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These are challenging times for physicians who aim to please their patients, and equally challenging for patients who are juggling full schedules and dread waiting for an upcoming appointment with their doctors. Technology has increased access but the demands on our time remain the same. Many of our email addresses are now posted online. Individuals prefer text messages to answering their phones and accepting a call from a private number is a thing of the past. On average it takes me three attempts to reach my patients.   Rarely is my call picked up the first time. The number one reason I am not on the phone, having conversations or emailing my patients during the day is because I’m either seeing patients in the office, in surgery, or in a meeting. I typically reserve the end of the day to return phone calls and review results.

Health management and communication tools have also been created to deliver your results, often before we have had time to review them, call you, or send a letter. Patients feel frustrated if they receive results that are not clear about, or run if they encounter unfamiliar medical terminology.

With increases in access, it is easy for patients and doctors to lose site of the value of a conversation. Especially since we are all leading rich full lives with our daytime hours filled with career priorities, relationship responsibilities, family obligations, and parenting.   But some topics do warrant a discussion. It will be up to you and your clinician to discern when a conversation is needed. I understand when patients prefer talking by phone or using electronic messaging tools, however I find nothing replaces an actual face-to-face conversation.

Several weeks ago I was caring for a young woman who serves as a professor at one of Boston’s top universities. She was new to me. She had many complaints such as pain and irregular periods. Needless to say, I had to start from the basics. I ordered many blood tests, lab work to rule out or confirm peri-menopause and a pelvic ultrasound. I requested she schedule a follow up visit to discuss all of the results and make a plan of care. Whether we would need to perform a biopsy, surgical procedure or treat with hormones would depend on an analysis of all of her results and her desires. She admitted her schedule was full and could only be reached between a 30 minute to one-hour window on any given day.  After a typical game of phone tag, She sent her questions electronically. I’d reply as thoroughly as I could. Every question I answered generated new questions. Unlike when having an actual dialogue, I’d receive messages for clarification throughout the day. You can’t imagine how long it takes to explain each individual lab result and what they all mean in an electronic fashion. There is a time and a place for everything… I had to be realistic that I don’t have the time or patience to write several paragraph messages. Ultimately I had to insist she return. She needed a biopsy anyhow. Every doctor is different. But I know I practice best with open, direct communication. I find it least confusing and important to my relationship with my patients. I take everything into account; my patient’s energy, body language, their history, and their results. Each element comes together to help me practice the art of medicine with a heightened sense of trust, connectedness and level of understanding. I agree not every blood test or imaging study may warrant an office visit, but somehow we are losing the relevance and necessity of conversation and personal interaction. This feeds into why many individual live in a state of confusion about their health.

If you have had extensive blood work, imaging studies or have a more involved complaint or health care issue, I advocate for a follow up visit to discuss those results and to discuss a management plan. This is especially true when I am considering multiple possible diagnoses or contributors to any one medical concern. Many results do not warrant a lengthy discussion, however there are scenarios that require a follow up visit and a dialogue. Your best litmus test is your level of understanding, concern, and acuity.

I honor personal contact, face-to-face discussions and dialogue. As much as I try to accommodate, realizing that I’m not for everyone early on in my life and career has given me a sense of freedom and authenticity that helps me perform my mission in serving women in a way that makes me proud.

I don’t offer my personal email or encourage its use because that would imply that I’m constantly checking it throughout the day when in fact I’m not. I’m working throughout the day actively engaging the essential beings in front of me, one patient at a time. I am grateful that the hospital I work for still finds the value in a pager and paging system. The days of me finding messages from a hemorrhaging patient in my in basket several hours after the event started are over. I set limits early on.   As I would expect of every woman I care for, I too check out from my workday at some point and put on my Wife, Mother, Sister, or Friend cap. I embrace family time and quiet time. I place a high priority on direct communication. One guarantee I know I can honor is that no one leaves my office confused.

Honor Health Vow # 4

Promise to Be an Active Participant in the Patient-Doctor Relationship