Choosing a doctor is one of the most important and personal decisions you will ever make. It is a decision that is reversible if need be, but to the extent that it is possible, needs to be done with care. The key to choosing the right doctor is feeling comfortable with that doctor. Being comfortable with the doctor is facilitated by several things. First, a physician should be competent. Competence can be judged by board certifications, quality of academic and training institutions attended, amount of training, years in practice, adjudicated bad outcomes, and often times what their patients tell you. If you are confident your doctor is doing the right thing for you, you will feel comfortable. Second, quality of communication between physician and patient is vital to feeling comfortable. Are you comfortable speaking to your doctor, or do you find you lie, distort, or withhold information because you feel you will be judged, discriminated against, scolded, or belittled? Free, open and honest avenues of communication contribute to a comfortable doctor-patient relationship. Yet a free, open and honest avenue of communication does no good if you can’t understand or follow along with the doctor because he doesn’t speak in a language or way that you understand. The ability to explain complex concepts, treatment regimens, and the pathophysiologic basis for these recommendations, in a way that is easily understandable is essential for patient comfort and a skill more uncommonly found in a physician than you might expect. Third, being comfortable with a doctor is knowing and sensing that you are in caring hands and that your needs matter and your doctor is sensitive to them. Finally, in order to be comfortable with your doctor, his philosophy of medical practice should meet with your approval. There are many specific and unexpected situations that arise in the course of treatment. It is impossible to know or predict in advance what any single physician might recommend or do. Understanding the ethical guidelines, their personal value system and the paradigm of thought within which they operate, you can feel comfortable knowing your doctor is conducting your treatment in a manner which meets with your approval.
Few doctors speak about or publish their philosophy. Dr. Arian feels very strongly that is essential for patients to know how he thinks and what he believes. No doctor is right for all patients. No patient is right for all doctors. “Goodness of fit” is the key to a successful doctor-patient relationship. Dr. Arian believes if your philosophy is not compatible with his, you shouldn’t be his patient and he shouldn’t be your doctor. What follows are Dr. Arian’s personal writings on the way he approaches medical practice, patients, people and life.
Dr. Arian on Privacy:
With the advent of the current communications revolution, very few things in our lives remain private. Our personal medical information should and must remain private. Your personal medical information is no one else’s business and should never be disclosed to anyone or any other entity without your expressed specific permission. I believe you should at all times guard the privacy of your medical information to the extent that you are able and pledge I will do the same.
Dr. Arian on Medications:
Medications are very expensive, have a myriad of side effects and adverse reactions, and are very inconvenient. The less used the better. If I have to prescribe I do so because I believe the benefits far out weigh the risks and inconveniences. I use inexpensive medicines wherever possible and am not in any way, in the pocket of the drug companies.
Dr. Arian on Testing:
I have been a patient many times and I am very aware that labs, imaging studies, and other testing is expensive, at times painful, and inconvenient. The less the better. Gone are the days that physicians ordered studies just to be able to write a diagnosis on the line of a chart or form. Bottom line, if it doesn’t change my medical management or if the benefits don’t clearly outweigh the risks and costs, I won’t order it. I don’t order tests to run up the bill or for intellectual curiosity.
Dr. Arian on Making Medical Decisions:
I view my role in the doctor-patient relationship as that of “health security advisor”. The patient then is “president” with absolute authority to “veto” any of my recommendations. My responsibility is to speak truthfully to the patient and provide accurate and clearly presented data and recommendations so that the patient is able to make a properly informed decision. Should the patient wish to exercise their veto power and go against my advice, I accept this and merely record it in the medical record as so. The patient as decision maker, accepts full responsibility for the consequences of their decisions.
Dr. Arian on Dignity and Autonomy:
I believe the most precious things a patient has are their privacy, dignity and autonomy. I consider one of my most important roles as a physician is to preserve a patient’s autonomy as long as possible. So long as they maintain the capacity to make medical decisions, I will protect their autonomy. Should conditions arise whereby myself or others must make medical decisions due to incapacity I will do so in accordance with the patient’s wishes, maintaining their dignity at all times.
Dr. Arian on Pain:
I have had and suffered with pain. I treat pain aggressively using all the latest prescription preparations in a manner consistent with my training and currently accepted pain management methods. I am ever vigilant for narcotic abuse and interact with the Drug Enforcement Agency on a regular basis to monitor compliance. I have a zero tolerance policy for those who don’t adhere to my regimen and requirements.
