Can This Doctor-Patient Relationship Be Saved?

A world-renowned internist gives her view of why things don't always go so well in the doctor's office.
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As a professor of medicine and an internist with a busy New York office, I hear a great deal about what patients want from their doctors. It seems there's more than enough dissatisfaction and disappointment to go around. Of course, most patients want to have a good relationship with their doctor, and most doctors try their best. I offer these thoughts from the other side of the desk about how patients can help doctors do their job well -- and what the patient does, usually unintentionally, that keeps the relationship from being effective.

Not Telling Your Story Clearly

It helps to put your thoughts in order before you arrive at the office. Try to give your doctor all the health information that's relevant. For example, if you smoke, don't be embarrassed to tell her; she's not the cigarette police. If you are concerned that perhaps you drink too much, ask. I won't be shocked; there's very little an experienced physician hasn't heard. If something specific is troubling you, describe it in as much detail as possible, including when the problem started. "I have a headache" doesn't say as much as: "I have a dull, throbbing pain in my forehead that began four days ago. Tylenol relieves it only briefly and I find it difficult to sleep because of the pain. I've never had this kind of headache before."

A doctor's job is to listen carefully, ask the kinds of questions that help her decide the cause of the problem, and never let her own attention wander. Eighty percent of diagnoses are made on the basis of the patient's story.

Wanting Friends in the Examining Room

Some patients like to have a friend or family member with them in the examining room. Many doctors, myself included, don't like that idea. Though it can help to have a friend with you in the doctor's office when test results are being explained or you're going over a treatment plan, the actual physical exam is a very personal experience. Often details of your situation will emerge that you might not be happy having revealed in front of another person. There are exceptions: I will always ask a family member or friend to help when the patient seems confused or overwhelmed by anxiety or if he or she is fragile and needs help with dressing.

Not Following the Doctor's Recommendations

If you don't want to take medications your doctor just prescribed, have a particular test or recommended surgery, or don't think you can follow suggestions offered about such difficult issues as weight loss or physical conditioning, say so! It's much better than throwing away the prescription as soon as you leave the office. A useful and rewarding doctor-patient relationship is a collaboration, and a good doctor can be trusted not to become irritated or abandon you if you want to modify a treatment plan. She also listens when you report that a treatment isn't working or makes you feel even worse than the original ailment. There is usually another approach to try. But it's important to talk first, not least of all because sometimes quitting a medication abruptly can be harmful.

Poor Telephone Etiquette

My office logs more than 200 calls a day from patients; routine ones should be returned the same day. The patient who calls five minutes after requesting a prescription to find out why her pharmacist didn't get it yet (this happens) is being unreasonable.

The other most irritating thing that happens (and it's very frequent) is when a doctor returns a patient's call, sometimes within moments, only to be met with an answering machine. I have to call an average of three telephone numbers for each patient I try to reach, and I often get a machine at every one of them. Telephone tag can be almost eliminated by just being there when you said you would be and answering the call yourself ! Or leave a cell number and carry that phone.

Keep your conversation short and focused. One of the things I hear most, believe it or not, is "I just want to ask you a quick question," which expands into three questions and is anything but quick! Phone calls work best for simple questions ("Do I need seasickness pills for my 12-day cruise?"). It's also fine to call for a prescription renewal -- giving the prescription details and phone number of the pharmacy -- or to ask the doctor to call in a prescription for a drug that has worked in the past for a recurrent problem.

Complex health issues, however, require face-to-face assessment. A cough may be a relatively trivial part of a simple cold -- or it may signal pneumonia. The treatment is very different. If your doctor asks you to come in, agree to do so. She's not trying to gouge you; she's just making sure you get the right treatment.

E-Mail-itis

Increasingly, patients seem to expect to be able to communicate with their doctors electronically. Many of my colleagues simply don't practice medicine by e-mail. I don't think it's the best way to communicate health information and I will reply to patients by e-mail only in special circumstances (if they are a continent away and need emergency advice, for example). Most doctors receive hundreds of messages a day; to add patient queries or comments to what we already get would be simply overwhelming.

Also, the tone of e-mail can seem very curt and off-putting. A conversation is much more responsive to the patient's needs and more accurately expresses what the doctor intends to say.

Leaving Without Saying Why

Many articles advise that if you are dissatisfied with your doctor, find another one. Here's a different suggestion: Have a frank talk with your physician before abandoning her. In the first place, she might learn something important from your comments; second, like all relationships, this one might improve with some tailoring. Don't be rude, but be clear if something has upset you; most of us are mature enough to listen and apologize if it's in order.

If part of the problem is your feeling that office staff treats you rudely or blocks access to the doctor, say so. My patients have, at times, felt coldly or rudely treated. I am always ready to hear what happened and have no issue with trying to correct a problem I think is real. Staffers are the patient's first contact with the office; courtesy and good manners are essential. But that works both ways: I have heard the rude tone and unpleasant tirades to which patients sometimes expose my staff, and in those instances, I never hesitate to ask the patient to treat the staff as they would me. Doctors cannot solve all problems, relieve all pain, and guarantee you perfect happiness. But we have had years of long, demanding training and usually do our best to help our patients. Clear, respectful, and focused communication between doctor and patient is the most important ingredient in a successful relationship. Both of us are responsible for achieving this.

 

Originally published in Ladies' Home Journal, December 2007.

 

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