Connecting The Medical Dots

Connecting the MEdical Dots SartellMedicine today has become fractured. Primary care does basic analysis of a problem and basic care of that problem, while specialists have become such experts that they often can not see past their own rabbit hole. Few doctors are willing to look at the whole picture, analyze the patient as a person and all the problems presented. When someone takes the time and connects the dots, something special happens, and a path to the future can be found. For many patients, finding the doctor that has the experience to listen, to ask the right questions and to find the source of the problem can take years.

One Patient’s Dots Become Connected

Being a patient can be very frustrating. The other day I had a new patient with back pain, which is a pretty normal complaint for a referral. The patient was referred from an orthopedic spine surgeon who felt the patient was not a candidate for surgery. She was in her mid-30’s and had neck and upper back pain. She also has had longstanding scoliosis, a prominent curvature of the spine, and she had been to a number of previous providers for the problems and wants answers and a solution.

I usually work with a scribe. When I started my visit with the woman with scoliosis, she was fascinated. Within in a couple minutes and a few choice questions, my scribe saw a light in my brain go on and the discovery of the unifying diagnosis that no one in the past had a clue about. The patient had scoliosis, but had been double jointed, had shoulder and knee joint issues, had heartburn, and cardiac problems. She also had siblings that were double jointed. The unifying theme was a genetic-based connective tissue disorder, probably a form of Ehlers Danlos syndrome or Marfan’s disease. This will need to be confirmed by further testing and probably genetic testing.

Finding a diagnosis that connects the dots changes the whole picture of a problem. It no longer is a set of random of events causing pain. Now there is a reason and a pathway to follow to manage the problems. There is also knowledge about the course of the disease and a way to anticipate future medical issues.

Unfortunately, most patients never can connect the dots. Primary care physicians often do not have the time to address more than one problem at a visit. Specialists are only interested in their small corner of the world. My world often consists of looking at odd medical issues. Many times helping a patient means having to analyze the past, ask a few questions, closely listen to what a patient says, and bringing together the story to develop a pathway to the future.

The best patient care is provided by those providers who can see the big picture. Medicine has been fractured by the pressures to see as many patients as possible if providing primary care, or staying in your specialty only for others. Seeing the big picture and connecting the dots is a lost art. Changing lives for a patient means being able to go beyond the ordinary and really trying to answer the all their questions to uncover a long-term solution.

Doctor Ratings and the Importance of Communication

Best Doctors MNEveryone wishes to have the best doctor available. In Minnesota there are multiple rating services available that score doctors, however, which rating systems are the best? Some services rate doctors on their compliance to medical guidelines such as those established for asthma and diabetes. Other services monitor the cost of a physician’s per patient billing to the insurance company, while others are patient reviews. The real question is, what will make you happy with your choice of physician?

Important qualities in a doctor includes their knowledge, skill, understanding of a patient’s condition and their communication skills. Almost every physician will have a good basic set of knowledge about any medical condition that they treat. In any profession, from car mechanics to teachers, 90 percent of the practitioners are good and 10 percent are exceptional and have a special talent in that field. Skill level is similar; most physicians have good techniques, but some just know the small things that make all the difference when doing any procedure, and are just better than others.

Understanding a patient’s condition is somewhat complex. First, a doctor must be prepared. This includes reviewing a patient’s medical record and knowing their history. This is ongoing, and the doc should know this information at each visit. Medical records are helpful, but personal notes may be needed in addition to fill gaps. Experience is also important, as is continuing to grow in their skill by attending conferences and seminars on a regular basis.

Doctor-Patient Communication

Communication between the doctor and patient is critical in quality of care. Most important is that communication is not one directional. To treat a patient, a doctor needs to know what is wrong, what are the symptoms, and what is actually working correctly. Since doctors often have limited time with each patient, they will need to guide the conversation to obtain the relevant information. Being honest is also extremely important. There are often multiple sources to confirm data, and if the information provided is not truthful, a doctor will likely be guarded in their care. Patients also need to ask questions about their condition and be open about their recovery.

Ratings of doctors are of limited value. The final rating that matters is how well you communicate with your doctor and whether or not you trust his ability and knowledge. Sometimes, you can find the right physician without any trouble. Other times, word of mouth and information from friends who know the practitioner is critical. Ratings on the web may be inaccurate or forums for the unhappy patient. No physician will be perfect, but finding the right physician may be a matter of how well both you and the physician communicate with each other.