7 steps to get what you need from your doctor—fast!

7 steps to get what you need from your doctor

Sick of phone trees, endless refill requests, packed waiting rooms, out-of-control bills, and other medical misadventures?  Follow these 7 simple steps to get your doctor to do what you want.

1. Get Organized. Be clear about what you need from your appointment. Make a comprehensive list of all the issues you want to discuss—and your ideal outcomes for each. Patients who are proactive and organized can cover twice as much in an appointment compared with patients who are passive and unprepared.

2. Prioritize. Organize your list. Assign numbers to each problem in order of significance to you. Now scrutinize your list for conditions that may be life threatening. Move those to the top. This is the order of significance for your doctor. Highlight the top 3 and handle remaining items as time permits.

3. Start early. The best time to see a doctor is early in the day. Twenty percent more polyps are found on colonoscopies before 11:00 am. Why? Physician fatigue. Need your physician’s full attention?  Mondays and Fridays are the busiest days so schedule your appointments on midweek mornings before 11:00 am.

4. Be human. You need a physician, not an automaton. But many docs feel more like factory workers practicing assembly-line medicine. Jolt your doctor out of the robotic technician role by making a human connection in the first 30-60 seconds of your visit. Start with a joke, a poem. Bring a smiley-face balloon or homemade chocolate chip cookies. Humans bond over food and fun. Try it.

5. Be direct. Now that you’ve got rapport, share the top 3 items on your list—and your desired outcomes—in as few words as possible. If you prefer not to take drugs, state that immediately so your doctor doesn’t go on a detour discussing medications. If you want a referral to a physical therapist, say so upfront. Just want reassurance, ask for it. You’re more likely to get your needs met quickly by stating your intentions directly.

6. Plan ahead. To avoid multiple visits, consider your medical needs over the next 6 – 12 months. Ask for refills at your visit rather than calling later. Are you likely to have a flare-up of a chronic condition in the next year? A bad back? A panic attack? Prevent midnight trips to the ER by getting emergency medications now.

7. Say thank you. End appointments with this sentence: “Thank you. I really appreciate ____________.”  (Fill in the blank). If you can’t say anything nice, find another doctor.

And if your doctor looks terribly distressed, hand your doc my phone number: 541.345.2437. I help physicians off the assembly line so they can enjoy seeing patients again. You just might save your doctor’s life!

Pamela Wible, M.D., is a family physician and pioneer of the ideal medical care movement. Join the movement to deliver ideal care to all Americans!

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7 Secrets to Loyal Patients for Life

LoyalPatiets

Loyal patients are the lifeblood of a medical clinic. And devoted patients are worth their weight in gold. It’s a lot easier to care for an established patient that lots of one-timers who never return. Beyond ease of workflow, the economic benefits are fabulous. A loyal patient panel will stay with you (and pay you) through sickness and in health even if you don’t take their insurance—even if you choose to go cash only. Loyalty is earned. So what should you do? Follow me:

1. Solve problems. Physicians must solve their patients’ chief complaints. Don’t get distracted by one-size-fits-all algorithms and computer prompts. Treat the patient, not the computer, not the insurance company.

2. Return calls. If a patient calls, call them back ASAP. Return emails, labs, and test results the same day. Sooner is better. Patients get anxious when left waiting.

3. Start on time. Respect your patients’ time by staying on schedule. If you run late, apologize. Better yet, offer a $5 gift card for a cup of coffee. When I run late, my patients choose handmade soap from a giant wicker basket. What will you do?

4. Stay put. If you want patients to stop doctor shopping, then doctors should stop job hopping. Jumping from one clinic to another isn’t a winning strategy for a loyal following. Find or create an ideal clinic and stay there.

5. Have fun. Nobody wants to see a doctor who is stressed and depressed. Smile. Laugh. Tell a joke. Lighten up. Host a patient appreciation day every once in a while and hand out balloons and chocolates—just because!

