The “Four A’s” of Medicine
I saw a patient last month, and her situation reminded me of the four “A’s” of medicine. The lady stopped me at the grocery store to ask a medical question. She was not my regular patient, but had seen a Neuse River show, and knew I was a Doc.
It took three sentences and four questions to know what she described had potential serious consequences. For reasons I don’t understand her regular doctor could not see her for a month, even though she gave his staff the exact history she told me. (They wouldn’t let her speak to the Doc or even give the message to the nurse- I promise you Lynn or Myrd woulda known exactly what to do.) I was reminded of the old “Four A’s,” some of which I learned from my Dad.
I suspect the “A’s” are also important in many other professions. They are, and not necessarily in order of importance, Ability, Accessibility, Affordability, and Affability.
I can only speak to being a general Doc with any authority, and I realize with different specialities the order of importance might change some. We used to have a Neurosurgeon at the Medical Center who was gruff and bordered on mean, but the guy was such a good surgeon I didn’t care. My patients would often complain, but I reassured them. “Look, he’s there to take out your astrocytoma, and he is great at it. Ya’ll don’t need a Family Neurosurgeon, he’ll turn you back over to me as soon as you are over the surgery.” On the other hand, if your Family Doc ain’t at least somewhat of a friend, I’d think that over.
I have one consultant, a lung specialist, who is notoriously difficult, and I use it to my advantage. He is extra tough on the smokers, and if I can’t get someone to quit, I’ll threaten to send them to him. “Now Ms. Smith, your lungs are getting worse. If you can’t quit smoking, I might have to send you over to Dr. Rales for a pulmonary cussing out consult.”
“Oh please don’t, Tommy. I promise I’ll stop. Give me a script for that Chantix you’ve been talking about. I’ll see you next month.” I try to give my folks good advice, but I never could bring myself to be mean about it- I left that to ones who did not deem all the “A’s” to be important.
It did occur to me with the grocery store case, though, that ability might not always be number one. The Doc whose office turned her away is a very bright fellow. I’m certain he knows the answer to the question at hand. I bet he never knew anyone asked it. (Of course, if every time his staff asks him to disrupt his appointment schedule he chews them out they might quit asking- I do not know the circumstances.) But even if he is smarter than me, he sure missed the diagnosis, or even any chance to make it. So, in this situation, accessibility trumped ability.
I am a gregarious sort of fellow, and have more friends than any one man deserves, but I don’t rank affability that high. I’ve had a number of people come to see me ’cause they like my mandolin playing, and that is an error. If that were a good criteria, they should choose Darrell or Ben as their Doc, not me- I can not begin to approach their level of play. This time the mandolin did come in handy, ’cause the woman felt comfortable enough to approach me at the dog chow aisle.
As far as affordability, with all the high tech demands we have now, I find it more difficult than ever, but I try to keep the costs down. Most of patients think I’ve been fair enough, but sometimes when I see the bill they get I don’t know if I’d go see me for that! Certainly for the indigent, or even the middle class folks with one serious illness and no insurance, the system is broken.
Well, going back to my lady at the grocery store, she did fine. The diagnosis was a TIA (trying to have a stroke) but she had some surgery and dodged it for now. And to be honest, she might have been O.K. without intervention, but I wouldn’t have rolled the dice on my own people if they had her symptoms. (Another rule I have: try to do for your patients like you truly believe you would do for your own family- can’t go wrong there.)
Ya’ll think about those “A’s.” I’m curious as to your perspective. Which ones do you find important in your Doc and why?
My agent said I was gonna learn a bunch from my readers. So far, that has proved true, so I will be interested in your responses.
And for mrschili, how the heck do you write the “A’s?” Is that right? I had no idea.
Dr. BAdvice- Five Cents