Case Study – Conceptualizing Doctor-Patient Relationships

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Discussion of why Doctor-Patient relationships are sometimes fraught with misunderstandings and irritations.

Doctor-Patient relationships are fraught with misunderstandings and irritation. This problem occurs all the time and causes patients to have expectations that are not realistic, and sometimes to accept treatment that they don’t realize can cause severe side effects.  We want to talk about both sides of the communication-doctors and patients—and shine a light on interactions that might cause you to refuse good and helpful treatment, as well as equally can motivate you to take risks that you wouldn’t if you really understood the risks. The blame is spread equally, but we want you to understand what to do if miscommunication is interfering with your our loved ones health.

In an ideal world a physician should recognize the value of patient communication. They should learn to be cognizant of non-verbal communication and they should spend the time necessary to interview each patient regarding the concerns and complaints of each patient. Sadly, we do not live in an ideal world. Most patients are ill informed or unaware of their own communication skills, and are often ill informed and unaware of the specifics of their bodies and cause of their symptoms. In reality it is the doctor who is responsible for asking the right questions and discovering the diagnosis, before he or she begins treatment. This  communication problem has gotten  worse due to insurance companies began limiting the amount of money they pay physicians for an office visit. The outcome of this “lack of time” is that a doctor does not have time to hear each patient’s symptoms, diagnose, treat and explain everything in ten minutes! The outcome is poor medical treatment die to lack of time or communication skills.

On the patient’s side of the problem is that they are worse communicators than doctors and either don’t tell the doctor everything or tell him or her too much so that the picture is muddled and the doctor gets “lost” in a diatribe. The withholding of information is often intentional, and when that occurs, the wrong diagnosis and treatment may be started.

The most “fibbing” that takes place in the doctor’s office includes how much and what patients eat, drink alcohol, lay around, and the lack of listing all medications or illegal substances, can cause huge side effects and dangerous complications. Another reason that doctors are working with less than adequate information is that the patient may not understand the doctor-speak, or they simply don’t think deductively like doctors must think and they get lost in the conversation. I can’t give you all of the reasons an individual would mislead a doctor who is trying to help them but it happens constantly and doctors are trying to solve a mystery (find the disease) with the wrong clues.

On the doctors side of it, doctors are people too and not only have sick patients that are distracting them from the symptoms and the diagnosis that is causing them, but they also have personal problems that may cause their communication to leave out something or fail to ask you the right questions. The  stress of paying the bills is now one of the issues of doctors who take insurance. The non-negotiated fees they are paid make them feel boxed in and worried.  So with money worries,  their own health problems, and family issues of their own they are not tip=top every day in the office and can seem disinterested even if their heart is in the right place. It is difficult to focus hour after hour or more truthfully refocus every seven minutes when a new patient walks in the door.  It is one of the reasons my practice does not take health insurance.  I am a better doctor without the insurance companies running my life.

One potential solution for physicians is for the physician to have a nurse or an assistant who will pre-interview the patient or follow up with the patient after treatment, which gives them time to vent and share or speculate (things the doctor honestly does not have time to do in most cases) alternative  solutions  for each patient.

In oncology offices physicians often hire a counselor to work for them who can also spend time with the patient and help them with emotional concerns, anxieties, depression, suicidal ideation, etc., or help them understand their treatment.. This can also be done by Nurse Practitioners, RNs and or PA’s There is shared information between the professionals and an improved ability to communicate accurately with the patient. Patients need some support to help manage anxieties, concerns or points of confusion, also to provide encouragement regarding following treatment plans and keep track of progress. This is one of the ways doctors can protect themselves from unhappy or incompletely treated patients. This takes time.

Expectations have changed in the last 50 years and our lives ask for and receive immediate answers—computers do this but they just can’t do a physical exam or associate symptoms with blood results. Patients now tend to expect immediate payoffs from treatment just like they do on the internet, but medical treatment doesn’t work that way.  A medicine or a surgery or treatment takes weeks, and sometimes many months to relieve symptoms.  In my practice it takes 5-8 months to feel better after a pellet insertion.  Many patients communicate daily with us asking and I feel better in ten minutes. Just like pellet hormone replacement that does have remarkable symptom relief, most medical conditions do not respond quickly to treatment so expectations are not met—unless the patient learns patience . We have nurse practitioners and an RN who hold the patient’s hand emotionally, to encourage them, and to focus them, all the while they are setting up good boundaries and reasonable goals.

Modern medicine has so many tools to utilize to help patients feel better and the list is getting longer all the time.  The medicine that I learned 40 years ago did not have so many answers—we learned to accept the fact that we might not know the answer.  Of course, it is always better to know more about an illness, but it takes more time with the patient, not less, to determine a diagnosis and treatment in the 21st century, and the insurance companies have taken that away from both doctor and patient.  So good communication that takes more time, but has fallen off the tool truck that doctors use every day,  just at the time when we need  it the most!. All of us should resolve to make this communication tool work more efficiently for ourselves as a patient, as well as for us as  physician!!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.  

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