The Doctor Patient Relationship!

docpatnt“You are feeling better today,” announced the Doctor, as he sat down by patient’s hospital bed.

Patient:  “Really? What’s better?”

“Well,” doctor sputtered, his face flushing, “in my professional opinion, you are better!”
Patient: sighed “ I don’t think so, I still feel the same, and tired “

Doctor:  “Your lymphocytes are better and you should feel better,”
Patient stops reacting, unhappiness visible on his face.

Can you hear the tension in this encounter? Why are doctors and patients so often at odds? Why are both expressing more frustration and less satisfaction? To answer these questions, more and more researchers are putting the doctor-patient relationship under the microscope. What they are finding is fascinating.
Tug of war is because doctors and patients are on different ends of the rope.

  • To the doctor, illness is a disease process that can be measured and understood through laboratory tests and clinical observations. To the patient, illness is a disrupted life.
  • The doctor’s focus is more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. Yet patient satisfaction comes primarily from a sense of being heard and understood.
  • Many doctors do not see the role of physician as listener, but instead view their function more as a human car mechanic: Find it and fix it. Yet patients often feel devalued when their illness is reduced to mechanical process.
  • Doctors feel frustrated, even betrayed, when patients withhold pertinent information. Yet patients who use alternative medicine, for example, may not tell their doctors for fear of ridicule or being labeled as “silly” or uneducated.

Changes in our culture and in the practice of medicine have also added tension to the doctor-patient relationship.

In some ways we have become more doctor dependent, because we see doctors sooner than people did 50 years ago, yet we are less dependent on the doctor for information and decision making.
All these changes are unsettling for both doctors and patients. Then there’s the blame factor. Doctors often blame patients when communication breaks down. But researchers have found that many doctors have shaky interviewing skills. For example

  • Doctors do more talking than listening. A new study published this year in Journal of the American Medical Association (JAMA) found that 72% of the doctors interrupted the patient’s opening statement after an average of 23 seconds. Patients who were allowed to state their concerns without interruption used only an average of 6 more seconds.
  • Doctors often ignore the patient’s emotional health.
  • Doctors underestimate the amount of information patients want, and overestimate how much they actually give. In one study of 20-minute office visits, doctors spent about 1 minute per visit informing patients but believed they were spending 9 minutes per visit doing so.

So what about the patients?

Patients aren’t perfect either. In one survey doctors rated 15% of their patients as “difficult.” Disagreements involve everything from expecting an instant cure to demanding prescriptions.
While one doctor’s difficult patient may be another doctor’s favorite, researchers have identified common characteristics of patients that everyone agrees are hard to manage. Patients described as “frustrating” by some doctors have the following characteristics.

  • Do not trust or agree with the doctor.
  • Present too many problems for one visit.
  • Do not follow instructions.
  • Are demanding or controlling.

Patients who use the doctor as a scapegoat for their anger at the illness are less likely to get good care. “Doctors are profoundly influenced by the demeanor, comments, and attitudes of their patients.” A patient who is consistently rude and irritable will almost certainly not receive the same medical care as a patient who conveys more positive attitudes.

In spite of all these problems, there is reason for hope. Yes, doctors and patients will always be on opposite ends of the health care system, but that doesn’t mean they can’t pull in the same direction. In fact they can be partners in care. After all the goal for both the patient and the doctor is to get a cure!

Both the doctors and patients can contribute making this relationship better. For instance doctors can try and cultivate a patient-centered partnership. “The patient desires to be known as a human being, not merely to be recognized as the outer wrappings for a disease. In a video-taped study of 171 office visits, doctors who encouraged patients to talk about psychosocial issues such as family and job had more satisfied patients and the visits were only an average of two minutes longer. Incidentally, doctors also benefit from the patient-centered approach, researchers note, because they feel more job satisfaction and are less likely to burn out.

To improve patient compliance, doctors can work on mutual trust. Research confirms that the health of the doctor-patient relationship is the best predictor of whether the patient will follow the doctor’s instructions and advice. Respect patients as experts in the experience of illness. Patient-centered relationship that accepts the patient’s unique knowledge as just as important to outcome as the doctor’s scientific knowledge. “The medical visit is truly a meeting between experts.”

Similarly patients have some obligations too! Patients can contribute building this relationship as much as the doctors can.

Patients are obliged to provide complete and accurate information about their health and the condition they are in at the time of contact with the doctor. Its not only the duty of the doctor to ask all information from the patient. There is an obligation to ask questions as well. Especially if the doctors’ instructions or explanations are not clear, patients have a right to ask questions and make a dialogue with the doctor till they fully understand.

Participating actively in care is also an obligation of the patient. Especially if in pain, patients can costribute to care by reiterating the effectiveness and/or the ineffectiveness of the interventions given to them. Also patients are obliged to treat caregivers with respect and courtesy and also to keep to appointment times as well.

In short, the best outcome of care will be in those instances where there is a good relationship between the caregivers and the care seekers. A partnership where both benefit by reaching the same goal.

(This article is a combined work of Dr. Jayashankar, Senior Registrar Urology at ADK Hospital and myself)

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2 Comments on "The Doctor Patient Relationship!"

  1. Dr.Jay
    01/06/2009 at 00:31 Permalink

    In my carrier so far i can remember very few incidences of patient anger 😉 .
    As in any meeting first impression always matters and will decide the course of the meeting, the same holds good for the doctor patient interaction.
    Just before patient enters the room a doctor must go through the Name and previous history of patient available on the com, when patient enters the room , with smile greet him with his name and ask him and his attenders to sit down , and proceed. It sounds a very easy thing and all of us know but very few follow this.
    In ADK itself , i have heard patients some times complaining doctor takes more time and they have to wait for long for consultation , but the moment they enter the room , they forget all the frustration and they go out happy and satisfied the wait is worth it .
    I was blessed in having real good teachers who thought their experience not the by book.
    For all of us we have develop the compassion for the fellow human being , that will bring out the best in us.

  2. Yasiph
    01/06/2009 at 02:09 Permalink

    Well written. Absolutely true. Patients and doctors both have a responsibility and they both need to tune into each other. As for a parent of a child with a disability, I too have been advocating for better relationships of parents and docs(as parents are the answer to children with special needs). I;ve also included some articles at my son’s website for parents on criteria choosing a doctor and questions to ask when choosing a doctor which intdirectly builds up a relationship with the doctors.

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