelevant-to-you information that they believe might be very
relevant to their illness. One important reason why patients change
doctors is that previous doctors did not listen to them which, to
the patients, always implied those doctors did not care.
Be considerate: During making rounds with colleagues at your
hospital, don't refer to a patient by his bed number or refer to him
as "this case". Patients consider this very impolite inconsiderate
to them as human beings. Always refer to the patient by his/her name
or precede it by the appropriate title according to the culture. For
example, in Egypt, you can say "Mr. Ahmed is suffering of…" or
"Brother Ahmed is suffering of …" Patients really appreciate that
respect and consideration. Likewise, in the Egyptian culture, it is
not appropriate that you call a female patient "Ya mama" or a male
patient "Ya baba". It also implies an inconsiderate and careless
attitude.
Create rapport: Invest in creating rapport with your
patients. Patients tend to open up and be more cooperative with
doctors who are friendlier. If you care for your patients, you will
find ways to create rapport with them and will find more ways with
time and experience.
How you look is important: Patients are observant of how
their doctors look, far more than doctors think. One of my patients
who later became a close friend of mine once told me "A good doctor
mostly takes moderate to good care of the way he looks. If it is too
much care probably he does nothing else in his life but taking care
of himself and has no time to become a good doctor. Messy looking
doctors can sometimes be exceptionally good although the rule is
that they are not."
Also patients tend to think of doctors who wear ties as more
credible than those who don't. In all cases remember that how you
look counts.
This is how competent physicians do it: If the reason for the
patient's symptoms is not rheumatological, then this patient is not
your patient and you should refer him to the appropriate specialist
at no charge. Embarking on treating a patient with diffuse aches as
part of somatization rather than a musculoskeletal disorder as
fibromyalgia for example is not only unethical, it is even very
unprofessional and shows you are not an efficient rheumatologist.
How? Efficient doctors are the product of common sense plus many
years of hard work and practice. Those privileged doctors, knowing
they have come to be good enough in their fields and believing they
deserve respect for their competence, would never jeopardize the
asset they have by giving amateur opinions in what they do not know
enough about. On the other hand, doctors who believe they can be
good at everything are in fact not good at anything.
Don't speak badly of other doctors: If you have any
reservations about other doctors' prescriptions or methods of
treatment but you still believe those treatments are not
scientifically inappropriate or are not unethical, then keep your
comments for yourself: First of all, decent people, whether doctors
or non-doctors, don't speak badly of other people. Second, speaking
badly of your colleagues will only make patients lose trust in all
doctors, including you, and in their treatments and will make you
lose their respect.
If you feel that other doctors' treatments or practices are
unethical or you have evidence for their malpractice, refer to the
Medical Ethics Manual at your hospital or syndicate to know how to
deal with such issues which, in all cases, are still beyond the
scope of your relationship and communication with the patient.
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