What makes a good family doctor?

[frozenarbitor]

I've been shadowing some family doctors. There are good and bad things to the way they practice. I was just checking ratemd.com for a doctor that I was shadowing and there were quite a number of angry patients. While I was shadowing the doctor, a patient told me privated how she was discontent with the service. These findings are quite disheartening. Furthermore, my personal family doctor is not a very good doctor. He didn't really care about patients and spent very little time for each visit.

 

Now, I'm very interested in family medicine primarily because I like the flexibility of it. I also find that there are some interesting cases in family med during shadowing, so it's not all boring stuff. You get to see a variety of cases from many different fields of medicine which is one thing I love about being a generalist over a specialist.

 

If I eventually go into family medicine (which is quite likely), I will try to do my best for my patients. I want to be good at what I do. My question is what do you think it takes to be a good family doctor? Have you met a good family doctor before? What did you like about them?

[superhero_doc]

Since family docs are primarily paid on a volume model, having quick, one-problem visits is the most lucrative thing. As one old cynical family doc told me: you don't get paid to talk to patients.

 

Thing is, if you don't talk to patients, they don't like you. And if patients don't like you, you get sued.

 

Therefore, being a high-volume, low-pleasantry doctor is a risky endeavor.

 

This is one reason why medical students are generally shunning classic office family medicine. Even the ones that go into FM do things other than FM, like emerg, pain, sports or cosmo.

 

Honestly, in my experience I've not met a family doctor that blew me away with their knowledge and skill. Then again, the practice of FM doesn't give one a lot of opportunity to impress.

 

I was very lucky to work with one family doctor that did blow me away with knowledge and probably matched some of the general internists that I've worked with. She was the type to catch a lot of medical problems that were missed and overlooked by specialists. Her patients loved her and she got city wide awards and recognition. She was probably not the norm.

 

I've seen a lot of bad family doctors out there.

[NLengr]

I can tell you what makes a poor family doc.

 

Do walk in clinic shift, refer every single person who is more complex than OCP rx or URTI to hospital ER for work up. Seen that happen a few times.

[frozenarbitor]

Appreciate all the answers. I definitely wouldn't want to be the FM who refer to specialist for everything except the simple cases. I've heard FM is easy and hard. Easy to be a bad FM doctor, hard to be good at it.

 

I'm not overly concerned about money. I think 100k is adequate. It's more than what I can spend. I don't need fancy cars or ridiculous houses. A couple summer vacations and eating out once or twice a week would be good enough.

 

The doctor I'm shadowing right now spend 15 to 30 minutes per patient, but some patients are still upset about the service they get. I think sometimes the FM doc spends too much time with the patient educating them about disease prevention. Too much of a good thing isn't so good I guess.

 

Can the mod move this to the lounge if you see it? I don't think this is getting enough response here.

[NLengr]

some patients are still upset about the service they get.

 

Some patients are just plain nuts. Nothing will fix that.

[simpy]

Some patients are just plain nuts. Nothing will fix that.

 

Surprising amount of negativity here. Maybe it's because I've done most of my family meds observerships in the context of a family health team in Ontario, where turnover isn't as important and there are actually cash incentives for some preventative health.

 

The patient load of physicians I've worked with tends to be in the 15-25 range per day which leaves a solid 15 minutes to work through at least one chief complaint.

 

From what I've seen, a good family doctor is knowledgeable, refers appropriately (i.e. doesn't waste the patients or colleagues' time), doesn't keep patients waiting long, and adapts their approach to the patient (for instance by spending a few minutes chatting socially with some patients, jumping right into it with others, providing more or less explanation as necessary).

 

Being a good communicator also seems important, for instance knowing when and how to cut a patient off who keeps talking forever, but not seeming like you're rushing them.

 

Anyway, don't let a good or bad experience with a specific physician sway what you want to do.

[tooty]

that's nice simpy, but it doesn't change the fact that some patients are out to lunch.

[thatonekid]

Can the mod move this to the lounge if you see it? I don't think this is getting enough response here.

