What Makes A Good Doctor?

It was almost 6 years ago that I first became alarmed enough to talk to my son's then pediatrician about his continued infections, and what I considered the long list of strange symptoms he always seemed to have, I sat down and made a list of what I considered to be all of his symptoms and then I tracked his health for 10 days.

The two lists mirrored each other.

His stools had never been firm, and were still like breast milk stools at nearly 2 years old, and they frequently had large amounts of undigested food, additionally, the transit time seemed unusually fast (think: he ate an apple and within 2 hours chunks of apple were in his diaper) he had low grade fevers every day, he was living on Motrin and Tylenol, he seemed to be in pain all the time, he was alternately very lethargic, and very hyper. He had a red target around his anus, and had since the day he started solids. He cried in pain nearly every night and seemed to have constant tummy aches, when he talked, he screamed, he seemed unusually pale, and bruised significantly more than what I thought was normal. In my mind all of these things added up to...something.

I was about 5 months pregnant at the time, and felt the need to figure out what was wrong before the new baby came, so I took the list to his then pediatrician, whom I had chosen because he had been my doctor as a child. I told him my "mommy instinct" said something was wrong, that he seemed to be sick all the time, and I gave him the list of symptoms.

Not only did he dismiss my concerns as being those of an over reacting first time mother, but he suggested my parenting skills needed help, and that I should immediately seek counseling. In fact, I believe his exact words, which I still remember, almost 6 years later were "You don't know how to deal with your hyperactive son, and you need to get counseling, before this new baby is born." I felt stupid, and dismissed and slightly crazy. Somehow I gathered the strength to ask for my sons medical records and tell him I'd find a new doctor. What I found was a doctor who has become our medical home base, the doctor I trust beyond anyone else, and the place where I feel like we are all safe.

The combination of his GI symptoms, his chronic sinusitis (confirmed by a CT scan, he had pan sinusitis - no wonder he was always in pain), the low grade fevers... all lead his second pediatrician to send us to specialist after specialist, and when his sister was diagnosed immune deficient, all the pieces suddenly made a clear picture. 13 months later, my son was diagnosed as immune deficient by a world renowned expert in pediatric immunology.

(C. at 4, with his pediatrician)

I spent some time being angry with the first pediatrician and then for awhile, I thought that the first pediatrician did not have the benefit of knowing that our second child was immune deficient to connect all the dots, so there was no way he could have made that leap.

After navigating the medical system for the past five years, I know better. He was either a good doctor I caught on a bad day, or he was just a bad doctor. You see over time, as we've added more and more specialists to our team...pediatric infectious disease, GI, ENT, dermatology, rheumatology, and immunology... I've learned what kind of doctor I want on our team.

We don't care if the doctor we see knows the most, I want the doctor willing to learn or investigate the most

We don't care if the doctor we see has the nicest office, we want the doctor who is nicest while in his office, not just to his patients, to his staff as well.

We don't need a doctor who can talk with authority on everything he knows, we want a doctor who knows what he doesn't know.

We don't need the doctor who can solve everything, we need the doctor who can find someone who can, when help is needed.

We don't need the doctor who will do all the talking, we need a doctor who can listen.

We don't need a doctor who always agrees, but we need a doctor whose opinion I can respect when they do disagree.

I've learned that my job as the parent of a chronically ill child is not just to be concerned with physical health, but I need to keep their psychological well being in mind too, and at the same time, I need to help them learn to navigate the medical system as well.

When I go to the doctor with my kids, my concern is not just the immediate infection or issue, it's long term, it's what effect will this have long term on my kids mental and physical health, and how can I help empower my kids in a medical scenario. They need to learn now to speak for themselves, because someday, that will be their job, and if I don't equip them now, they will not be able to handle that job if it's suddenly thrust upon them in their teen years.

Two years ago we were in our hospital with our then 3 1/2 year old daughter, getting a picc line, and sinus culture for an icky sinus infection that wouldn't go away after 7 rounds of antibiotics, it was supposed to be a three day stay. An event that occurred stands out in my mind as being the moment I realized that my kids had to also know what makes a good doctor, and learn to navigate the medical system.(K in the hospital for the sinus infection/picc line fiasco)

My daughter was so medically compliant and verbal, they asked to have their entire medical school class come by to observe her being examined. They split the group into three groups and the first two went off without a hitch.

The third group entered and it was a new doctor leading the group. This one was different than that last one that had led the first two groups. First, he was patronizing her. He was talking in "baby" talk to a chronically ill 3 year old who had likely been through more medical procedures than he had ever been in his life. Second, he was disrespectful to me. He didn't offer a hand shake, or even greet me for that matter. Third, he didn't wash his hands. Also known as the cardinal sin.

As he approached my daughter with his scope already at his eye, he asked her in baby talk "Can I look at you" he added in her formal name, something she is NEVER called unless she is in trouble, something that is noted in her chart, under name called, the nickname is right there.

My medically compliant three year old looked right at him and said "No"

"No?" He asked seemingly shocked, I'm guessing the first doctor had told him how compliant she was.

"NO." She responded

"Why not?" He asked her, the first thing he had done right since walking in the room. He turned to his students as if to show them he was in control of the situation.

"Because you didn't wash your hands" she said handing him antibacterial gel as his entire class laughed"Here, it smells like blueberries" she said with a smirk.

I've never been more proud in my entire life.

Not because she was sassy, which, she was.

Not because, she made him wash his hands, which he did.

I was proud because she took control and made sure he knew she was the boss of her body, and as a chronically ill child she deserved respect. I'm sure every student in that room will carry that lesson with them for the rest of their career. The day the 3 year old outsmarted the chief resident.

I guess that's what it really comes down to, I don't care how busy the doctor is, how great they are in their field, or how how much they know, when they walk in the room, they need to check their day, their ego and their agenda at the door and take a minute to get to know their patient, and give them an ounce of respect before even attempting an exam.

( C. with his pediatrician this year talking to him about his symptoms, and discussing health concerns)

Anyone else out there? What do you want in a doctor? How have you handled a bad one? How do you appreciate the good ones?