Many patients do not ask themselves this question when they first go to the doctor. Only with the futility of treatment (when 1-3-5 years of improvement there is no improvement or even worse) and your disagreement with the proposed treatment (to perform an operation, start taking a hormonal drug, etc.), they begin to doubt and visit different specialists in search of "the best". But how do you know the level of knowledge and skills of a doctor?
© A.V. Ushakov (when using the materials of the article in any form, it is necessary to refer to the source, indicating the author - candidate of medical sciences A.V. Ushakov)
8 signs of professionalism of doctors - at the end of the article.
I have sometimes thought about this topic for several years, trying to identify specific criteria and reject them (for various reasons). And I never started writing an article on this topic. Why? Because it is not at all easy to capture reality and give universal recommendations for choosing a doctor.
Firstly, because such advice always has a part of personal perception (subjective to some extent). Secondly, because people who are not familiar with the medical environment and the organization of order in medical institutions, it is impossible to quickly, simply and clearly navigate and understand some of the circumstances.
Who is a Professional Doctor? What are the signs of such a specialist? How not to get confused, how not to be deceived by some external signs and not to miss the real - internal signs of a talented doctor? (Shot from the movie "Dr. Richter").
As often happens, the Zen article prompted the writing of this article, written by a person (55-60 years old), who was far from real medicine, but who had recently begun to inform readers about it.
MYTH 1. I’ll go to a paid medical clinic, where the doctor should be more professional
The division of medical centers and doctors into paid and free is not an indicator of professionalism.
On the one hand, because the same doctors work in state and non-state medical institutions. On the other hand, because almost all doctors use the same standards.
MYTH 2. Head of Department or Head of Department - the best doctor. I’ll go to the professor (including academician). Only a professor knows everything and can help
Regardless of the regalia, almost all doctors use the same standards.
The position held does not add professionalism and knowledge.
MYTH 3. This is an experienced doctor (with an experience of 20-30 years), so he is the best
Experience is inferior to KNOWLEDGE!!!
If the experience is based on knowledge distorted by hypotheses and does not improve the level of diagnosis and treatment (for example, the thyroid gland cannot be cured), then there is no benefit from the decades spent. But experience, supported by regular knowledge, is valuable.
MYTH 4. Abroad more professional medicine
Alas, neither in Germany, nor in Israel, nor in the USA the level of knowledge and capabilities of doctors is better than in Russia (the difference is that in some places there is modern equipment, but not everywhere). This is due to the fact that in Russia all the same patterns are used in diagnosis and treatment, as in the USA, at the level of which all other countries, including the post-Soviet region, are equal.
MYTH 5. I will turn to a special medical center (endocrinological, neurological, etc.), because there doctors specialize in ... i.e. know better
Specialization in the professional field is divided into narrower specializations. For example, in endocrinology there is a division into diabetes mellitus, thyroid disease, adrenal gland disease, etc.
You can get to the doctor (including a doctor or candidate of medical sciences), who will be an endocrinologist, to know a lot about diabetes, but not at all in depth, and therefore stereotyped, about the thyroid gland.
Until you find out what the doctor specializes in more narrowly, then you should not hope for his best competence in the right field (You can look at the scientific publications of a specialist on the Internet or other sources).
MYTH 6. An endocrinologist-surgeon diagnoses better than an endocrinologist-therapist
In fact, surgeons initially should better navigate the technique and methods of performing certain operations than endocrinologists-clinicians.
The endocrinologist-therapist is the main clinician in endocrine diagnostics and, when indicated, refers to a surgeon only for choosing the method of operation. A change in this order indicates either the unprofessionalism of the endocrinologist (does not know - therefore directs), or the agreement between the endocrinologist and the surgeon.
The fact that the surgeon penetrates the organ with a scalpel does not improve the understanding of the functional features of the diseases of this organ. (For decades and centuries, surgeons have been studying organs within a person, but only theoretical medicine has improved understanding of the disease processes of these organs).
Also mythical is the opinion that the surgeon performs ultrasound better and understands the processes of changes in the organ. Surgeons wither macrostructural changes, including "distorted" by blood, and ultrasound, due to an increase in other techniques, shows in the live, intact tissue section of the organ all that is difficult to see with the naked eye during surgery.
How to determine the professionalism of a doctor?
