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In addition to this, many doctors want to re-take the history from the patients and re-examine them for themselves, rather than rely on a brief handover or pote

In addition to this, many doctors want to re-take the history from the patients and re-examine them for themselves, rather than rely on a brief handover or potentially sub-optimal notes from another doctor. Clinical signs can be subtle, as can points in a patient's history that may point to a diagnosis. I see patients often frustrated at being asked the same questions by each doctor they see, but most of the time this is in their best interest.

arkades 9y ago
I try to preempt the frustration by saying that we each take our own history for the purpose of making sure no details are missed, but rest assured, I’ve gotten the overview from your other docs. I then make sure to complete a sentence for them once in a while, to evidence that that is the case. A good percentage still get frustrated. Can’t be helped. Patients reshape their narrative, remember new details, just plain open up more to some docs, etc. the repeated history taking really pays off in improving patient care. Where I find patients get most frustrated is when docs come in for a specific job, and patients don’t have the health literacy to understand what that is or is not. “Doc, can I go home today?” “ I’m just the consulting cardio here to check out your heart for your primary doc, Doc McStuffins, I have no say in that at all, you need to ask McStuffins.” “Oh. But when do you think I can go home?” There’s no good response to that. No one wants to cough up cash to pay for health professionals time to repeat themselves all day long. But the patient that’s asking? They want that answer. They don’t -feel- like they’re asking an inappropriate or stupid question.
- mikecsh 9y ago
  I think this hits the nail on the head. There is a huge information gradient between most patients and the doctor and perfectly bridging that gap takes more [time|money] than any system is willing to support. I think about this when it comes to providing a patient with "informed consent" for a particular treatment/operation. What does "informed" really mean in this case? A brief overview of the main risks and a couple of statistics? Or a thorough understanding of the pathophysiology of the disease and the trial data supporting the therapy? How long is a piece of string?
BurningFrog 9y ago
Each doctor also has an incentive to re-examine the patient so they can bill for that examination.
- arkades 9y ago
  No, they don’t. Most patients get admitted under a DRG, which is a lump sum payment. It’s true that doesn’t apply to every patient, but enough of them that doctors habits aren’t going to be shaped by the minority. For that matter, you can come in and see a patient without asking the same history as the guy before you, if you’re just checking a box for a billing.
- mikecsh 9y ago
  And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money). What you describe is a pitfall of private medicine.
  - chimeracoder 9y ago
    > And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money) This meme really needs to die. The NHS has massive financial incentives that impact clinical decisions. In fact, you literally go on to mention as such in your next sentence. It turns out that having an incentive to "save the system money" results in a different set of clinical decisions. And no, those don't always work out in favor of the patient. (They're particularly problematic for the patient in cases of long-term care, which is why the NHS does rather badly on complicated and chronic conditions like treating cancer compared to the US and other countries).
    - YeGoblynQueenne 9y ago
      The NHS does worse in treating cancer than other countries, but many of those countries (Germany, France, etc) have public health care also. It's not clear that the difference in performance is because of public, vs privately, funded medicine.
ardualabs 9y ago
It's tough, and I get that. I also know that as a person with neurological trauma that makes speech difficult at best, having to recall what amounts now to 50+ pages of chart every 4 hours is... BS. You might as well be telling someone with a broken ankle to run up and down a flight of stairs every so often while they try to recover. There is also an argument that, unless there is some sort of ongoing peer review (they did this during my Oncological Adventure(tm)), you're increasing the number of moving parts, and thus the chances of a breakdown. Charting errors are a significant source of medical mistakes. The problem as I see it is not the intent of the procedure, it's the while (1) do x; mentality. There should be some "ifs" and mitigating functions instead of a hardcoded 1

arkades 9y ago

I try to preempt the frustration by saying that we each take our own history for the purpose of making sure no details are missed, but rest assured, I’ve gotten the overview from your other docs. I then make sure to complete a sentence for them once in a while, to evidence that that is the case. A good percentage still get frustrated. Can’t be helped. Patients reshape their narrative, remember new details, just plain open up more to some docs, etc. the repeated history taking really pays off in improving patient care. Where I find patients get most frustrated is when docs come in for a specific job, and patients don’t have the health literacy to understand what that is or is not. “Doc, can I go home today?” “ I’m just the consulting cardio here to check out your heart for your primary doc, Doc McStuffins, I have no say in that at all, you need to ask McStuffins.” “Oh. But when do you think I can go home?” There’s no good response to that. No one wants to cough up cash to pay for health professionals time to repeat themselves all day long. But the patient that’s asking? They want that answer. They don’t -feel- like they’re asking an inappropriate or stupid question.

mikecsh 9y ago
I think this hits the nail on the head. There is a huge information gradient between most patients and the doctor and perfectly bridging that gap takes more [time|money] than any system is willing to support. I think about this when it comes to providing a patient with "informed consent" for a particular treatment/operation. What does "informed" really mean in this case? A brief overview of the main risks and a couple of statistics? Or a thorough understanding of the pathophysiology of the disease and the trial data supporting the therapy? How long is a piece of string?

BurningFrog 9y ago

Each doctor also has an incentive to re-examine the patient so they can bill for that examination.

arkades 9y ago
No, they don’t. Most patients get admitted under a DRG, which is a lump sum payment. It’s true that doesn’t apply to every patient, but enough of them that doctors habits aren’t going to be shaped by the minority. For that matter, you can come in and see a patient without asking the same history as the guy before you, if you’re just checking a box for a billing.
mikecsh 9y ago
And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money). What you describe is a pitfall of private medicine.
- chimeracoder 9y ago
  > And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money) This meme really needs to die. The NHS has massive financial incentives that impact clinical decisions. In fact, you literally go on to mention as such in your next sentence. It turns out that having an incentive to "save the system money" results in a different set of clinical decisions. And no, those don't always work out in favor of the patient. (They're particularly problematic for the patient in cases of long-term care, which is why the NHS does rather badly on complicated and chronic conditions like treating cancer compared to the US and other countries).
  - YeGoblynQueenne 9y ago
    The NHS does worse in treating cancer than other countries, but many of those countries (Germany, France, etc) have public health care also. It's not clear that the difference in performance is because of public, vs privately, funded medicine.

ardualabs 9y ago

It's tough, and I get that. I also know that as a person with neurological trauma that makes speech difficult at best, having to recall what amounts now to 50+ pages of chart every 4 hours is... BS. You might as well be telling someone with a broken ankle to run up and down a flight of stairs every so often while they try to recover. There is also an argument that, unless there is some sort of ongoing peer review (they did this during my Oncological Adventure(tm)), you're increasing the number of moving parts, and thus the chances of a breakdown. Charting errors are a significant source of medical mistakes. The problem as I see it is not the intent of the procedure, it's the while (1) do x; mentality. There should be some "ifs" and mitigating functions instead of a hardcoded 1