Wednesday, August 11, 2010

Patient Anonymity

Between the closure of my medical practice, largely a reality, and my new job, still awaiting a start date, the days linger.  I read more, I chat with colleagues and friends about life as a physician, I read a little more endocrine science than I usually do.  Today's Endocrine Society Daily Briefing had a ditty from the LA Times citing a study from Waterbury Hospital, one of the Yale Medical School affiliates.  The study compared perceptions of physicians with how well they conveyed information to their patients with the reality of how much the patients retained.  Presumably these were hospitalist physicians who do not have ongoing relationships with patients that they care for in the hospital.  About 20% could name the doctor directing their care.  A relatively small fraction understood why certain decisions were made on their behalf.  Only about 10% received a heads up on potential side effects of their new medicines that might appear after discharge.  Needless to say, the physicians thought they conveyed the information much more effectively than they did.

This approximates my last couple years experience in the office.  Despite being the principal source of medical care for many, it is not unusual for patients to return for an office visit relating a hospital experience that occurred since their last visit that had been unknown to me.  They tend to have a vague grasp of their diagnosis, can name the medicines but not what they are for or why they were started.  Most cannot tell me a doctor's name, relating instead that "there were a lot of them."  This could reflect hospitalist shift work, resident care including changes in resident team based on the calendar of assignments or by changes in location within the hospital, consultorrhea, or weekend coverage.  Whatever the reason, nobody seems to be the focus of their care in the hospital, though it is usually well defined outside the hospital.

There have been physicians since the time of specialization that never connect to individuals.  We have radiologists, pathologists, anesthesiologists, researchers, public health officials and the like that never have to field a phone call from a patient or ever find out how a decision based on their work turned out later.  I think these medical colleagues miss one of the most gratifying aspects of being a physician, both from a personal and a professional view.  Moving this anonymity to the bedside cannot bode well for us.

rich the furrydoc

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