Sure thing, boss.

[Birdy]

Dont be a jerk.

 

I'd hope that would be the first rule of family medicine! My previous family doctor was House with a Scottish accent. Utterly brilliant, impossible to work with.

 

Admit ignorance, work to rectify it. My mother has had doctors refuse to take her on because they don't want to deal with something as complex as her chronic disorder, even though she very rarely would actually see a GP for anything related to it. They just didn't want to learn, didn't want to deal with her. I am far more likely to trust a doctor when they can admit that they don't know something and are willing to educate themselves.

 

Don't practice 'sit down, shut up, do as you're told' medicine, by which I mean not taking into account the various factors in a pts life that may affect their ability to carry out physicians' orders. There is a lot more to a person than a collection of pathologies.

 

Be empathetic.

 

Don't lecture or shame. It really doesn't help. Encouragement goes so much further, at least for everyone I know. Lecturing me about this or that is just going to put me on the defensive.

 

Because I moved around so much, I've had a lot of family doctors. I've also gone a long time without one (I'm on my 4th in the past decade, with only 3.5 years total where I have been under the care of a family doctor) so I ended up seeing lots of walk-in clinic doctors; as a result I've gotten a fair idea of what I like and what I don't as a patient. Having spent thousands of hours in hospital as well, I've seen loooots of doctors, so all of this is simply from my perspective as a patient. I've seen doctors who are absolutely incredible, and some who I wonder why they ever went into medicine in the first place.

 

My current family doctor is pretty awesome, honestly. She's pleasant, firm about lifestyle things without being scolding, admits if she doesn't know something but will come back to you with an answer, she gets you in quickly (usually within 24 hours) and reviews information with you, clarifying anything you need further information on, while at the same time talking to me at my level which is much appreciated. Her practice here is just getting started, and they aren't at a full complement of patients yet, so some things may change, but her personality is really one that I get along with quite a lot.

[aaronjw]

Surprising amount of negativity here. Maybe it's because I've done most of my family meds observerships in the context of a family health team in Ontario, where turnover isn't as important and there are actually cash incentives for some preventative health.

 

The patient load of physicians I've worked with tends to be in the 15-25 range per day which leaves a solid 15 minutes to work through at least one chief complaint.

 

From what I've seen, a good family doctor is knowledgeable, refers appropriately (i.e. doesn't waste the patients or colleagues' time), doesn't keep patients waiting long, and adapts their approach to the patient (for instance by spending a few minutes chatting socially with some patients, jumping right into it with others, providing more or less explanation as necessary).

 

Being a good communicator also seems important, for instance knowing when and how to cut a patient off who keeps talking forever, but not seeming like you're rushing them.

 

Anyway, don't let a good or bad experience with a specific physician sway what you want to do.

 

Cash Incentives for what? For the physician?

[Der Kaiser]

It is my feeling that if a family doctor gets nothing but accolades from all his/her patients then he/she is doing something wrong. Obviously, try to be as pleasant and thorough as possible, but as someone else mentioned sometimes patients are crazy and in doing your job correctly (kindness and everything) some will not like you. For instance, patients often want tests done that are not at all indicated (and cost the system a lot of money). Patients want you to bend the rules for them (prescribe their drug plan covered spouse a medication that they will take). Finally, some patients have enormous expectations based on an emotional deficit in their own life. So yeah, doing everything right some patients will not like you.

[aaronjw]

I could careless about any of those things.

 

I care more about a physician who wants to help. I don't care if they are a jerk, are empathetic, or are an outright ass. I care that they do their job and are invested enough in their ego to help me.

 

If people want more sensitive and caring physicians then people should balance that out by being less sensitive themselves. We shouldn't have to tip toe around Patients. If a patient is obese and has blood values through the roof, why must we cozy around in a sensitive way to telling them they need to change heir lifestyle, etc. I say tell it like it is and stop the political correctness but that's just me and recognize many don't share the same viewpoint.

