Connecticut College Magazine · Spring 2008


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A Check-Up for Physicians

A Check-Up for Physicians
Eric R. Carlson ´81, University of Tennessee

Responding to today´s proactive patients requires a new protocol. Here´s what five alumni physicians want you to know.

by Peggie Ford Cosgrove ´73

How well did medical school prepare you for dealing with real patients?

Dr. Eric Carlson ´81 Professor and Chairman,
Department of Oral, Maxillofacial and Head/Neck
Surgery, University of Tennessee Medical Center –
Knoxville, and University of Tennessee Cancer Institute

“As a medical student, it was impressed upon
me that the doctor´s greatest diagnostic tool is
his or her ability to listen to patients and lay eyes
and hands on them. In other words, a history and
physical examination is paramount in medical diagnosis.

"In this great age of informational technology,
doctors should never lose sight of this fact. I teach
surgical residents that we should resist the urge
to make medical diagnoses and decisions independently
on the results of laboratory studies and
sophisticated radiographic studies. Rather, these
decisions must be made inclusive of a patient´s chief
complaint, history of present illness, past medical
and surgical histories, and physical examination.”

Dr. Evelyn Marienberg-Miceli ´69 Radiation Oncologist
and Clinical Assistant Professor, SUNY Downstate
Medical Center, Brooklyn, N.Y.

“At Stony Brook Medical School, they would
hire actors to role-play as patients, which was
helpful in my early training. You meet all kinds
of people in a teaching hospital, so that was good.
We had clinical day once a week in med school,
and I´ll never forget this particular day. The
patient was a man with a rashy and uncommon
sort of skin cancer. I was trying to ask him about
his diseases and hospitalizations, but he wouldn´t
talk. His wife answered every single question. I
was quite nervous. I wanted to ask ´When did you
have the biopsy?´ but the words that came out of
my mouth were ´When did you have the autopsy?´
The silent patient roused himself and quickly
replied, ´I´m not dead yet!´

“Doctors should not be treated like gods. We all
make faux pas.”

Dr. Anjuli Basu ´91 Physician, Internal Medicine,
Kaiser-Permanente, San Raphael, Calif.

“There is never a substitute for ´real life.´ Health
is intensely personal and can be very emotional
for the patient and his or her family members.
While the medical school ´standardized patient
program´ (with role-playing actors as patients) was
very good, I am not sure that anyone can truly
teach empathy, which is necessary when forming a
partnership with a patient.”

Dr. Lucy B. Van Voorhees ´71 Cardiologist, Peninsula
Cardiology, Berlin, Md.

“I think that my liberal arts education (economics
major) prepared me better for dealing with
people than a traditional science background before
medical school. I´ve always had a fairly outgoing
personality, and I love talking to people, so some of
it comes naturally. Interviewing patients successfully
necessitates a comfort level with the patient.
I never call people by their first name, and I try to
put them at ease by sitting in a chair in the exam
room or by sitting on the side or end of their bed
when I´m talking to hospital patients.”

Dr. Michael M. Weinik ´78 Associate Professor,
Department Chair, Physical Medicine and
Rehabilitation, Temple University School of
Medicine, Philadelphia, Pa.

“I tell my medical students and residents that
if they listen well enough to the patients, they will
know the additional questions they will need to
ask the patients.

“There is no substitute for a good physical
exam. Medicine has become myopic. Look at all
the MRIs that are done. If you just read an MRI,
you are treating the test, not the patient. For a
correct diagnosis, everything must match up: the
symptoms, the findings of the physical exam, the
medical history and the medical imagery.”

How do you feel when a patient enters
your office with a sheaf of papers
printed off the Internet?

Basu: “It helps and hurts. The information depends
upon the source and is mostly incomplete.
As long as the patient understands this, there is
no harm in looking at things online and bringing
them to the attention of a doctor. But such
research becomes problematic when people fail to
realize that the Internet is the same place you can
get a 2-percent mortgage. The Internet is not a
substitute for a good physician. If you trust what
you see on the Internet more than your personal
doctor, it is likely time to find a new doctor.
Certainly, however, you should discuss anything
you read that you are concerned about.”

Carlson: “The Internet is a source of information
and misinformation. Having said this, I am happy
when a patient is informed when appearing for a
first consultation. A patient who has preliminary
information regarding his or her diagnosis represents
a favorable situation in my opinion.

“There are times, unfortunately, when patients
will read an article published in a journal
that is inaccurate. Medicine and surgery are
not black and white. Rather, there are times
when surgeons, for example, will have greater
experience and wisdom about a procedure than
the individual who published a paper about
the technique. Nonetheless, patients may place
greater confidence in the published word, and
this can prevent them from receiving the care
they truly require.

