An article in Sunday’s Star Tribune discussed a new program at the University of Chicago where doctors work to better explain medical problems to patients in order to provide better care. It sounds perfectly obvious to patients that doctors should be doing this, but doctors do not often understand this issue. What is obvious and simple to a doctor is a mystery to the patient. Being able to understand and explain the complex situation to a patient is what old time medicine is all about, and has often been lost in our high tech world.

Why The Change?

Medicine has changed significantly in the last twenty to thirty years. Technology and computers have taken a leading role. In the past, time was spent with the patient taking a history, doing an exam, and then discussing with the patient a plan of care. Afterwards a couple minutes was spent dictating a short note and checking off a sheet for a bill, then you were done. Most of the time was spent interacting with the patient. Today time is spent staring at a computer, first searching medical records, then filling out pages of forms to create a new report for the visit, then typing out orders for tests and bills. More time is spent interacting with the computer than with the patient. Government regulations demanding electronic medical records and ridiculous details for billing are partly to blame. Unfortunately, for many doctors it is easier to be quick and done than to spend time and effort explaining the complexities of the problem.

Pain management is no different, as many doctors do not spend the time to explain complex medical problems. Chronic pain is usually quite complex. There are often multiple factors contributing to the sensation of pain, and multiple areas affected. A lot of doctors just want things to be simple, and are not considering the full picture and how many issues may be present and interacting. Furthermore, they want to only deal with one problem at a time. Many pain doctors want to do only procedures and do not want to manage patients. Other pain doctors want to only deal with certain problems; they do not want to deal with medications, or have limited beliefs and are against many types of treatments from interventions to surgery. Finding a pain management doctor who is comprehensive, who understands the multiple complexities of pain problems and who can work with a patient as a partner to explain the problem and possible management options is difficult.

The solution to finding a good doctor is no easy task. There is no one place to look for a good doctor. Insurance companies set up panels of preferred providers that patients must pick from that have no correlation to quality. Physicians often have limited knowledge about their colleagues and their skills, and are even more reluctant to say anything negative about any other practice. Internet rating sites often have limited value since there is no good standard method to evaluate quality of medical care. Word of mouth from patients can sometimes be the best source of information. As rule of thumb, 90% of all physicians will do a good job, the trick is really to find the 10% who provide that exceptional level of care. Those 10% who are special in their level of skill will always be tough to find. When you do find those special quality providers, no matter what the profession, spread the word.