 

 

 

 

Dont be a jerk.

 

I'd hope that would be the first rule of family medicine! My previous family doctor was House with a Scottish accent. Utterly brilliant, impossible to work with.

 

Admit ignorance, work to rectify it. My mother has had doctors refuse to take her on because they don't want to deal with something as complex as her chronic disorder, even though she very rarely would actually see a GP for anything related to it. They just didn't want to learn, didn't want to deal with her. I am far more likely to trust a doctor when they can admit that they don't know something and are willing to educate themselves.

 

Don't practice 'sit down, shut up, do as you're told' medicine, by which I mean not taking into account the various factors in a pts life that may affect their ability to carry out physicians' orders. There is a lot more to a person than a collection of pathologies.

 

Be empathetic.

 

Don't lecture or shame. It really doesn't help. Encouragement goes so much further, at least for everyone I know. Lecturing me about this or that is just going to put me on the defensive.

 

Because I moved around so much, I've had a lot of family doctors. I've also gone a long time without one (I'm on my 4th in the past decade, with only 3.5 years total where I have been under the care of a family doctor) so I ended up seeing lots of walk-in clinic doctors; as a result I've gotten a fair idea of what I like and what I don't as a patient. Having spent thousands of hours in hospital as well, I've seen loooots of doctors, so all of this is simply from my perspective as a patient. I've seen doctors who are absolutely incredible, and some who I wonder why they ever went into medicine in the first place.

 

My current family doctor is pretty awesome, honestly. She's pleasant, firm about lifestyle things without being scolding, admits if she doesn't know something but will come back to you with an answer, she gets you in quickly (usually within 24 hours) and reviews information with you, clarifying anything you need further information on, while at the same time talking to me at my level which is much appreciated. Her practice here is just getting started, and they aren't at a full complement of patients yet, so some things may change, but her personality is really one that I get along with quite a lot.

[larva]

I don't need a lot of pleasantries from a GP, but my god, if you don't know something then just admit it.

PLEASE don't take a wild stab in the dark and tell your patient they probably have cancer, when they actually have a chipped ankle bone.

 

(written from experience)

[A-Stark]

I could careless about any of those things.

 

I care more about a physician who wants to help. I don't care if they are a jerk, are empathetic, or are an outright ass. I care that they do their job and are invested enough in their ego to help me.

 

If people want more sensitive and caring physicians then people should balance that out by being less sensitive themselves. We shouldn't have to tip toe around Patients. If a patient is obese and has blood values through the roof, why must we cozy around in a sensitive way to telling them they need to change heir lifestyle, etc. I say tell it like it is and stop the political correctness but that's just me and recognize many don't share the same viewpoint.

 

It's not "political correctness" to avoid being a jerk. Getting patients to make lifestyle modifications is challenging enough without going out of your way to insult them in the process.

 

And, to be blunt, your approach is an excellent way to get sued or get involved with College investigations. It's not about being touchy-feely sensitive, but about maintaining the trust of your patients and their families. It is perilously easy to lose that trust and very difficult to regain it. I would not underemphasize the crucial importance of respectful, clear communication.

[simpy]

Cash Incentives for what? For the physician?

 

Yeah. In Ontario there are bonus payments if you get a certain percentage of your practice to do things like get pap smears, fecal occult blood samples done, talk about smoking cessation etc. The bonuses aren't very much relatively speaking (getting all of them works out to like a 5-10% boost to your billings), but many doctors I've worked with have been pretty highly motivated by them.

 

And yeah tooty, some patients really are jerks. Just had one today! At least with ratings websites though, good doctors seem to have many positive ratings outweighing the bad ones that they can't do much about.

[frozenarbitor]

Thanks mod for moving this and everyone contributing.

 

I agree with A-stark on the trust between physician and patients. From my shadowing (only shadowed 3 physicians so far), I definitely got a feel of how prudent physicians can be when it comes to communication and how delicate the relationships between the physician and patients are.

