As a patient, a parent, and a pediatrician, Julia, M.D. has seen this scenario play out on days too numerous to count:
I get it. While feeling miserable, you scheduled an appointment, found a parking spot, waited, read stale gossip magazines, got undressed, waited some more, had ten minutes with a doctor, got redressed and sent off a $50 copay to your insurance company.
So when you learn your illness needs no treatment beyond TLC and Tylenol, it can feel as if the visit was a “waste”. You want something for your effort. You want to feel you got something for your time and money.
But you did get something out of it – an expert evaluation – and hopefully some peace of mind. Your doctor thought about all the awful things you did not have. But all you heard was “it’s just a cold.”
It takes years of training, then more years of practice to gain the experience and confidence we need to say: “I think you will be okay without getting a prescription or a test or a referral to a specialist. Go home, drink plenty of fluids, rest, and call me if things get worse.” Dr. Julia explains how our thought processes are shaped:
We are trained to think in a particular way — by building something called a differential diagnosis. We take your story, the symptoms you do and don’t have, the concerning or reassuring observations from your physical exam, the normal and abnormal findings of tests and create a unique picture of you, then consider which diagnoses do and do not fit.
Learning this way of thinking starts in the first few years of medical school with hours in the library and the lab. We then apply and grow this knowledge base in the hospital and clinic, where we are mentored by senior physicians, gradually taking on more responsibility and independence.
But medical school forms only a basic foundation. The house of medical practice only becomes a real home — with insulation, paint, landscaping, furniture — by caring for patient after patient after patient. By the time we’ve completed years of 80-hour weeks during residency, we’ve listened to and examined thousands of patients — seeing their quirks, their patterns of illness, their responses to treatment.
This continues as we practice independently as attending physicians. Like most homeowners, we tinker, mend, and redecorate our house for our entire careers, adjusting our practice based on new discoveries, research and experiences with patients.
So when you sit in a gown on the examining table, you aren’t the only patient in the room. The thousands of patients your doctor cared for before you are there as well — in her mind. Add in the thousands of patients seen by the hundreds of doctors who trained your doctor, and it’s quite the party of patients.
Dr. Julia takes a common complaint — a stubborn cough, for example — and “lifts the curtain” on the thought process guiding physicians, through detailed medical histories and physical examinations, towards thorough differential diagnoses and individualized treatment plans. What her patients receive is “a personalized expert consultation” built on trust. And Julia MD’s readers receive this sage advice:
Your health is important. You deserve care from the hands and mind of someone who has dedicated years to diagnosing and treating thousands of people.
An online symptom checker, a Google search or the opinion of your cousin who’s a nurse will never substitute for an evaluation by a physician. You can DIY a lot these days, but some things should be left to the experts – plumbing, electrical work, and I would argue, your medical problems.
Find a doctor with strong credentials and a commitment to lifelong learning, who is curious, humble and treats you as a partner in your health. Then care for the things you’re able to (like exercise, sleep, diet), then question your doctor thoughtfully and kindly, while trusting in her training.
Read the rest of this excellent essay by Julia, M.D. here.