1) Always set an agenda: “What would you like to cover in our visit today, before we get into any detail – so we can plan our time.”
2) Always summarize what you understand of your patient’s symptoms, and don’t be afraid to ask “anything else going along with this feeling that I might have missed?” And never take self-diagnoses at face value. Ask for details.
3) Always explain your diagnostic thinking and always emphasize that symptoms can change and then lead to other conclusions or treatment choices. Don’t make snap diagnoses in a way that might seem arrogant or lazy.
4) Always spell out if you are adding a medication or making a substitution. We know hypertension and diabetes often require multiple medications as time goes by, but patients don’t (or don’t want to) understand that. Just the other day I learned that a diabetic patient stopped his pills when I asked him to start insulin!
5) Always make a followup appointment, especially if you just made a new diagnosis and treatment plan – just to make sure your diagnosis was correct and that your chosen treatment works. I have found that “call and let me know if this isn’t working” often leads to less than perfect outcomes and less than happy patients.
A Country Doctor Writes: 
This is great! I wish someone would have spelled it out like this when I was an intern – I learned a lot of these the hard way!
Thank you!
In todays telehealth era I’ve been offering ‘I’ll give you a call in a few weeks’ as a f/u appointment. My heart isn’t in it as I know they will go to the scheduler and not be able to see me in that time frame.
Wonderful advice which I wish I had known when I started out. Dr Pam Cobb Columbus, Ohio
Calling a doctor to let him know how the treatment is going, in the clinics I am a patient of, often entails many minutes of going through robot menus, then a long wait listening to bad music, to finally speak with someone at the front desk. Someone who might misinterpret what you are saying and has no business knowing your medical history. It’s a tough world, no matter most of us don’t call unless it’s something getting worse, in which case coming by is the best option.
I agree with the advice offered. I practiced medicine for 32 years in private practice. I was able to see any patient I wanted within 4 to 24 hours and we always offered follow up visits. Private practice was rewarding ethically, emotionally, and financially. It is sad to see the poor entrepreneurial drive of newly minted physicians who expect to find an employed position that fulfills their expectations and cares about their happiness.
You are are an arrogrant old fool. You would loose your house if you tried to have a private practice in the current climate. PracticED for 32 years? Your generation is very culpable for creating the abusive American Medicine system amd handing the keys over to the 50 million per year corporate raiders! You accepted and built the fee for service system that has made it impossible for a physician to survive outside of a large group. You sold your soul to devil and mortgaged mine and the next generations. Please examine your ethics becasue there is no way anyone with ethics and a clue of what private practice has become in the last 20 years would say what you just did. Shame on you!
I am sorry you feel so angry about this. I just retired in October and was able to sell the same practice I bought in 1990. I was content professionally and supported two children who graduated from college and are both successful in their lives. I don’t understand how “fee for service” ruined “everything “. I think that the insurance industry is to blame, not we retired geezers.
What a ridiculous and mean comment! You apparently have no idea what you’re talking about. When exactly did physicians have any say in the mechanics of the practice of medicine? The federal government decided that all physicians were to be employed, and have tried to eliminate private practice. This so that they did not have to negotiate anything with individuals or small groups, but they could just deal with large numbers of employed physicians. Fee for service was implemented without any conversation with physicians, as was all the coding and other regulations that help precipitate burnout. If physicians had any say in our current system, do you think it would be so messed up? Yes, I was in rural private practice for 33 years.
There’s a lot of truth in Dr. Wolfe’s post. I say this as I enter my fifth decade of practice, enthusiastic and burnout-free.
Our two doc practice offers the same access as Dr. Wolfe describes, we leave by 5 every day with no work to take home, and make above the average for FPs. And we do this by charging a fraction of what practices across the street owned by “no-profits” charge.
I would just add that I don’t think new doctors lack entrepreneurial drive; rather, they’ve been so lied to over and over again by the AAFP and others that they don’t understand what is possible.
We can disagree with each other, but name calling is completely inappropriate.