This is a very difficult question. It can be compared with the question (for women): "How to choose a man whom you can marry for love and for life, getting exactly what you wanted throughout your life?". How much time does it take to choose the right person (husband, wife, doctor ...)?
This is what the author of the previously mentioned Zen-Yandex article composed. In his opinion, there are 5 ways. Consider them (this is another 5 myths about the criteria for the doctor’s professionalism).
1. Reputation? Allegedly, reviews on the Internet can shed light on the possibilities of a doctor.
But, from my many years of experience, I know that it is extremely rare that a person satisfied with a diagnostic or medical treatment will write a positive review. They think this way: “I received a full-fledged diagnosis or treatment - it’s good. Everything is as it should be. I paid for it. Why strain - write in more detail. Once. A bunch of other things. Then ... someday ...". If someone didn’t like something (even if the person didn’t carry out the diagnosis or treatment), then you immediately find the desire and time to write and embellish your negative review comment, thinking like this: “They must be nice, indulge our desires, if they want to make money on me. Oh, I didn’t like something. The whole world is obliged to know about this. Let me fulfill my civic duty - I will teach paid doctors. And I’ll make an elephant out of a fly ".
People are different. With a different level of good and evil, education, with a different mood, etc. A good and decent person is unlikely to decide to write that "they had to wait as much as 30 minutes".
There is still much of the realm of online reputation that requires a separate article.
2. Does a Good Doctor Listen-Explain?
I am sure that almost none of the unprepared patients (i.e., those who do not have knowledge in the field of their disease) will not distinguish between a professional among the listening and explaining doctors.
Many doctors, to whom the patient gets for the first time, listen and explain something. But later, when the patient reads about the diagnosis and treatment of his condition, he learns about all the errors in his case of illness (independently, from other patients, from competent doctors), and begins to ask the same doctor specific questions on the merits (for example, when to expect recovery organ, because it is able to regeneratively recover, etc .; why didn’t all the necessary signs of the node be indicated in the thyroid ultrasound protocol?), the doctor becomes less patient and explaining, responding that he does not need such “smart” patients.
3. What pills is the patient taking? Allegedly, only a "worthy" doctor will be interested in taking medications and their effect on the patient.
In reality, for several years all students in medical schools at different departments were forced to question patients, clarifying precisely this circumstance - taking medications and their individual influence.
To find out what medications the patient is taking is an absolute and habitual duty of any doctor.
4. Prescribes expensive drugs - a bad doctor? Again the issue of payment. If a doctor, in his opinion, believes that it is this medication for a greater cost that is needed in a particular case, then this is not a criterion for his lack of professionalism.
Ordinary doctors do not have a direct benefit from what kind of medication patients get. There is no direct mechanism for such compensation. But it is for training specialists - professors, etc., and here it is not always expressed in crisp bills, but is presented in the form of payment of travel expenses when traveling to a conference, etc.
5. Punctual patient intake? Yes, this is an indicator of the quality of organization of medical care. But if the previous patient needed more time and the doctor took this time to him, making you wait, then there is no trouble in this and, moreover, there is no unprofessionalism. On the contrary, this is an indicator of due attention to patients (Imagine yourself in the place of a person who needs to devote more time to a doctor's appointment!).
If in the lunchtime area the doctor warned that you still have to wait 10 minutes while he takes tea with a bun, then this is not an indicator of unprofessionalism. This is a sign of a large number of visits to the doctor, because of which he does not have time to dine normally and spends his lunch time on visitors who want to visit him. Who needs a tired and hungry specialist (it doesn’t matter if he is a doctor or a hairdresser)? I don’t. I'll wait. Or sign up and come back at another time.
Real professionalism
All of them are conditional, but can be accepted and evaluated in aggregate, and not each separately. You should also understand that for a short visit you will never see all the signs indicating professionalism.
1. KNOWLEDGE in the field of specialization.
You need a knowledgeable doctor. Pay attention to everything that demonstrates the knowledge of a specialist. Of course, these are not glasses that give the appearance of “smart”.
These are specialized books and magazines. On the table, on the shelves of the bookcase. For example, for me this is not ostentatious, but a necessity.
But what matters is not the know-it-all doctor, but the one who understands the meaning of what is happening. A well-built head is better than a well-filled head.
Modern doctors usually do not read specialized monographs. They use master classes (they have a different name) and reading the Protocols - i.e. template recommendations.
How will you identify and notice this? Think about it.