 

Do GPs get paid for ordering drugs and lab tests? Does anyone know if there is the problem of over prescribing either due to cash incentive or being overly careful?

[apache]

it's easy to be forward, while also maintaining a partner in care based approach so to speak, stating that you are invested in a patients outcome and that you want to work with someone so that together we can work towards getting them in the best health allows you to be forward, yet polite, as well as maintaining trust and the obligation becomes reciprocal... i agree... being forward doesn't necessitate being cold... in fact, if you sit down and discuss personal concerns you feel it's a way of building rapport as you're no longer providing a service but building a professional relationship with someone with mutual obligations.

 

It's not "political correctness" to avoid being a jerk. Getting patients to make lifestyle modifications is challenging enough without going out of your way to insult them in the process.

 

And, to be blunt, your approach is an excellent way to get sued or get involved with College investigations. It's not about being touchy-feely sensitive, but about maintaining the trust of your patients and their families. It is perilously easy to lose that trust and very difficult to regain it. I would not underemphasize the crucial importance of respectful, clear communication.

[apache]

you can sit down and talk to them about why they want test x, what they're worried about, why, etc. talk about any home problems... etc., then again, in fam med... well, yeah, maybe not in 15-20 min max... personally if it's a benign medication, zopiclone or something... maybe the spouse does need it, it's quite expensive

 

It is my feeling that if a family doctor gets nothing but accolades from all his/her patients then he/she is doing something wrong. Obviously, try to be as pleasant and thorough as possible, but as someone else mentioned sometimes patients are crazy and in doing your job correctly (kindness and everything) some will not like you. For instance, patients often want tests done that are not at all indicated (and cost the system a lot of money). Patients want you to bend the rules for them (prescribe their drug plan covered spouse a medication that they will take). Finally, some patients have enormous expectations based on an emotional deficit in their own life. So yeah, doing everything right some patients will not like you.

[Guest Physioprospect]

I think it's sad how a lot of posts on this forum not this thread per say are all about how much money will I make etc. my parent is a physician and she says the culture of money first practice is disgusting and because of the way the fee schedule is set up most docs try to b Billing machines. The structure of healthcare needs to change. Roles need to diversify. For example if someone has a sore muscle etc.. There should be public funding for physio rather than going to a gp for a one minute appointment.. They collect there $45 fee or whatever and refer them to a physio, what a waste of resources.

[xkittens]

I think it's sad how a lot of posts on this forum not this thread per say are all about how much money will I make etc. my parent is a physician and she says the culture of money first practice is disgusting and because of the way the fee schedule is set up most docs try to b Billing machines. The structure of healthcare needs to change. Roles need to diversify. For example if someone has a sore muscle etc.. There should be public funding for physio rather than going to a gp for a one minute appointment.. They collect there $45 fee or whatever and refer them to a physio, what a waste of resources.

 

LOL

It's okay as long as you're a good doctor right?

Yeah when you're shelling through 15 patients an hour because you want to bill the max you can that's really not being a good doctor.............................................................................................

[jerkoutnow2]

being a good FP will always be difficult. I feel like there will always be patients who will be dissatisfied.

 

i really don't think it's all got to do with the people who are in family medicine but more of the nature of FM. Most people that do come to FM clinics are chronically ill, frustrated, and pain-ridden individuals who are not sick enough to have to really rely on the docs to take care of them (although most of the caring is by the nurses).

 

Look at ratemd and guess what discipline the worst rated doctors are in.

Yep, PM&R. Why? because a lot of patients who do visit PM&R are chronically in pain looking for relief. Obviously they will be frustrated when PM&R tells them that there is really nothing to do for them except for them to lose weight.

 

People, naturally, want quick fixes. This is why surgeons get such high ratings! (it's because surgeries fix things in the short-term, not necessarily in the long-term, and people can actually 'see' the change right away). Whereas FMs tend to take care of people who are (on the extreme) 20-pack-year smokers, 230 pounds, 5'6", diabetic, arthritic, with high blood pressure.

