Today's Doctors

The problem is that casualness goes to the point of nurses yelling out HIV test results as happened to someone I know and the next thing it is legislated upon and HIPAA comes into being and and then I can't even meet my parents in an exam room because their "privacy" is being guarded. HIPAA is a medical privacy Federal Law. The only time I was ever called a Honkie to my face was by a skin doctor who said "Don't you Honkies know anything?"

The increase in informality is common almost everywhere, I'm sure. However, here in Michigan I haven't really encountered it much, at least when it comes to doctors. Perhaps certain parts of the country tend to be a little more casual. As far as sensitivity to modesty- when we came from Israel to California, we were shocked to see orange juice without preservatives being described as "naked" juice. I have heard that some people are making more of an effort to look "formal", wearing white shirts and ties, etc, in hopes of finding employment, as employers look more favorably on those dressed more formally.

I have found some wonderful Doctors. And have observed some that are pretty relaxed, and casual. With my primary care physician it is totally a more relaxed visit. We are in touch a few times a year for my general well-being and we get on well and are friendly. I set the tone when I am meeting a new specialist physician. When they first enter the room I stand up and introduce myself to them in the way I want to be addressed. "Dr. Smith, how nice to meet you. I am Jane Jones and this is my first visit to your office. Everyone here has been just wonderful." We exchange what is expected of each other about asking questions and clear information. You also must be dressed appropriately and be very clean as you expect him to be. If you are seeing a physician and don't feel comfortable, tell him why you are not happy, and find another one. Sloppy manners don't always mean sloppy care, but you need to be assured with your professionals. Also, I am there to see my specialist. That's why I pay the big bucks, for his expert eye. I won't see the P/A for a follow-up, as nice as she is. If it's important to have the follow-up then it's important enough to be seen by the Doctor. My insurance company has been billed at the same amount as the specialist fee for each trip. I won't allow that to happen again.

I thought that I was the only one who felt that way. Maybe here in Israel, casual is in - but I am never comfortable with the professional in bluejeans. Not appropos. Thank you, Mrs Braverman.

I don't believe I'm an "Old Codger" just because I expect higher standards from people that gave up (8-12 years) of their life and say, "we go in to this profession to help people". I never have liked the medical industries attitude of (Battlefield Marine Officer...I ask you listen) type of doctors, but on the hand...I also don't like the "I'll tell you if we find anything wrong with you and "you will talk only when I ask you" tone either...in the mean time you just sit there like a good little patient". Remember they all are still "ONLY PRACTING MEDICINE", I don't care what they have hanging on their office wall. With the snails pace and (I'll get to you when I decide) attitude and the "I just came from the local tavern (dress code)...not to mention the LANGUAGE (OY VAY)...It's disturbing to think you trust these people with your well being. No, there is excuse for the (as you so well stated) cavalier approach to people that are scared and suffering, they have come to you for help! These people are just like small children, you the medical professional must be their Comforter as well as their Helper...isn't this why you choose this field of work? If we the public, wanted chewing gum, flip flops, dirty jokes and a "your not that sick attitude" we'll go hang out at the beach. Of course it's not completely their fault...the human race as a whole has done away with standards to live by. "Standards" are perfect, they demand you be responsible/and answer for your actions...thank G-d, there are some people still out there, but we are the EXCEPTION. minnie@aol.com

I am a physician and agree with most of your article. My son's doctor, a specialist uses low or seemigly vulgar words to my son because in the area that he practices, the children have never learned appropriate terminology. after i explained this to him, he began using more appropriate terminology. regarding the advertisements, you need to take that up with the advertising execs. Direct to consumer advertising is terrible for many reasons, and the litany of personal and uncomfortable listings of effects and side-effects only add to that.

Hi, I haven't been to see a doctor in a long time so all this is news to me. The last time I went and it was to the Emergency Services at MIT I was treated with respect for privacy and in a professional manner. I like it when places such as the Health Service at MIT does follow up by way of asking how patients felt about service and I think this helps doctors realize what's missing and how care can improve. I do feel that doctors are often insensitive and I have certainly as a psychiatric social worker heard psychiatrists speak with disrespect to patients and also doctors talking in earshot of people with severe Alzheimer's as if they cannot comprehend what's being said, and it is demeaning. So YES, there are certainly major problems in medical care and I do think slang, inappropriate use of language, and totally casual dress, meaning flip flops, seems unusual in the extreme and I would certainly wonder what's going on. Also treaters should not be joking about the patients, and certainly NOT within earshot. In stressful life situations everyone needs to find an outlet, but making fun of patients is totally inappropriate and cruel.

While it really should be done outside of the hearing of patients and their families, "graveyard" humor actually serves as a stress-reliever for those working in health care, particularly in emergency situations. During the years I spent as an Army medic, the jokes we made about what we'd dealt with were appalling to an outsider, but it's either that or take everything so seriously that we can't do the work anymore because the load is too heavy. I fully agree on the issue of dress in a professional environment, though. People who want to be treated as professionals need to dress the part. It doesn't take any longer to dress well than to dress badly. I believe this is also one of the reasons that teachers don't get as much respect as they used to. If you dress like one of the students, you'll be seen by the students as one of them and not someone in authority. A suit and tie will generally get more respect than a polo shirt or t-shirt and pair of dockers.

I indorse your comments about doctors and nurses, although in my recent experiences with both (knee replacement, hernia repair, trigger finger repair) I saw nothing abut absolute professionalism from everyone from intake to discharge. Perhaps you may want to come to Tacoma, Washington for health care. (I know, I know, that's a bit far for emergency care.) So my concern is similar but with a different profession: teaching. I taught with teachers who wore to class bib overalls and t-shirts that displayed less than attractive navels and rolls of fat. Perhaps these teachers set the example for the doctors and nurses who feel that casual is good and slovenly is better.