“I believe that and
are good sources of accurate information
for patients as well as doctors.

“An informed patient is also one who has
searched for information about his or her doctor.
The electronic age permits the patient to know
about the appearance of their future doctor, where
he or she went to school and how much he or she
has published about a particular diagnosis.”
How do you feel about relatives accompanying
the patient?

Basu: “I am fine when people have others attend
their visit. I just ask that that person allow the
patient to tell his or her story and not constantly interject.

Save any ´corrections,´ concerns or additional
facts until the end. It is helpful if the patient is
an unreliable historian or has difficulty communicating.
It is also helpful if having someone familiar
in the room makes the patient more comfortable.”
Miceli: “We welcome it. Patients are so often
overwhelmed by a diagnosis of cancer that they
can´t take in everything the first time around. Their
apprehension means that what the doctor says goes
in one ear and out the other.

“Since our patients´ first appointments do not
involve radiation treatments, we hand out instructional
materials about the radiation treatments
and suggest patients and family members write
down their questions on a page left blank for that
purpose at the back of the booklet, then bring it to
their next visit.”

Van Voorhees “No problem. I really could have used
some help when I saw a very demented lady for her
three-month appointment recently. She´s always
´fine,´ so a history from her is useless. It´s too bad
her daughter is not interested enough to come with
her for her appointments.”

Are you put off when a patient asks for
a second opinion?

Carlson: “Doctors must place the welfare of patients
above their own ego at all times. The Golden Rule
must prevail in medicine.”

Marienberg-Miceli: “Second opinions are a good
thing. I often recommend them. I do worry with
some straightforward cancers that the delay for a
second opinion might affect the outcome, and I´ll
say that if I have a good rapport with the patient
or family. On some rare cancers, people absolutely
should get a second opinion. A doctor shouldn´t
be offended if you seek a second opinion. If your
question offends, that person probably shouldn´t
be your doctor.”

Van Voorhees: “The physician should recognize
when the patient needs attention from a tertiary
care center and make the appropriate referrals.
Even though we are in a small town way out here
on the Eastern Shore of Maryland, we have great
access to teaching hospitals in D.C., Baltimore and
Philly. Or if a patient is not comfortable with the
care being received, he or she should request the
next level of care.”

Weinik: “My regular patients who are looking for
a referral to a specialist ask me how much time
they should expect for a ´new patient´ evaluation.
I tell them to call the doctor´s office and ask the
staff how much time is allotted. If the staff can´t
tell you that, find another doctor. Even if he´s a
great doctor, if you spend most of your time with
a resident or a physician´s assistant, it isn´t worth
it if the specialist doesn´t perform the physical
exam and take the medical history. You should be
getting 45 minutes to an hour of the doctor´s time
and attention.”

Some people have “white coat fever.”
If a patient becomes extremely nervous
during an appointment, how do you
put him or her at ease?

Carlson: “The first consultation with a patient
should be conducted as an interactive experience.
It is important that the doctor and patient ask
questions. I believe in introducing myself to the
patient and allowing him or her to vocalize what I
can do to help. It is humane to permit the patient
to give you as much information possible to make
that individual understand that his or her history
is important to the doctor. Numerous studies have
indicated that most doctors interrupt the patient
delivering a history within the first seven seconds.
Depriving the patient the opportunity to completely
vocalize his or her problem interferes with the
primary objective of the interview process.”

Van Voorhees: “You have to ´psyche out´ the
personality type and figure out how to structure their
visit. I left my white coat behind in the city when
I came to a ´country´ cardiology private practice.
Nowadays, I enter the exam room with my laptop
and tell all new patients that I´m inputting
into the computer as we are talking. No one has
ever objected; in fact most seem to like this sort
of format. I have a good relationship with most of
my regular patients. We spend some time talking
farming, gardens, family, etc.”

What common problem affects Baby Boomers as
they age?

Weinik: “About 90 per cent of all of us
will have a lower back problem at some time.
Sitting at a desk all day causes muscle tightness
problems in the trunk. And working out at the gym
only addresses certain muscles. I know we´d all
be better off if we continued to play as we did
as children, running, jumping, kicking a ball and
swinging on monkey bars. That´s a total-body workout.
Having said that, I recommend that if you do have
a lower back injury, make sure your doctor traces
the injury to the right place. A problem with your
knee can trigger back pain, for example.

“Being informed and maintaining a positive attitude
are keys to longevity and recovery from major illnesses.”

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