They (representing roughly 50% of the NA population) come in to a FM clinic for some instant pain relief (whatever that is) and are told that they need to stop eating their cokes, big macs, and popcorns and start to exercise, and the first reaction to that is "wtf is this mofo telling me to do. I just want my fkin pain gone".

 

And then these same people deteriorate, develop COPD, get a heart attack/stroke, claudications, get pathologic fractures, go into the ER, and now the IM specialists + surgeons miraculously come and begin 'curing' them from all their sicknesses. And now they're thinking 'wow these docs are amazing they're actually doing **** for me' and go online to leave all the good ratings.

 

Honestly, it's also more of the culture in NA than anything else. The sense of entitlement, pride, self-indulgence is so rich in NA that no one gives a **** about respect for others and just want to be served no matter poor/rich you are. Look at the fkin native americans in Canada demanding free $$$ because what, they used to live here for some couple thousand years with the fkin trees and the 'mother nature' and after being utterly devastated by the europeans from a legit war, that they think they deserve some entitlement to free $$ and easy life? Well no fkin wonder all your little kids are sniffing pot and fking enriched with STIs, living in the streets. 'oh you colonized us, you put us in residential schools, raped us etc etc' well **** u that's life and humanity get the fkin over with it and move on.

 

it's human nature and esp. with this culture where people are always bombarded with the 'now' message, everyone wants things done now not later. They want their problems gone now, not later. Look at all the fkin advertisements. No advertisement says 'Use our skin products and you'll look like this! 2 years from now' 'Get this newest gadget 2 years later!'.

 

You OP got to decide if you want to be a FP who is 'awesome' and 'good' according to the public even if that means being a prescription mill for those T3 addicts and the advocate for those WCB leeches (human trash imo).

or you could be a medically sound FP who, despite whatever your patients say about you, do good medicine, not some ****head trying to please your patients.

 

If you know your medicine in and out and do all **** right, nobody will say **** about you cuz you didn't smile when you were with them or you didn't spend so many minutes with them. We're fkin medical doctors not some social worker to listen to all their bs.

 

Also hire a hot chick as your receptionist, no one will say **** about your clinic then.

[apache]

lol, i enjoyed your post except for the s worker comment, since i think you should be both, then again, there's a fine line b/w listening productively, and honestly like, ok, who is the most anti-biopsych shrink i can think off, and how fast can i refer, fml, lol

 

honestly though, prob an indication of why fm is frustrating to me, it's to hard not to pull off the miracles you can do, say in psych, cause you get 52 hrs a year plus social programs to help you out... the er me thinks, wow, i love when ppl walk out happy, and usually if u ship em out, they do, the unhappy ones get shipped to cardiology or surgery... where ever, where, they can be fiixed quick, or i can remain unaware of bad outcomes and/or *****ing or unsatisfaction... oh my, those two motivations are so in opposition, if i believed being a walking oxymoron mattered, i'd prob have cognitive dissonance, but **** it, eventually you just gotta do what's right for you

 

p.s. i liked the rawness of ur post, ur mostly rite imo!

 

being a good FP will always be difficult. I feel like there will always be patients who will be dissatisfied.

 

i really don't think it's all got to do with the people who are in family medicine but more of the nature of FM. Most people that do come to FM clinics are chronically ill, frustrated, and pain-ridden individuals who are not sick enough to have to really rely on the docs to take care of them (although most of the caring is by the nurses).

 

Look at ratemd and guess what discipline the worst rated doctors are in.

Yep, PM&R. Why? because a lot of patients who do visit PM&R are chronically in pain looking for relief. Obviously they will be frustrated when PM&R tells them that there is really nothing to do for them except for them to lose weight.

 

People, naturally, want quick fixes. This is why surgeons get such high ratings! (it's because surgeries fix things in the short-term, not necessarily in the long-term, and people can actually 'see' the change right away). Whereas FMs tend to take care of people who are (on the extreme) 20-pack-year smokers, 230 pounds, 5'6", diabetic, arthritic, with high blood pressure.

