What I learned from my family doc

January 20, 2006

Good medicine, the author learned, consists of more than tests, therapies, and double-blind studies.

Last February, leaving behind my medical school in the northeast, I went home to Florida to spend a month rotating with my family doc. As a fourth-year student, I could diagnose appendicitis, do an ECG, and read an X-ray-probably all at the same time. It never occurred to me that Donald Auerbach, a GP with 30 years of experience could add anything to what I already knew. I thought I might even be able to teach him a thing or two.

Was I ever wrong! Spending a month with Dr. Auerbach opened my eyes to parts of medicine that I hadn't encountered in medical school. I'd like to share some of what he taught me.

Always be kind. Behind Dr. Auerbach's desk, there's a wall hanging that reads: "You cannot cure every patient, you cannot even help every patient, but you can always be kind." He told me that if this was all I remembered from my month with him, he would be satisfied.

Every day and with every patient, however, Dr. Auerbach managed to work a little kindness in. Sometimes, kindness was all he had to offer, whether it was making a house call on a 96-year-old woman or listening silently as a man told the story of the car accident that crippled him and killed his father. During my month with Dr. Auerbach I learned that patients look to their physicians for more than a diagnosis and a treatment plan. They need compassion, empathy, reassurance, and, yes, kindness.

Respect your patient's time. Dr. Auerbach schedules patients so that they rarely wait longer than a few minutes to see him. This is in sharp contrast to my hospital's general medicine clinic, where patients typically wait two to three hours to see a physician. In our ED, admitted patients can wait up to three days before being taken up to the floor. Then they wait for lab tests, consults, and X-rays. Why? Although the party line is that it's due to hospital overcrowding and understaffing, the truth is that the system was set up with the doctor's convenience in mind. Patients wait because they have no choice.

At the beginning of my third year, when I first started on the wards, I was shocked by all of the waiting, as well as the anger, frustration, and helplessness it inevitably brought out in patients. Over time, however, I got used to it.

Patients' time, Dr. Auerbach says, is as important as physicians'. The respect that Dr. Auerbach shows for his patients pays off in the form of better rapport and greater patient satisfaction. In those few instances that he runs late, his patients understand and forgive.

Money isn't a four-letter word. There seems to be an unwritten rule that physicians and their patients don't discuss financial matters. Out in the real world, however, money is a fact of life. The cost of care, especially the price of medications, can even mean the difference between life and death. Dr. Auerbach taught me that although my diagnosis may be brilliant and my therapeutic plan well thought out, if the patient can't afford the treatment, he or she won't get better. Part of being a good doctor is recognizing and responding to this.

Dr. Auerbach has some creative ways to help patients with limited incomes get the medications they need. First, he maintains good relationships with his pharmaceutical reps, and they provide him with free samples of new drugs. In addition, he buys in bulk some of the drugs he most commonly prescribes and gives them out as samples. Finally, he frequently checks in with local pharmacies to find out which has the best prices on certain medications. He puts the information into a handout for his patients.