Dr. Arian on Alternative Therapies:
Although my training is in classic allopathic medicine, I acknowledge that in certain unique medical situations, alternative therapies such as medical marijuana, acupuncture, biofeedback, herbal remedies, and chiropractic may have a role. As a physician, aiding and healing the sick are paramount and I would be ignorant, short sighted and ineffective if I didn’t acknowledge the roles that alternative therapies can sometimes play.
Dr. Arian on the Healthcare Team:
I believe it is a strength and not a weakness to be willing to consult specialists as a primary care physician. I tell my patients that the difference between a primary care doctor and a specialist is that a primary care doctor has a knowledge base 16 miles wide and a foot deep while a specialist has a knowledge base a foot wide and 16 miles deep. The crucial role that I play is knowing what my limitations are as a physician and when to consult. All physicians have areas of strengths and weaknesses and if I am working in an area that I am not as strong, I consult sooner than if I am working in an area of my strength. For the sake of analogy, if medicine were Pro Football, the primary care physician would be the head coach while the specialists the offensive and defensive coordinators and the special teams coach. Ultimately, the responsibility for the outcome is that of the head coach but he relies on the advice of his coordinators. It is important to realize however that this style of practice is geography dependent. Out in the middle of nowhere the standard of care is different. Out in a rural area, primary care doctors do not have access to the resources that suburban or urban doctors do and thus they have to rely a lot more on themselves. They are given more leniencies if things go wrong than a doctor practicing in town. A case that goes bad in town is almost always followed by the question why didn’t you get a consultation and/or ask for help. I maintain a pool of the smartest specialists in and out of our area. All my specialists have been personally selected by me because they are bright, competent, have a good bedside manner, and communicate well with me. These are all traits I believe are essential in a specialist. With the help of specialists, we form the healthcare team that competently cares for you.
Dr. Arian on Hospital Medicine:
I love hospital medicine. I am trained to do hospital medicine. However the world of medicine is changing and I must adapt to the new realities or suffer the fate of the dinosaurs. Hospital medicine is an art form. It is a style of medical practice that needs to be practiced all the time for a doctor to remain competent. There are many tricks of the trade in the hospital from the doctor’s perspective and these are quickly lost if you don’t see a lot of patients in the hospital. My current practice is set up with a very small number of patients overall, by choice. Consequently less than one patient per month on average is hospitalized. This is not enough patients to remain sharp and competent at hospital medicine. Thus I have all my patients followed by Hospitalists at either Desert Regional or Eisenhower Medical Centers. Hospitalists do this work all day long; everyday and I could not possibly ascend to their level of care at my current rate of patient hospitalization. I work with the hospitalist so that there is appropriate flow of information into and out of the hospital to reduce the chances of a medical mistake. I am of course available for their consultation as I know more about the patient than they do in most cases. I understand wanting to see your family doctor by your bedside but the reality is you get better care from a specialist in Hospital Medicine. It’s all about outcomes. This is the overwhelming trend in Medicine today.
Dr. Arian on Quality Assurance:
I am obsessed with Quality Assurance. Quality Assurance starts with setup of policies and procedures for the Private Practice before you as a patient even step in the door. I have spent an enormous amount of time developing policies and procedures that are custom tailored to my particular practice based on my theory and trials. These policies and procedures are under continual review by my staff and I and if we see problems, we fix them. If we are not seeing problems, our attitude is we must be missing them and we hunt for them, find them and fix them. I try to buy the finest quality medical supplies as I believe that investing in quality produces quality results. I employ the finest medical assistants without exception. My medical assistants are among the very finest I have ever worked with and my reputation for being hard on them and training them rigorously is well documented here and during prior practices in Bakersfield. They take regular tests on medical knowledge and medical assisting knowledge and I personally sign them off on a regular basis on medical calculations and mathematics so I know they can administer medications properly. They are given continual feedback on their performance and their performance is continually monitored by me. I maintain currency in ACLS protocols and keep my continuing medical education and Board Certification current at all times. In the end from the in door to out door, I assure that what goes on in my office is quality. Quality Assurance is the most expensive cost a medical practice has and in many practices the corners are cut to save money. In my practice that is viewed as penny wise and pound foolish. We practice rigorous Quality Assurance no matter what the cost.