6. Research & refer. If you can’t solve a problem, research and refer to someone who can. Reach beyond allopathic medicine when needed. Refer to acupuncturists, massage therapists, and other health professionals. Replace, “We have nothing left to offer you” with “I’d like you to see my colleague who has had some incredible success treating your condition.” Never abandon your patients to Dr. Google.

7. Do house calls. You’ll basically stand out as the town hero when you treat a patient in their home. Try it weekly—even monthly. I bet you’ll love it!

Patients are routinely held hostage on phone trees and in packed waiting rooms, in paper gowns and cold stirrups. Believe me. It doesn’t take much to wow your patients. In fact, now I even get tips! Yesterday, I  got an $80 tip on a $95 bill. Follow my strategies and you’ll get tips too! And you won’t even have to put out a tip jar :)

Pamela Wible, M.D., is a physician entrepreneur and pioneer of the ideal medical care movement. She teaches physicians cutting-edge business strategies at her biannual physician teleseminars & retreats. Join us anytime! Medical students are welcomed.

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Why medical conferences feel like funerals

DeathByDespair

A friend just got back from a big medical conference at a fancy hotel. The cleaning ladies actually pulled her aside to ask, “What’s with all the grim faces and sad eyes?”

Do doctors realize medical conferences look like funerals? That’s what the cleaning ladies think. I bet they’re not the only ones.

Why do medical conferences feel like funerals? Maybe because doctors are dying by suicide at twice the rate of their patients.

Why?

The truth is doctors are dying from despair.

I attend lots of conferences. Writing conferences. Entrepreneurial conferences. Marketing conferences. I’m fueled by the energy and enthusiasm of authors, entrepreneurs, and business people who are so darn passionate about what they do in the world.

But I avoid medical conferences, and here’s why: the energy is low. Doctors look depressed, defeated, checked out. I’m naturally a hypomanic optimistic, and even I have to admit—most medical conferences make me feel sad.

Don’t get me wrong. I love the hotels. Meals are superb. My pillow is nice and fluffy. The medical content is enriching. But the doctors look miserable. I could reference their clinical symptoms in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), but if the cleaning ladies are so worried about us that they’re questioning our mental health, maybe we should stop diagnosing patients for a moment and examine ourselves.

Health care is making doctors sick. Even suicidal.

I was once a depressed and suicidal doctor. I thought I was the only one. Now I know depression and suicidal thoughts are an occupational hazard of the medical profession. Let’s face the facts: it’s depressing to be surrounded by sick people all day without enough time to care for them—or ourselves—in 7-minute office visits. And if we seek mental health care, we face real retribution and license restrictions.

Doctors are fed up with assembly-line medicine. The solution I found for my own despair is simple. I went from suicidal to successfully self-employed in six weeks! I took a leap of faith and invited my community to design their very own medical clinic! In less than 30 days we opened the first ideal clinic designed entirely by patients. I’ve never been happier.

Since opening our community clinic 10 years ago, I’ve helped doctors open ideal clinics all across America. In my travels, I meet lots of physician entrepreneurs. They all have one thing in common—they’re happy!

Our medical training doesn’t teach us the business skills we need to thrive as physicians today. Maybe doctors should attend fewer medical conferences and more entrepreneurial and marketing events. Hang out with happy people who love their careers and see what we can glean from them.

For now, I’m going to continue to do my continuing medical education online.

Pamela Wible, M.D., is a family physician and founder of the ideal medical care movement. She offers bi-annual retreats for medical students and physicians who want to learn the business skills they need to be open their ideal clinics.

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Heroic doctor’s heart-wrenching letter

Most heart-wrenching e-mail I have ever received. From a true hero, Dr. Varun.

VarunLovePic

Dear Pamela,

Hi, der. I don’t know how thankful I am to you for writing that article on physician’s suicide. I really wanted to hug you after reading it. I had really rough day after seeing 130 outpatients and around 60 admission emergency in a 12 hour duty. I work as a final year MD internal medicine resident in one of the busiest hospital in India. I saw a part of myself in every page of your article  Just couldn’t stop reading the article. It is 3:00 am in the morning here and after a physically and mentally demanding day of work and studies reading your article was the best thing today.

