How the little things a doctor does can make all the difference

While much of modern medicine emphasizes the science, what can make the biggest difference in quality care remains an art.

Two physicians can follow every medical guideline to a “T” in caring for a patient, but how they follow those guidelines will distinguish one from another.

If the first physician is cold and methodical, he or she will have followed the standard of care. But, the second physician, who does not act as though he or she is simply going through the motions, who takes the time to interact with the patient, will follow all of the recommended steps, but deliver a better experience for their patient.

This truth of the practice of the medical arts was revealed in one sentence in a letter I received from my daughter’s pediatrician.

As part of getting our daughter qualified for our State’s Medicaid waiver program, we needed to establish that she, indeed, had a disability. The clearest medical record to accomplish that was the lab report showing she had an extra 21st Chromosome, referred to as Trisomy 21 and better known as Down syndrome.

To get this report, we contacted our pediatrician. The first line of his cover letter is why he delivers quality care to his small patients:

Juliet is a delightful young patient who has been under our care since birth. Juliet has Down syndrome diagnosed clinically and by chromosomal analysis for Trisomy 21.

He didn’t have to include that first sentence or even describe Juliet as “delightful.” That he did is the little thing that made all the difference. It conveyed that while Juliet did have a chromosomal analysis for Trisomy 21, that did not sum up all that she was.

This small measure reminded me of another example.

Kelle Hampton’s blog post of the birth of her daughter with Down syndrome was widely read when she first shared it, and continues to be a favorite of many. I wrote further about Hampton’s story at this post. Her blog is called “Enjoying the small things.” One of the small things her pediatrician did when she delivered the diagnosis was kneel down beside Hampton’s bed. Hampton writes that her pediatrician did this so that, “she could look up at me … not down.”

That simple change in positioning made all the difference. The doctor was there to serve Hampton. To look up at her, not down her nose, judgmentally from a position of standing over Hampton.

Medical guidelines cannot list all of these things that good doctors do. Instead, medical guidelines provide the basic, common, required steps. But they don’t cover all that can be done, or should be done, to deliver quality care to patients. It’s those small measures–kneeling beside a patient, describing a patient’s child as delightful–that truly render care to patients and make all the difference.