Sometimes casual crosses the line and becomes sloppy and unprofessional. This is not acceptable. Here in Canada we have found that it helps if you use goats and chickens to help pay for treatment. Don't be stingy, it takes a lot of chickens to help defray the costs of medical care. For an office visit you will want to take along 12 chickens or two goats.

The issue should not be casual vs. strict but only hygiene.Knowledge,competence and results should be the basis for measuring a doctor not political correctness.

For the most part I agree with you. However, I am a nurse and I personally know that working an emergency room is hard work, with very long hours. Some nurses need to joke around or talk about something 'light' because otherwise you can get very down seeing a lot of patients. The question is would you rather have a nurse who tries to calm you down with patience or a nurse who is completely frazzled and burnt out? It could be I am taking this too personally, however this provides you with another perspective.

As a young health professional myself (I look even younger and people sometimes don't believe) I completely agree with the author of this article. We should act as professionals if we want respect. I never have gum when I speak to a patient and never wear things you can catch me wearing at home or on vacation. And I notice that my patients treat me with more respect and trust than other colleagues who act more casual. As for the slang with kids, sometimes we use it in order to help a younger patient feel comfortable with you. Youngsters will often trust you more and respect you if you know their "language." But of course, using profanity is a no-no.

I am sorry you found many medical caregivers that did not see you as a parent or patient deserving of respect. I don't know if the flip flops or gum where needed by your provider or just the habit of your caregiver. I have seen some who are wearing flip flops due to a health condition or chew gum for mouth dryness, often caused by medications. If I understand why, I don't mind accomodation. I certainly don't agree that you should be subject to foul langauge from anyone. Please inform your health care team of your concerns as they occur so they can demonstrate caring or you can react accordingly and vote by your feet. I have often been called in for a second opinion when patients don't care for the subjective feel of another doctor. We have clue-less people in all areas of service, medicine included. It is best to politely clue them in. If they are too preocupied to change or inform you why they don't adhere you your expectations, you should take your issues to a more responsive caregiver when you can. I often inform caregivers I will not sign in or tolerate other privacy lapses. If they do not assist me I do report them for potential HIPAA violations. I have had similar performance issues with clergy too, but I still belive in both medicine and religion. Do your best to politely ask for change you deserve, and when you get continued lack of responsiveness, find a more responsive caregiver.

I would not mind having a doctor with flip flops, this would be the least of my worries. What worries me is the so called "Renowned" doctors who are so full of themselves they don't bother to come down to the level of their patients, this is dangerous. I had an experience with a so-call "renowned" doctor at Northwestern Memorial Hospital, who dismissed me & the reason I was there. I did write a letter of complaint, all they did was refer to another doctor on his staff. The hospital would not dare question or reprimand someone of his "caliber". That is unfortunate, because one of these days the hospital will have a big lawsuit when this "too full of himself" doctor makes a mistake.

You are correct with everything you wrote. As a doctor, I too am often appalled by the casual attitudes of many of my colleagues. Professionals should dress like, well, professionals, which for doctors, means dressing appropriately and smartly. Of course, this does not necessarily mean wearing a white lab jacket and tie, but a person can be dressed well and not be dressed "up". Certainly flip flops are not acceptable, and gum-snapping is a no-no. Casual attire can be "smart". Of course there is wide latitude for personalization, but propriety should be the rule. Finally, concerning such a lack of privacy as you describe from your HMO, you should know that your doctors office could be closed down by the government for such a significant lack of discretion as you describe. Famaliarize yourself with HIPAA privacy rules and regulations. While there is may be more leeway in emergency rooms when it comes to HIPAA interpretations, there is no excuse for such a break in these mandated regulations in a private setting.

The medical profession is losing self-respect, and the respect of others.

As a young physician, I am constantly confronted with criticism aimed not specifically at me, but at doctors in general. I can appreciate the experience of being a patient, which is often (very) frustrating. It can leave you feeling powerless and impatient. Frequently it appears that doctors and nurses are "busy telling jokes and making personal phone calls", as you say. In reality, something as simple as a blood test must pass through many hands before the results come back to the patient, and each step takes time. Doctors and nurses are often powerless to speed up these processes. [My best advice to handle the often overwhelming challenge of visiting an emergency room is this: Find an urgent care center that is close to your home where your insurance is accepted. If the medical problem is not life-threatening (eg-your daughter's in-grown toenail, a cold, or even a broken bone), this is the best place to go. The wait is short and the physicians are not as stressed!] It behooves patients to consider the emotional stress and physical burden that physicians endure. We have chosen this career path because we are concerned with the health and well-being of others. These days, not only are our salaries shrinking considerably, but the amount of time and paperwork has doubled or even tripled depending on the type of practice we are members of. This is a tremendous obstacle to providing expeditious service. I am the mother of one fabulous daughter, Baruch Hashem, with another child on the way. It would be impossible for me to describe the difficulty and sacrifice of being a frum physician, spouse and parent. But for some reason that I cannot explain, no one, from my Rabbi to my best friends, have any compunction about complaining to me about doctors and healthcare. Some have even been downright insulting! I totally agree with you that there is a casualness that has pervaded medicine (and all sectors of business). There is very little sense of Tzniut, and Lashon Hara runs rampant. But let's not point fingers at physicians alone. These problems exist everywhere, starting in the home. Please keep in mind the tremendous sacrifice we physicians have made from medical school to residency and beyond. Medicine is often a thankless job with many obstacles preventing us from performing the way we would like to. Please be patient with us and have some rachmanus. We are doing the best we can.