Ten Things Medical Doctors Are Not
Good At


Gary E Cordingley, MD, PhD
Here is one doctor's take on what physicians need to do to improve their services.
Of course, I'm not referring to your doctor who, like Mary Poppins, is practically perfect in every way. But let's
just say that the rest of us physicians have things we could do better...

1. Taking time to actually stop and get to know the patient.

I know one lady who says she has a better relationship with the checkout clerk at the grocery store than with
her physician. It's true that doctors have a legitimate need to see a certain volume of patients in order to cover
practice-expenses and still have money to take home. This translates into a limited amount of time per patient.
However, some of the time-pressure doctors feel they are under is of their own making, and even the same
amount of time might be better spent.

How is this any different from what a restaurant owner has to do? The restauranteur has to supervise
employees, handle deliveries, and oversee the preparation and serving of food, yet still finds time somehow to
chat with the customers.

2. Sticking to appointment schedules.

Yes, medicine is unpredictable and doctors must meet the medical needs of the patients in front of them before
moving on to others. Patients understand this. But scheduling ten different patients for a 1:00 p.m. appointment
is inexcusable.

3. Remembering what happened at the last visit, what test they asked for and why they asked for it.

Need I say more?

4. Dealing with more than one chief complaint per visit.

This is a variant of the time-pressure issue. With the allotted time being only just adequate to cover one
problem, woe to the patient who has two or three. There is no easy solution apart from scheduling another visit
to handle an additional problem. But if you're the patient, it's in your best interest to prioritize your problems
and take control of the agenda. Get the most important issue out on the table first thing and before the doctor
launches into an unrelated and time-consuming tangent.

5. Diagnosing conditions for which "objective" tests are not available.

Even modern medicine doesn't have good tests that show every condition as an abnormal blood-level or as a
spot on a scan. But that doesn't mean that the untestable conditions don't exist or are somehow less credible.
For example, there is no confirmatory medical test for migraine, but unless the 12% of the population
experiencing this problem is lying, there are a lot of folks out there for whom the tests might be normal, but
they
aren't.

6. Staying interested in you when there are no more tests to order or procedures to do.

This is not a good time to drop the ball. Regardless of the outcome of a test or procedure, there is still some
unmet need to be addressed.

7. Delivering on promises.

This one seems so needless. For example, why would a doctor promise that records and films will go to a
specialist and then not follow through? Better not to make such promises in the first place.

8. Picking up a telephone to call another doctor.

I don't understand why this occurs, but physicians often seem incredibly reluctant to phone another doctor to
sort out a question concerning their shared patient. Sometimes they order a nurse or clerk to do it instead, or
leave the issue unresolved.

9. Respecting boundaries.

This bears explaining. Boundaries refer to the lines at which one person's rights and responsibilities end and
another person's rights and responsibilities begin. Crossing a boundary without permission usually leads to
grief and resentment. An example of one doctor not respecting a boundary with another doctor is when doctor
#1 tells the patient to change the dose of a medicine prescribed by doctor #2. This leaves the patient caught in
the middle.

10. Calling you back with results of procedures and tests.

Once patients have had, say, a scan, a colonoscopy or a blood-test, they start worrying about all the most
dangerous things that might turn up. A simple phone call to the patient that nothing bad turned up on the tests
and that the details can be discussed at the next visit--even if it comes from staff--prevents a lot of worry and
sleeplessness.

There seems to be a recurring theme here. Perhaps I'm revealing my age when I say I am reminded of the
chain-gang boss in Paul Newman's "Cool Hand Luke" movie who drawled, "What we have here is a failure to
communicate!"


(C) 2005 by Gary Cordingley