They (representing roughly 50% of the NA population) come in to a FM clinic for some instant pain relief (whatever that is) and are told that they need to stop eating their cokes, big macs, and popcorns and start to exercise, and the first reaction to that is "wtf is this mofo telling me to do. I just want my fkin pain gone".

 

And then these same people deteriorate, develop COPD, get a heart attack/stroke, claudications, get pathologic fractures, go into the ER, and now the IM specialists + surgeons miraculously come and begin 'curing' them from all their sicknesses. And now they're thinking 'wow these docs are amazing they're actually doing **** for me' and go online to leave all the good ratings.

 

Honestly, it's also more of the culture in NA than anything else. The sense of entitlement, pride, self-indulgence is so rich in NA that no one gives a **** about respect for others and just want to be served no matter poor/rich you are. Look at the fkin native americans in Canada demanding free $$$ because what, they used to live here for some couple thousand years with the fkin trees and the 'mother nature' and after being utterly devastated by the europeans from a legit war, that they think they deserve some entitlement to free $$ and easy life? Well no fkin wonder all your little kids are sniffing pot and fking enriched with STIs, living in the streets. 'oh you colonized us, you put us in residential schools, raped us etc etc' well **** u that's life and humanity get the fkin over with it and move on.

 

it's human nature and esp. with this culture where people are always bombarded with the 'now' message, everyone wants things done now not later. They want their problems gone now, not later. Look at all the fkin advertisements. No advertisement says 'Use our skin products and you'll look like this! 2 years from now' 'Get this newest gadget 2 years later!'.

 

You OP got to decide if you want to be a FP who is 'awesome' and 'good' according to the public even if that means being a prescription mill for those T3 addicts and the advocate for those WCB leeches (human trash imo).

or you could be a medically sound FP who, despite whatever your patients say about you, do good medicine, not some ****head trying to please your patients.

 

If you know your medicine in and out and do all **** right, nobody will say **** about you cuz you didn't smile when you were with them or you didn't spend so many minutes with them. We're fkin medical doctors not some social worker to listen to all their bs.

 

Also hire a hot chick as your receptionist, no one will say **** about your clinic then.

[Tacrolimus]

Bumping an old thread, but checking your patients' lab results will definitely make you better. *sigh*

 

We had a patient come in to the Pharmacy with a prescription for Metformin 500 mg. He had always taken that dose, but recently, he had tests done for blood glucose. The patient saw his doctor few days after the results were available. What was his blood glucose while taking Metformin? 18 mmol/L.

 

Guess what the new prescription was for? Metformin 500 mg. The doctor literally did NOTHING about the high concentration of glucose in his blood.

[rogerroger]

I was just checking ratemd.com for a doctor that I was shadowing and there were quite a number of angry patients. While I was shadowing the doctor, a patient told me privated how she was discontent with the service. These findings are quite disheartening.

 

A short comment.

 

Rate your MD sites are useless. If you think the comments on there represent anything meaningful you are sorely mistaken. You get a pretty biased sample population. Also giving your patients everything they want does not make a good physician. These sites are good for a laugh if you are bored. Beyond this they are of no use.

[Birdy]

A short comment.

 

Rate your MD sites are useless. If you think the comments on there represent anything meaningful you are sorely mistaken. You get a pretty biased sample population. Also giving your patients everything they want does not make a good physician. These sites are good for a laugh if you are bored. Beyond this they are of no use.

 

Agreed.

 

My son's paediatrician is one of the best doctors I have ever met. She spends a lot of time with us, really discusses things and educates me. She will discuss the research and help me make informed decisions. She is also careful about medicating children, something I was *very* happy about, but that I can see many parents being displeased with. When it did become apparent that my son needed medication, I really trusted her judgement when she considered my observations and described the medication she was suggesting based on that. She is very thorough and extremely kind.

 

I have been consistently impressed with her and I am beyond thrilled my son is her patient.

 

She also has absolutely terrible reviews on ratemymd.com.