Informed Choice

Learning From Experience, Pt. 1

“One after another, our respondents told us that the doctor-patient relationship is a deeply intimate one — that to show their doctors their bodies and tell them their deepest secrets, they want to first understand their doctor’s values. Just because doctors have to see every patient doesn’t mean that patients have to see every doctor. People want to know about their doctors first so that they can make an informed choice.” – Leana Wen

In 2009, I completed an evaluation with Charles, while working in an outpatient clinic; I don’t remember much about that encounter. What I do remember, however, was the encounter I had over the phone only an hour later.

I hadn’t even had an opportunity to dictate my evaluation yet, but I was already answering a phone call from his physician. Dr. Kors had arranged for Charles’ PT evaluation personally and was eager to hear my impression. I probably disappointed him.

I was unable to explain to him why an otherwise healthy 70-year-old man had been working on his farm 6-months earlier and was now rolling into the physical therapy clinic in a wheelchair. It seemed be a neurological ailment, but I could offer him little more in the way of details, and it became apparent that the physician had already provided him with a thorough exam. Even still, he asked me questions, and (gasp!) invited questions in turn. Dr. Kors spent about 10 minutes on the phone with me as we tried to consider any variety of maladies that may be afflicting this gentleman. I had been practicing therapy for 9 years, and I had never had a conversation where my insight was sought out, and respected, by a physician to this extent.

Throughout our conversation, Dr. Kors expressed his frustrations: he was unable (yet) to help the patient, he was begging specialists not to wait to see the patient, the patient had already waited 5 months before seeing him in his office only a few weeks earlier. Dr. Kors openly acknowledged that he didn’t have the answers, but would continue to work until he found one. He had personally arranged for physical therapy, and 2 consults with specialists. In each instance, he remained ultimately accountable and would be coordinating care. In my 9 years of practice, I had never met a physician who was so open with, and accountable to, a patient.

Now that I am in home care, I call Dr. Kors once or twice per year when a patient he is responsible for begins to exhibit the signs of a change of condition (e.g. CHF exacerbation). The scenario usually plays out quite predictably:

  1. I call the office and leave a message
  2. He promptly returns my call: “I am glad that you are working with Mrs Smith, Keith. What do we know?”
  3. If it is the weekend, and he is covering for another doctor, I provide a through past medical history so he understands the patient’s baseline, then I share the findings of that day’s visit
  4. He replies, “Thank you, Keith. As always, that was very thorough; as you know, I don’t know this patient, so the history is appreciated. What do you think is going on?”
  5. I remind him I only pay $150 per year in malpractice because I do not differentially diagnosis (he chuckles, because he still lives in much nicer house, I presume), but I go on to offer my less-educated, less-experienced opinion, nonetheless
  6. He talks aloud as he goes through the differentials without talking down to me; still seeking input as needed
  7. A plan of care is determined and ordered by Dr Kors
  8. I follow through as instructed and notify agency management/nursing services

I have never had a discussion with Dr Kors about his values. I don’t have to.

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