It takes me 5 hours by flight to reach my home from my hospital. I have my wife and 6 month old son (whom I been with for 15 days since his birth) at home. I work day in and out just to be with them once in 3 months. I don’t see my colleagues smile, I hear my patients misery every day. I smile and crack jokes even when I am sad so that I can bring some joy into my patients sorrowful life.

Today I saw this patient who died, married with a son, the only earning member of his family …….his widow just wouldn’t accept that he was dead. She kept talking to him. I just didn’t know what to feel ….. I was numb for a minute thinking what if that was me …. And the kid is my son…..

I see deaths everyday in ward …..I don’t know if you would believe me, but 4 deaths per day in a single ward of 40 beds overcrowded to 125 patients admitted at a time. Two patients on a bed, two lying together on the floor. Poverty, misery and pain all around. I have declared 12 patients dead in a day during one of my duties. I just don’t feel death anymore, just don’t feel human. My uncle died recently, I felt nothing deep inside just some memories and that is it.

I write this mail hoping that the way I survive my day would help you in helping others.

I always wish my colleagues and say hi when I see them in the morning. Say hi to everyone from my ward sweeper to the guard in the ward. I never eat alone and always make sure I share my food. I always smile whenever I talk to my patients. I hold their hands when I talk. Listen music whenever possible. And everyday whenever possible I talk to my wife, father, mother, and brother (all of them are doctors).

But still this profession demands too much from us. I have thought about giving up and suicide a thousand times ……the misery was too much for me to see 12 people die in a day. The only thing that keeps me moving forward is my family and friends.

I appreciate what you are doing. It took me 4 hours to write this mail. It is 7 am in the morning. But your article was worth it. Thank you. Thanks a lot…..

Dr. Varun

Pamela Wible, M.D. is a family doctor who is dedicated to physician suicide prevention. Please be kind to your doctor. The life you save may save you. Photo credit: Dr. Varun (and his newborn son)

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Physician whistleblower exposes human rights abuse in U.S. hospitals

Whistleblower

This courageous physician blows a whistle on the human rights abuse in hospitals. Doctors forced to work 8 consecutive days. No sleep. No access to food. Doctor forced to work in ICU after having seizure. Is this the care you want in American hospitals?

Watch this video

Full transcript:

The hospital administration and the national hospitalist company that I worked for made this agreement that the shifts would be 24 hours. And they would be consecutive 24-hour shifts. And there were only 3 of us dong this job for 365 days a year—seven on and seven off. So seven 24s [that’s a 168-hour shift!] You know, that works if you are just taking call at night, but really what it became was you’re up at the ER at night. And you would see the poor exhausted ER doc who would come on at 7:00 am and get off at 7:00 pm while the next guy came in.

You’re exhausted too and you’re like, “They’re going home and the nurses are going home. Okay, I can do another night. Okay, I can do another night.” Then you are staying through and maybe you get done at 1:00 am and you’re like, “Should I eat? Should I shower? Or should I sleep? Well, you know if I shower then they might call me again from the ER.” So everything just gets let go and then you try to go to sleep and then you get called back again and then you see that ER doc and nurses are going off shift and the new army of people would come in and you’re still there. And then the same thing that night.

And it just got worse and worse. It got busier and busier. And the way that they do that is they hire J-1 visas [international medical doctors] and they’re locked into 3 years. So I was one of the very few people that was not a J-1 visa at this job. And they’re locked in. They can’t complain because they’ll lose their visa. So I tried to speak up eventually. And I waited a while to do that because I wanted to make relationships first and I waited. I stayed there for almost two years. And I finally brought it up and tried to have some meetings and tried to be politically correct and tried to document the conditions.

I slept in the hospital. I showered in a broom closet, a little closet in the CCU [Cardiac Care Unit]. The cafeteria closed at 1:00 pm so usually we’d miss breakfast because you’re on the wards at 7:00 am and breakfast is at 7:00. And then you’d often miss lunch because it is really hard to get off at 12:00 pm to go get something to eat. And then the cafeteria was closed because it’s a small hospital so you’d have no access to food. And then you’d think, “Well, I’m gonna go out to get a Whataburger, or whatever, (which I hate eating) and then you wouldn’t get out.” And then you’d say, “Could we have access to food?” And they’re like, “Well, you outsiders, you come in and you tell us how . . .” It was insane.

