Caring doctors?

Specialties run a spectrum - from very procedural to very counseling oriented. I wouldn't worry too much - you're merely seeing one (pretty far) end of the spectrum 🙂

There's also just the personality of the doctor. Doctors in the same subspecialty will simply differ in how far/how willing they are to spend time doing the nitty-gritty with their patients (going through their meds, patient education, working on compliance issues, etc).

In a hospital setting it is NOT the doctor's job to be the actual one taking care of the patient. The role of a doctor is taking a history/patient interview, physical examination, ordering tests, diagnosing, and informing the patient about his/her condition and subsequent management and sometimes doing the actual procedures. Surgeons often have less interaction, as they are usually having patients referred to them to have a specific procedure done, in which case they will normally just talk to the patient about the procedure, do the procedure, and do follow-ups. The other technical stuff like administering drugs, changing wound dressings, etc. is done by the nursing staff, because that's what nurses are there to do.

tl;dr, in a hospital setting, nurses will MOST DEFINITELY be spending a lot more time taking care of the patient because it is THEIR JOB and not the doctor's job. This doesn't mean that a doctor can't be caring and empathetic towards the patient during their interactions, though.

In my experience, part of rarely seeing physicians who have a strong rapport with their patients has to do with the pressure to see as many patients as possible in a day. When a physician only has 15 mins to figure out everything + give prescriptions for one patient before moving on, anything a nurse practitioner or nurse can do instead will save them time to see another patient. After all of that, there's almost no time left to chit chat and be besties with everyone. There's also those who seem to find a nice balance between the two, but every doctor has their own operating style 😛

When patients complain that they never see the attending I always remind them that for every minute the attending is with the patient they are spending at least quadruple the time considering the case, following up on labs, consulting with other physicians etc etc. It is the physician's job to be working at their "pay grade" as much as possible and quite frankly most specialists, especially surgeons (and ESPECIALLY neurosurgeons) are earning their keep when they are in the OR. Proper patient counselling needs to be performed but when it comes to hand-holding it is often time to call in the nurse...

Survivor DO

polevaultgirl said:

I've been volunteering on the neurosurg floor (this is my first volunteer position in a hospital) and I've been noticing something. The doctors are rarely seen, flitting in and out, while the nurses are the ones doing most of the actual patient care. It seems that the doctors hardly interact with their patients! I understand that I may not get the full picture, from my volunteer position, but this concerns me. I realize that this is SDN, and I'll take everything you guys say with grain of salt, but what have you guys seen? Is it possible to be a doctor and still be personal and caring towards your patients? To spend time with them and get to know them? I'm worried that if I become a doctor I'll stop thinking of patients as sick, scared people, and instead see procedures and medications and lab values. What do you guys think?

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I'm sure it is possible.

Mental part (of caring): A sense of social responsibility, value for the individual, a value for human life, maybe a work ethic, and sympathy could all work against getting burnt out or not caring about your patients. If I were concerned that I no longer cared for my patients, I would seek counseling. (The counselor would have to keep confidential so there would be no concern about reputation damage if a lack of care about patients was admitted.)

Behavioral part (of caring and being personal): There will, of course, be personal and professional boundaries involved in a patient/doctor relationship. Some doctors are personable within professional guidelines, genuine yet professional and personable, unprofessional, very professional and not very personable, down right robotic, etc. Where and how to set these boundaries, I think could be a good discussion.

Cultural part: I cannot comment on the different cultures of different specialties, or if they exist. I do suspect that is a lot of variation from hospital to hospital, and between different groups of physicians about how patients should be regarded and treated.

Skill part (in busy settings): The ability to adequately, tactfully, and efficiently answer patients' questions is important. The better you are at this, the happier the patient. It's also important to be able to tactfully pass a patient off to the nurse or a staff member sometimes. In that case, it's helpful to phrase what you are saying so it sounds like you are doing the patient a favor. For example, "I'd like to help you, but the nurse is really the best person to answer that." When a patient is happy, you job is more pleasant. Probably vice versa. (If "caring" means taking all day, it probably won't be possible.)

polevaultgirl said:

So, if I am interested in being involved with direct patient care, should I look into a career in nursing?

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Well, not necessarily. Like I said, this is the norm for hospital physicians and especially for surgeons. Docs in private practice, especially in family med and peds, tend to have more one-on-one interactions with their patients and can afford to spend a little more time talking and counseling about chronic conditions rather than acute and urgent ailments that are typically seen in the hospital.

I would recommend shadowing a family med doc in an out-of-hospital setting to get a better feel for that realm of medicine and to see if that is the kind of work you want to be doing. If you're more interested in sticking in IVs, giving shots, and administering drugs than you are in diagnosing and coming up with treatment plans, then maybe nursing is something to consider. Physician assistant is also another path with a bit more direct patient care.

polevaultgirl said:

So, if I am interested in being involved with direct patient care, should I look into a career in nursing?