A modern doctor is busy listening to and attending various events to obtain points for subsequent certification. He is not busy with the patient, but with hunting for NMO scores. To this he is inclined by the situation created by the Ministry of Health, colleagues and superiors.
The doctor may indicate that he constantly attends specialized conferences and courses, but this only indicates the likelihood of his knowledge within the template Protocols. Those. The doctor is unlikely to be able to offer anything other than a limited limited diagnosis and the same non-healing “treatment” (ie lifelong administration of drugs).
The doctor may report that he is a member of foreign specialized associations, etc. organizations to give themselves credibility. But membership in any structure does not give the doctor intelligence and ... knowledge.
Only personal abilities to master and apply knowledge, to improve in theory and practice are the basis that should be identified in the search for a doctor (this is not easy and not fast).
2. ATTENTION to the patient.
It is important, mainly, not courtesy and affectionate attitude, as well as careful listening. But not attention at all, but the key - professional attention to the main circumstances of the disease.
Therefore, I can stop the patient’s story about informatively superfluous (by what medical institution the patient had been before, what the other doctor looked like ...) and direct my question to the main thing, important for understanding the onset and development of the disease.
However, without "courtesies" it is not complete. From the “wardrobe”, as in a theater (“Hello, are you coming to my appointment? Please wait, please, 15 minutes. I will invite you”. That is, certainty appears, the patient understands that he is not forgotten and he will accepted as soon as possible, despite the fact that the reception time is different), goodbye ("Do not forget to start fulfilling these appointments today. The prospect is good, but you need to try. All the best ...).
3. HONESTY.
In the field of medicine, as a science and practice, it is impossible without honesty. A doctor, like an ordinary person (for various reasons), may be mistaken in something. Recognition of one’s mistakes (including minor ones) is an indicator of honesty.
Honesty will not allow the specialist to give preference to the economically advantageous option for the doctor (diagnosis-treatment) over the treatment-rational for the patient.
How to determine this symptom is up to you readers. But this assessment, like others, is not simple, it consists of a relatively long communication with the doctor (as with any person) and depends on the level of honesty assessment by you.
4. Sufficient time for diagnosis.
The speed of the study, brevity and general words in the Study Protocol are not indicators of professionalism in therapy (endocrinology, neurology, cardiology ...).
For example, I usually perform an ultrasound scan longer than my colleagues. It is necessary to determine all the basic and additional circumstances, to make sure that the ultrasonic sign is not perceived erroneously.
5. ISSUE OF THE MAIN when questioning the patient.
6. Did the patient understand the doctor’s explanation?
Does the doctor ask you if his explanations are clear? In this matter - focus on the final result - a sufficient understanding of the basis of the disease, its features and the direction of treatment by the patient.
The result is important for the professional!
7. Low level of ostentatious AMBITIONS.
If on the advisory form the name of the medical institution, name and surname of the doctor occupy most of the page, if the scientific degree and titles are written without abbreviations, then these can be obvious signs of increased ostentation ambitions.
Also, high showy ambitions indicate the type of document design (For example: in color, on special paper, with holograms ...). The more ostentatious ambitions, the farther the doctor is from his patients.
Some symptoms are not ambitious. For example, the name of the doctor in the name of the organization. When our Clinic did not yet have any name and I was a hired worker, but practiced according to my own methods, the patients on the phone almost all asked as one: "Is this the clinic of Dr. Ushakov?" Therefore, when choosing a name, I chose "Clinic of Dr. A. V. Ushakov", which simplified the perception for patients, and the surname was a guide for them, like a pennant on an admiral ship.
The use of a surname in the name of a medical institution by me and other specialists often bears this very value orienting patients, aimed at an absolute difference from others. But applying my name, I also bear the responsibility of my medical honor.
Using links to your own scientific achievements is not a sign of overvalued ambitions.
8. FOCUS ON HEALING, but not on an intermediate stage.
The professional "sees a few steps forward", prompting the patient the steps of this path. The main purpose of visiting a doctor is not a procedure, manipulation or selection of a dose of the drug. This is a focus on organ-saving and restorative improvement of the activity of an organ or organ system.
Did the operation remove the organ? And then what? Where to rehabilitate, etc.?
They prescribed and started taking a hormonal (or other auxiliary) drug - medical explanations about the prospect of this path are important!
Evaluate at the time of the doctor’s reception what is his focus on recovery, and not on support and the process itself (appointed - accept - follow - do not ask ...).