The Prescription for a Better Doctor's Visit
Dr. Greg Rubin gives it to you straight.
When it comes to living a happier, healthier and longer life, your relationship to your doctor might be as important as the one with your spouse or partner. That's why it's important to feel good about the one you've chosen -- especially since an apple a day doesn't quite cut it anymore.
Greg Rubin, M.D., Internal Medicine, is here to help. As a partner based at Kaiser Permanente in Woodland Hills, Calif., Rubin has interacted with tens of thousands of patients at this HMO since first donning the white coat in 2004.
Recently, he shared his thoughts on everything from choosing a doctor to getting the most out of your visit.
Q&A with Greg Rubin, M.D.
- What's the best advice you can give a patient looking to choose a doctor?
- Rubin: Compatibility is the key. You are entering into a relationship with your doctor in every sense of the word. Physicians have many different qualities and we're not all the same. Don't just pick a doctor because someone else said he or she is good. Choose someone who has qualities you want or like. If it is important to you to have a doctor with a good bedside manner, then look for that. If you don't like to take a lot of medicines, look for someone who's going to prescribe only what you need. If you feel you want a doctor who's more accomplished, or more well known in their field, then go with that.
- What mistakes do patients most often make during a visit?
- Rubin: Many patients have a preconceived idea of how their visit is going to go and what the doctor's going to do for them. This can lead to disappointment or dissatisfaction with your provider if it doesn't go the way you thought. Just because you have an infection, doesn't mean we'll be prescribing antibiotics. Colds and other viruses often don't require any treatment. If you have pain, we may not necessarily order a bunch of tests. Often we can diagnose your problem clinically. Ordering tests may reassure you that we're taking your problem seriously, but often we know what your problem is and don't need any other tests in order to treat you. Just let us guide you -- we are trying to help you get better as much as you are.
- Any advice to get patients started on the right foot?
- Rubin: Come early. We may even see you early ... We often see 20-30 patients a day and always try to run on time. If we're late, it's likely because we're seeing other patients who may need more of our time. If you come early, it gives us time to see you and take care of you and we don't have to rush.
- How can patients make a doctor's visit go the smoothest?
- Rubin: Keep it simple. Just be direct and truthful. We are your doctor; we are on your side. Tell us your symptoms, answer our questions honestly, let us examine you and we'll probably have an answer for you. When you hide things due to embarrassment or exaggerate your symptoms, it could potentially work against you. If you are experiencing chest pain -- but don't mention it because you think it is just stress -- we may not find out until it is too late.
- What general health trends concern you most right now?
- Rubin: Obesity. I am an internist, so a lot of what I see is related to obesity, whether it be high blood pressure, diabetes, high cholesterol, sleep apnea. A lot of the time, these problems are self-induced. If we can improve our diets and exercise more, we can avoid a lot of these diseases. There is no magic pill or magic diet that's going to help this either. People just need to go back to the basics, eat less calories, burn more off.
- What symptoms do people ignore too frequently?
- Rubin: Chest pain. Heart disease is the number one cause of death in the U.S. and men typically try to downplay their chest pain attributing it to something else. Meanwhile women often have atypical symptoms and may not think their symptoms are important. Also, unexplained weight loss. Unless you are trying to lose weight, it usually doesn't happen on its own and you may need to get it checked out. Significant unexplained weight loss could definitely be a sign of cancer or infections, so let us know.
- Where has health care changed the most for the doctor in the last five years?
- Rubin: Health care has become more sophisticated, taking advantage of more advanced technology. We used to write our notes on paper. I think my writing is fairly good, but I have seen some terrible handwriting and used to have trouble reading prescriptions or other physicians notes. Now we have the electronic medical record, everything is kept track of by computers including prescription history, notes from previous visits, consultations from other doctors. I can pull up your X-ray report in seconds on my computer. We're taking advantage of this, streamlining this aspect of our work, which has led to significant improvements in the care of our patients.
- Can you give a specific example of how technology has improved your ability to provide care?
- Rubin: If I want to filter out all of my patients with uncontrolled diabetes from thousands of patients, it would literally take me seconds now ... If I want to make a graph of all of your cholesterol readings from the last 10 years to evaluate any trends, it is simple. My patients can email me, even attach photos to the email if they need and often we can resolve problems this way; sometimes without even a doctor's visit. It is really remarkable.
- Has the prevalence of medical information on the Internet made your job harder, or easier?
- Rubin: The Internet is great, but many people don't know how to use it. Message boards and chat rooms are not the place to find your medical information. Also, if you have a symptom, check out information for that symptom. Don't look at cancer and see if your symptom fits ... Physicians appreciate it when you can clearly describe your symptoms and don't have a preconceived notion based on what you read on the Internet.
- What websites do you like for medical information?
- Rubin: There are some useful sites that are accessible to patients like Web MD, Mayo Clinic and the Kaiser Permanente website, which all have legitimate and useful information, but beware of what you read on other sites.
- What's the most rewarding part of your job?
- Rubin: The job itself is rewarding. It's intellectually stimulating, which is a lot of the reason doctors become doctors. Plus you get appreciation for helping people feel better. I love that part.
- How can people ultimately stay out of your office?
- Rubin: To be honest, most of what we see in patients is kind of self-induced in a way. People smoke; then they come in because they have bronchitis or something worse. Or people eat whatever they want, they get overweight, then they come in because they're diabetic and having symptoms ... You can prevent so many things just by doing basic things -- by eating well, exercising regularly, getting plenty of rest and avoiding stress as much as possible. If we can just kind of correct the basics and stop harming ourselves, we'll be a lot better off.