By Dr. Anthony Policastro

Physicians usually have a style of approaching patients. It is sometimes called bedside manner. Patients have certain expectations for the way they expect a physician to act. Those expectations vary from patient to patient. The result is that every physician has patients that like their style and others who do not.

There are multiple factors that go into meeting patient expectations. One of those expectations is related to the kind of advice the physician gives. Some patients want a physician who is paternalistic. The physician acts as a father figure and provides guidance in an authoritative manner.

Other patients prefer physicians who are more collaborative in their approach. They explain the options and reach a conclusion together with the patient. This is not for everyone. Some patients will feel that the doctor is asking them to decide on treatment.

Some patients want a physician who will take the time to answer their questions. That is sometimes difficult in a busy practice. However, it is important to address. When I used to do well baby exams, I would instruct the mothers to come prepared with a written list of questions so we could answer them all by the end of the visit.

Some patients just want a physician who is a good listener. They are more concerned with having themselves heard. They need a doctor who is good at doing that.

Physicians see patients from many cultural backgrounds. It is impossible to understand all of those different cultures. However, it is important to try and do so. If the physician gives advice contrary to cultural beliefs, it is not likely to be followed.

There are many patients who try a variety of natural remedies. They need a physician who is not going to dismiss those things outright. My approach was often that, for many of these things, we just did not yet have enough evidence to be sure of their role.

Some patients like their physician to use humor. In pediatrics it was frequently necessary. Sometimes I felt like I needed to be an improv comedian. Others feel that kind of behavior is a waste of time.

The result is that patients often compare physicians and come to different conclusions. It is not because the physician is different. It is because each patient has different expectations. The opinion of the physician is usually based on each individual patient’s expectation. That is why opinions on physicians vary so widely.

COVID-19 update- New cases nationally continued to rise this week. They went from 775,000 to 923,000. See attached chart for comparison to last year. Sussex County cases more than doubled from 247 last week to 540 this week. That is the highest number since February.

The original reason for recommending masks and hand cleaning was not to stop the virus. It was to control the spread so that hospitals did not become overwhelmed. However, the latest surge has seen hospitals in many areas stretched to the limit. Those have been in areas with low vaccination rates.

As I keep saying the choice is to get antibodies from the vaccine or to wait until you get sick and get antibodies that way. Not getting the vaccine and then avoiding infection is an unrealistic expectation.

The Delta variant also leads to decreased effectiveness at prevention of disease in vaccinated individuals. Both Moderna and Pfizer vaccines were 95 percent effective against the original strain. Moderna protection against the delta variant is 76 percent. Pfizer protection is 46 percent. Thus breakthrough infections are more common.

However, it appears that serious infections are not. They still might occur but at much lower numbers. In addition, it appears that the breakthrough infections are contagious to others.

The original COVID virus had a reproduction number in contacts of between two and three. That means that each infected individual would infect two to three other people on average. The Delta variant infection causes an infected person to further infect between five and nine people. That makes it two to three times more infectious.

For example, we can look at how many new cases occur in a 30-day month with the original virus. With the Delta variant we would reach the same number of cases in one-third (10 days) or half (15 days) of that 30-day period. New cases are now doubling in half to one third the time. It is no surprise that the numbers are increasing so quickly.