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That depends on how you define direct patient care.

polevaultgirl said:

I've been volunteering on the neurosurg floor (this is my first volunteer position in a hospital) and I've been noticing something. The doctors are rarely seen, flitting in and out, while the nurses are the ones doing most of the actual patient care. It seems that the doctors hardly interact with their patients! I understand that I may not get the full picture, from my volunteer position, but this concerns me. I realize that this is SDN, and I'll take everything you guys say with grain of salt, but what have you guys seen? Is it possible to be a doctor and still be personal and caring towards your patients? To spend time with them and get to know them? I'm worried that if I become a doctor I'll stop thinking of patients as sick, scared people, and instead see procedures and medications and lab values. What do you guys think?

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This is usually the norm on inpatient floors. The doctors aren't usually there on the floors to cater to the patient as often compared to nurses. The jobs are different. The physicians make rounds on patients, but usually nurses are the ones who check up on them, take vitals, administer meds, and help with other needs of the patient. Doctors do interact with patients, and when you have a large amount of patients to see in a limited time, it's more about quality time. Don't worry, you won't be seeing patients as lab values and medications. Even though you round on patients once or twice, later in the day, doctors still check on patients, talk with family, etc.

polevaultgirl said:

I've been volunteering on the neurosurg floor (this is my first volunteer position in a hospital) and I've been noticing something. The doctors are rarely seen, flitting in and out, while the nurses are the ones doing most of the actual patient care. It seems that the doctors hardly interact with their patients! I understand that I may not get the full picture, from my volunteer position, but this concerns me. I realize that this is SDN, and I'll take everything you guys say with grain of salt, but what have you guys seen? Is it possible to be a doctor and still be personal and caring towards your patients? To spend time with them and get to know them? I'm worried that if I become a doctor I'll stop thinking of patients as sick, scared people, and instead see procedures and medications and lab values. What do you guys think?

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Warning: I'm stroking my ego (a fair amount).

I started this whole gig about 2 months ago and since then have had a handful of patients who now ONLY want to see me or have even said they don't want to see my cointerns anymore and would rather switch to me; the patient just happened to be in the office a day I was there and not the same cointern. Is this because my cointerns are bad people and uncaring? Absolutely not. They're awesome.

I don't neglect my patients. If they need my time, they get it. But, physicians are extremely busy and have to manage their time well. Being in a room is not productive if you're just rehashing the same information over and over again and not making headway. If your patient needs you to listen, you listen. However, you don't often have time to just shoot the breeze. You'll find on your volunteering stints that if you're with attendings, they are trying to fulfill many commitments. In the hospital, I would say exposure to care in length of time is: nurse>resident>attending. You're probably not seeing a resident and if you are, they're also trying to get 100 things done simultaneously but do have more time than the attending. The attending often comes to round, but otherwise has so many different things on that they need to be very efficient with their time. They're not uncaring or neglecting the patients, it's just how the system is.

Definitely shadow physicians if you haven't already. Whenever I volunteer at the hospital, I rarely run into physicians working with patients. But that perception will change if you shadow and you're standing awkwardly in the room wondering how much longer the physician can possibly talk to the patient

Doctor Strange said:

Well, not necessarily. Like I said, this is the norm for hospital physicians and especially for surgeons. Docs in private practice, especially in family med and peds, tend to have more one-on-one interactions with their patients and can afford to spend a little more time talking and counseling about chronic conditions rather than acute and urgent ailments that are typically seen in the hospital.

I would recommend shadowing a family med doc in an out-of-hospital setting to get a better feel for that realm of medicine and to see if that is the kind of work you want to be doing. If you're more interested in sticking in IVs, giving shots, and administering drugs than you are in diagnosing and coming up with treatment plans, then maybe nursing is something to consider. Physician assistant is also another path with a bit more direct patient care.

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This, and maybe also shadow a specialty that does a lot of minor procedures (like derm, ENT?).

Surgeons... yeah you might not see as much of them as a patient in the hospital compared to nurses or residents (esp. interns) but they can still be caring and have good bedside manner. I'd recommend shadowing one to see more of what their day is actually like and have a better chance of being able to witness their interactions with patients.

survivordo said:

When patients complain that they never see the attending I always remind them that for every minute the attending is with the patient they are spending at least quadruple the time considering the case, following up on labs, consulting with other physicians etc etc. It is the physician's job to be working at their "pay grade" as much as possible and quite frankly most specialists, especially surgeons (and ESPECIALLY neurosurgeons) are earning their keep when they are in the OR. Proper patient counselling needs to be performed but when it comes to hand-holding it is often time to call in the nurse...

Survivor DO

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+1. This is something that has really struck me and made an impact on me since I started scribing. Sure, physicians don't spend as much time in the patient rooms as nurses do, but they spend TONS of time reviewing the patient's records, consulting other doctors, ordering tests, reviewing labs, etc. Before I started scribing, I honestly didn't realize how much effort and care that the physicians put into each and every patient. Patients don't often understand that, because they only see the doctor coming in for a brief moment and then leaving. But just because they aren't sitting at the bedside for hours on end doesn't mean that they aren't spending hours on their care.

Although gratitude and appreciation from the patient are definitely bonuses, I know that I personally don't need the patient to fully understand everything that goes on in their case. I think that as long as I realize how much effort I am putting into taking care of that person, and that they are able to become healthy as a result of it, that will be enough for me.