We had case management meetings in the morning with the case management team and on a transition day if I was going off my shifts and a new doctor was coming on the shifts we would all meet together. And the case managers were all fresh because they worked an 8-hour shift. They worked hard. But if they worked over 8 hours they were on overtime. So we’re doing these 24s and they’re coming on fresh. And then their boss would say, “Oh, Dr. __ is so irritable. Why is she so irritable?”

So I’m sitting there one day. I’m just exhausted going off of a 3 or 4 day stretch and my new boss . . . There were only 3 of us and everybody kept leaving. The program director left so they asked each one of us if we wanted to be program director and we, of course, anyone who had smarts said, “Uh, no way.”

So who gets to be program director? It’s the newest guy who’s like 28 and J-1 visa nice-enough guy. So he comes on and he tries to manage this program in addition to being the new family medicine grad at this hospital where we were the ICU doctors. No cardiologists. No pulmonologists. Sick, sick, sick, sick, sick patients. So he’s managing all this.

He comes on to the shift and we’re having this meeting. Or maybe he was going off the shift. I can’t remember. [She believes he had been working 8 days straight] He starts seizing. Literally seizing. You know, having a seizure. And they allowed him to work that day. In the ICU. And we are unsupervised in the ICU. It is us and only us. In fact as an internist I even got called into OB there because there’s nobody to do critical care for hemorrhages. So it was exciting, but you have got to be on your game. And I tell you what—when you have worked 36 hours you are not on top of your game and there is nobody else overlooking those cases. And, of course, the patients don’t know that you’ve worked that long. Would they fly in a plane if the pilot had been flying for 36 hours—and seizing?

UN Declaration of Human Rights: Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. Article 24. Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay. 

Pamela Wible, M.D. is dedicated to ending the human rights abuse of medical students and doctors so patients can receive the health care they deserve.

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Physician Suicide Challenge

This summer I did the [ALS] ice bucket challenge. But I’m challenged by another disease. A disease so scary people won’t say it out loud. A disease so frightening that doctors are afraid to talk about it. A disease so feared that physicians falsify death certificates, families deny the cause of death, and most victims’ names are hidden for eternity.

Every year we lose over 400 doctors to suicide. That’s like an entire medical school—gone. I was suicidal. I survived. But I lost both men I dated in med school to suicide. And 3 doctors in my town in just over a year to suicide. Each year over 1 million Americans will lose their doctors to suicide. These are just the physician suicides I heard about this year:

Gregory Miday, MD, internist, by scalpel in bathtub

Vincent Uybarreta, MD, surgery intern, by belt hanging in closet

Kaitlyn Elkins, third-year medical student (and her grieving mother, Rhonda Elkins), both by helium overdose

