Sunday, July 06, 2008

The doctor as salesman

All of us pine for the family doctor of yore – the friendly old gentlemen who would come home and treat us over a cup of coffee. We all want our doctor to be a friend, philosopher and guide – a trusted adviser, who will guide us when we are sick and help us to become better.

Unfortunately, the sad truth is that this type of Marcus Welby is now a dying breed. Given the fact that we move much more from town to town; that HMOs dictate whom we can see and who we cannot; and that medicine has become much more specialized , few of us have the luxury of having our personal physician and are rarely able to establish a long-term relationship with our doctor.

While doctors of an older generation looked down on advertising, today marketing is a fact of life for hospitals, doctors and clinics. For-profit hospitals are corporate entities who need to earn money for their share-holders, and spend a sizeable chunk on advertising. Doctors, who need to compete, also do the same, which means that many patients now feel that medicine has become much more commercial and that doctors are often trying to sell them on tests, procedures and operations.

So has the doctor just become a high-powered salesman who is peddling his wares ? Is your heart surgeon advising bypass surgery, even if you don’t need it, because it helps him to make a quick buck ? How can you protect yourself from overtesting and overtreatment ? Can you trust your doctor to be professional and do what’s in your best interests, rather than in his ? Does he have a hidden agenda ?

It’s a fact that doctors in private practice need to sell to survive. The key question is - what is he selling ? Is he selling good advise ( which all of us are happy to pay for !) Or is he pushing the procedures he performs ? And how can you tell the difference ?

This is a hard question to answer – but one of the most important ones you will have to tackle when you fall ill ! Which doctor can you trust ? and why ? A wrong decision can prove to be extremely expensive !

So how do you know if you can trust your doctor ? All of us do our “due diligence” when selecting our doctor , but for many of us, this is a haphazard , hit and miss procedure, based more on word of mouth referrals, rather than a systematic analysis. Your doctor should earn your trust – and he can do this by being generous with his knowledge; showing you that he cares; respecting your time; and fulfilling his promises. The hallmark of doctors who have been elevated to the status of being treated as trusted advisors by their patients is that the doctor places a higher value on maintaining and preserving the doctor-patient relationship itself , rather than on the outcome of the current consultation.

Establishing a history of reliability is one way to build trust. For example, if your doctor tells you he is going to call with lab results, does he do so ? If he does this the first time , this shows that you can count on him. If he does it consistently, this will build trust. This is why senior doctors value their reputation so much – it is built on the foundation of a lifetime of hard work – and even though it is intangible, it represents the fact that patients have trust in them.

The Trust Equation , as defined by David Maister, is simple.

T = C + R + I/ S, where

T = Trustworthiness
C= Credibility
R= Reliability
I = Intimacy
S= Self-orientation

Credibility = can you trust what your doctor says ?
Reliability = can you trust his actions, confident that you will act honorably ?
Intimacy = are you comfortable discussing your feelings and emotions with him?
Self-orientation = can you trust his motives, knowing that he cares about you , and will act in your best interests ?

In the final analysis, please trust your gut feelings ! If your doctor promises too much; hides facts from you; cannot be trusted to respond to your calls; does not answer your questions; does not respect your time by making you wait for interminable periods; or treats certain patients selectively as VIPs , while the rest are short-changed, you should smell a rat !

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