Saturday, I had an opportunity to listen to the two best doctors in New England. They are both graduates of MIT. Their offices sit not far from its campus. They host a weekly call-in radio show during which they handle telephone calls from across America. They address a variety of diagnostic challenges—some mundane, some quite complex.

Their style of practice is one that every physician in America should admire. It embraces warm humanism seasoned with a generous dollop of humor. They also demonstrate a rational and thoughtful approach to problem solving. They have won a devoted following.

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They begin each encounter with a basic acknowledgment of the patient’s identity as an individual human being—they pay attention to the patient’s name. “Toni, “one of them will ask. “Is that T-O-N-I or T-O-N-Y?”

They proceed to an often ignored part of history taking. They ask a question and listen to its answer. If there is doubt that they understand what the patient is saying, they ask questions until that doubt is allayed. They encourage patients to define problems in their own words. They never finish a patient’s sentence, substituting their words in a rush to judgment.

They then refine their understanding of the problem with more questions—“Is this more common early in the morning?” or “Did anything unusual happen when the problem started?” But if their questions are leading in the direction of a particular diagnosis, they readily admit so. They share with the patient their thoughts, allowing the patient to disagree. They try to glean an honest appreciation of the patient’s problem, not what they would like the problem to be.

This transparency continues as they consider diagnostic possibilities. They openly discuss those possibilities, defining technical terms in precise but very simple language. One need not have graduated from MIT to understand what these doctors are thinking. They pull no educational rank.

When they come to a diagnostic conclusion and make a therapeutic suggestion, they present it with a humility that acknowledges they may be wrong. But having shared their reasoning with the patient as they came to the conclusion, the patient typically feels comfortable with the suggestion.

I was reminded of the truth that patients who know the why of a diagnosis and treatment usually develop an appropriate confidence in its basis.

These two doctors are brothers. Their names are Tom and Ray Magliozzi, but they are better known as Click and Clack. Their call-in show is Car Talk.

As the writer of this piece, I admit to having taken literary license by implying that Tom and Ray are medical doctors. As its reader, you must admit that had I started the article by saying, “I was listening to these two guys who bill themselves as auto mechanics ...”  you probably would have skipped it in favor of something about HIPAA.

Other than this gentle bend of truth, I stand by everything else I said. Click and Clack adhere closely to the tenets of transparency, humanism, and rational thought. Those are concepts equally applicable to the diagnosis and treatment of valvular heart disease or a blown valve on an ’87 Toyota station wagon.

Listen to their show on NPR. I think you’ll see what I mean. If you disagree, write them, not me. They’re the ones making the big bucks.

About the Author

J.R. Waggoner, M.D. practiced family medicine for thirty years in Aurora, Colorado. He also worked as a consultant and herded cats as the managing general partner of a general partnership of physicians. Three years ago, he left his practice to study health care policy and write. During his time away from clinical work, he has written two books and worked as a Senior Clinical Content Specialist and freelance writer.

His current book Medical Metamorphosis: The three step cure for America's health care crisis is available at Lulu.com. 

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