Unfriendly encounters with poison ivy in his childhood might be the reason why Professor Steve Feldman chose to specialize in dermatology. He began his career as a ‘test-tube-doctor,’ focusing on laboratory work and seeing patients only one half day a week.
Today Steve Feldman is a professor of dermatology, pathology and public health sciences at The Wake Forest University School of Medicine in North Carolina, USA. He directs the center for dermatology research whose mission is to improve the care of patients with skin diseases.
– When I started my career, I thought I was a good doctor and did a great job if I gave patients the correct diagnosis and prescribed the right drug for their skin illness. But I found that a lot of patients were not getting well and some were not happy with me as a doctor. I realized that I had a lot more to do and learn.
It is early in the morning, and Professor Steve Feldman’s voice is a little rusty. The reason why might be the fact that the day before he used his voice eagerly, as he does especially when it comes to two subjects; patient satisfaction and human perspective. These are the main topics in his work as a doctor seeing patients with skin diseases, as a researcher, and, he adds, as a good citizen.
THE DOCTORS NEED TO LOOK INTO THEMSELVES
– All doctors want the best for their patients. We want them to be well, we make the precise diagnoses, and we prescribe the most helpful medications. Too often, patients don’t respond to treatment as expected. Many times, when treatment fails, it is because the treatment wasn’t used.
Feldman did research with medication bottle caps containing computer chips that would record the date and time when patients open and close the containers. He found that patients with a wide variety of skin diseases don’t use the medication as recommended.
The important question is why? Other researchers studying the issue have identified many patient-centered reasons why medications aren’t used. Feldman sees it differently.
– When patients aren’t using their medications, it’s probably our fault. We do a terrible job getting patients to take treatment. We spend so much time learning biochemistry and physiology, so much time learning how to make the right diagnosis and prescribe the right treatment, but we spend too little time and resources understanding what we can and should do to encourage patients to use treatment properly.
The foundation of getting patients to take their treatment, says Feldman, is to make sure they trust the doctor. Feldman has a variety of approaches for encouraging this trust. But to know where you stand, you have to measure it.
– Quality care is based on feedback. Today we cannot buy a book or a holiday trip without being asked to deliver feedback. And medical care is at least as important as any buys we make, states Professor Feldman and pauses a second with a sip of his tea – the ‘drug’ for his morning sensitive voice.
– We need to know what the patients are thinking about their experience. If they are not satisfied, we have to find out what we as the specialists might have done wrong – and to do that we need to step into the patients’ shoes.
Tea or not, the voice is getting much better now. Professor Feldman is warm to his subject and emphasizes that not only is feedback needed on how the doctor acts, but feedback from a consultation has to include the complete experience, from the long trip to the hospital, parking possibilities – or impossibilities, disorder in the papers, to old and poorly kept facilities. All this influences how patients perceive their doctor, even when the doctor has done everything else right and precisely as he learned in medical school.
– Bad experiences will give rise to loss of trust in the doctor and, therefore, in the treatment the doctor recommends. The result is obvious; the patients will stop using the drugs too soon, assuming they ever start on the therapy! The awareness of this fact was my reason to change my own attitude and the context in which the patients see me. It may sound fluffy but in my opinion it is worthwhile to look into yourself and how you are perceived by others if you want to be an effective specialist.
TO KNOW HOW THE MIND WORKS
Professor Feldman’s change of behavior focused primarily on communication. He points out that he is a naturally bad communicator, a successful test-tube scientist who was accepted to medical school because of his excellent qualification in standardized tests, not in interpersonal skills.
Out of his pocket he suddenly fetches a small black pouch. And the interviewer is now exposed to a magic moment just like some of his patients. “The magic tongue depressor” trick is not suited for verbal explanation, it’s much better to be viewed https://www.youtube.com/watch?v=mGmWT3qeGO4
– What I try to stress is that magicians know how the mind works. Doctors need to be able to learn that too. You have to understand the way patients perceive things. A doctor has to put on a ‘show,’ and the show has to be tailored for each patient. All patients want a friendly, caring doctor, but some like levity and others want seriousness. Some of my patients love seeing the magic trick – others may think I am not serious enough if I do a magic trick and not stay focused on their medical concerns.
– If I have a patient who is a chemist or pharmacologist, she will probably want to know in detail what the recommended treatment is and how it works. Another patient wants me to bring their system into harmony with pure natural therapy. These two need two different kinds of approach. It is my job to be able to meet the needs of each of them. This is a critical aspect of quality care, because patients’ satisfaction is both important in its own right and also critical to getting patients to take their medication – something we need to take seriously if we want our patients to get well.
SKIN IS TOUGH STUFF
Steve Feldman has been practicing dermatology for 25 years and is a top international psoriasis specialist. He has been the author of almost 1000 scientific articles and gives medical lectures around the world.– Dermatology has been good to me! The area allows me to visit other parts of the world, to be an expert in something, to do some surgery, to see patients of all ages, and still have time to do research. Skin is a fascinating organ. Skin is tough stuff. How many people have you heard of that have died from skin failure? No one. Skin has to be tough, because it is the interface between you and the environment. You can put your fingers in dirt. You bang them on something. You wash them. You get skin wet, you get it dry. Nothing bad happens. But if you did any of that to an internal organ, if you injected the dirt into your organs, very bad thinks would happen. We talk about how the immune system protects us – but your main protector is your skin.
The tea is getting cold. It is time for Feldman to continue the planning of common research in teledermatology with Professor at the University of Southern Denmark, Anette Bygum, who is consultant, DMsc, at the Department of Dermatology and Allergy Centre, Odense University Hospital.
Much more could be narrated about Professor Feldman’s point of view regarding the importance of understanding the perspective of other people. Because seeing this subject through a broader lens, much could be achieved in the world – peace for instance.
Professor Steven Feldman has developed the site www.DrScore.com to help patients give doctors feedback to enhance the quality of care.
A book from his hand has come out with the title “Compartments”