David Brooks, MD, family doctor, by standing in front of train

Phillip Henderson, MD, III, fourth-generation obstetrician, by gunshot wound

Rafael, family doctor in South Carolina, by overdose

Gregg, internist in California, by overdose

Pediatrician in Oregon, by gunshot wound in park

Vascular surgeon in California, by carbon monoxide

Urologist in Oregon, by gunshot wound

Larry, anesthesiologist in Oregon, by overdose in hospital closet

Edward, family doctor in Oregon, by gunshot wound in clinic

Otolaryngologist in Kentucky, by jumping from balcony

Orthopedic surgeon in California

Anesthesiologist in Washington

Female third-year medical student in Michigan, by overdose

Another medical student in Michigan

Male surgeon

Male radiation oncologist

Male internist

Male doctor

Male doctor

Male colorectal surgeon in Texas

Male medical student

Male doctor

Male doctor

Male intern

Male pediatric surgeon, by gunshot wound in bedroom

Male doctor

Female internist

Male family medicine resident

Male doctor, by gunshot wound

Male family doctor, by drowning

Male second-year medical student in Washington, by gunshot wound

Male neurosurgeon

Cardiologist in California, by gunshot wound in laundry room

Male anesthesiologist

Female family physician in Iowa

Male anesthesiologist, by overdose in hospital

Another male anesthesiologist, by overdose in hospital

Male medical student

Jack, doctor

Male doctor in Oregon

Jose, doctor

Craig, doctor

Male physician

Male surgeon

Female physician

Female medical student

Another female medical student

Male medical student

Male doctor, by heroin overdose

Male pediatric intensivist, by plane crash

Male family physician, by gunshot wound

Female obstetrician, by driving off bridge

Male obstetrician, by gunshot wound

Male internist, by overdose

Male medical student, by jumping

Male medical student, by gunshot wound

Male physician

Male surgeon

Male family physician in Alabama, by gunshot wound in driveway

A married physician couple, by overdose

Another married physician couple, by overdose in hotel room

Female doctor in Wyoming

Male allergist in Oregon, by jumping from hospital parking garage

Rudolph Fajardo, MD, pediatrician, by gunshot wound

Bruce Feldman, MD, surgeon, by jumping from bridge

Male doctor

Captain Michael Ryan McCaddon, MD, Army obstetrician, killed himself at Tripler Army Medical Center in Honolulu

Nicholas DePizzo, MD, family doctor, by gunshot wound in office

Henry Norrid, DO, by gunshot wound

Male radiation oncologist in Illinois, by jumping from window

Leonard Graff, MD, by gunshot wound in clinic

Jonathan Drummond-Webb, MD, pediatric heart surgeon, by overdose

Harry Reiss, MD, urologist in NYC, by overdose in clinic

Male doctor

Carrie Largent, second-year medical student

Douglas Meyer, MD, gastroenterologist, by jumping from hospital window in NYC

Daniel Gunther, MD, pediatric endocrinologist, by inhaling car exhaust

Hamza Brimah, MD internist, by gunshot wound

Male doctor, by overdose

Male doctor, by gunshot wound

Female anesthesiologist

Medical student in Boston

Another medical student in Boston

A third medical student in Boston

A fourth medical student in Boston

Male otolaryngologist, by hanging himself in hotel room

Male anesthesiologist, by overdose at the hospital

Male family doctor, by gunshot wound

Male doctor, by gunshot wound

Male pediatric endocrinologist, by hanging

Male physician

Another physician

Medical student

Male physician

Male medical student

Male physician

Male physician in Oregon, by gunshot wound

Male obstetrician, by gunshot wound

Male family medicine resident, by gunshot wound

Male obstetrician, by gunshot wound

Female physician, by overdose

Male family physician, by overdose

Male obstetrician, by overdose

Male psychiatrist, by gunshot wound

Female medical student, by gunshot wound after failing exam by 2 points

Female pediatrician

Emergency room physician in Oregon

Female anesthesiologist, by overdose

Orthopedic surgeon in Seattle, by gunshot wound in car

Male physician, by jumping from hospital

Another male physician, by jumping from hospital

Pediatric cardiologist

Pediatric immunologist

Male urologist, by stabbing himself in abdomen in hospital parking garage

Female medical student

Female otolaryngologist, by carbon monoxide

Medical student

Surgeon in Houston, by gunshot wound

Male medical student

Male urologist in Oregon

Urology resident in Portland, by walking in front of a truck on highway

Female physician, suicided after not getting a dermatology residency

Male first-year medical student

Radiologist

Obstetrician in Arkansas

Another obstetrician

 

When will it end?

 

Pamela Wible, M.D., is a family physician dedicating her life to ending physician suicide. She recently learned of these victims (though not all died this year).  This list represents a small fraction of the U.S. medical students and doctors we lose every year to suicide. Learn how you can stop these suicides: Physician Suicide 101: Secrets, Lies & Solutions and Physician Suicide Etiquette: What to do when your doctor dies suddenly.

Director of photography: GeVe. Voiceover and cello: Pamela Wible, M.D.

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